Reflex test reminders in required cancer synoptic templates decrease order entry error: An analysis of mismatch...

Area of Science:

• Oncology
• Genetics
• Pathology Informatics

Background:

• Endometrial carcinoma (EC) is the most common extracolonic cancer associated with Lynch syndrome (LS).
• Lynch syndrome is caused by germline mutations in DNA mismatch repair (MMR) genes.
• Screening for LS in EC patients typically involves MMR immunohistochemistry (IHC) to detect loss of MMR protein expression.

Purpose of the Study:

• To implement and evaluate an informatics-based approach to ensure timely screening for Lynch syndrome in endometrial carcinoma patients.
• To improve the completeness and timeliness of MMR IHC ordering for women aged 60 or younger with EC.

Main Methods:

• An algorithm was implemented in the pathology reporting system requiring mandatory MMR IHC assessment for EC patients ≤60 before report sign-out.
• A comparative analysis of cases before (PreImp) and after (PostImp) algorithm implementation was conducted.
• Data included MMR IHC ordering status, timeliness relative to sign-out, and missed cases.

Main Results:

• The informatics approach significantly reduced missed MMR IHC cases (13.8% PreImp vs. 3.39% PostImp, P=0.0448).
• MMR IHC was ordered more frequently before or at sign-out postimplementation (60.0% PreImp vs. 91.2% PostImp, P=0.0004).
• The mean delay in ordering IHC relative to sign-out was significantly reduced and became negative (indicating ordering before sign-out) PostImp.

Conclusions:

• The informatics algorithm effectively ensured timely and complete MMR IHC ordering for eligible EC patients, preventing oversights.
• Relying solely on manual processes for ancillary test management is insufficient; informatics solutions are crucial.
• This approach can be adapted for similar clinical scenarios requiring systematic ancillary testing.