Electronic health record (EHR) systems can be customized to capture breast cancer-specific metrics in real time using a synoptic note template. These findings were published in JCO Clinical Cancer Informatics.

EHR systems are in widespread use across the healthcare arena. However, collecting and extracting data for quality improvement projects and clinical research continues to be a challenge, especially in the oncology arena.

A team of researchers created a custom EHR-based registry that would enable users to extract needed data elements. Specifically, structured Commission on Cancer (CoC) axillary-surgery metrics on patients undergoing breast cancer surgery. The customization to the EHR is a synoptic-note registry within the Epic system, a commercially available enterprise-based EHR system.

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Epic was already in place at the team’s institution in Massachusetts. The researchers leveraged the system’s smart functionality to create a customized smart phrase that could capture axillary surgery-specific variables and other CoC metrics for breast cancer.

The intended end users, identified as “breast surgery providers operating on patients with breast cancer diagnoses,” were presented different iterations of the smart phrase during its creation so the researchers could receive feedback. The smart phrase included all 11 breast cancer variables required by the CoC.

After the system was set up, the researchers convened clinical content and technical teams to assemble a report that compiled the smart data elements from each note. The report is designed to run on a weekly basis to provide a summary of the CoC metrics.

“We were able to demonstrate successful implementation of provider-driven structured data entry into EHR systems that creates synoptic operative reports and permits automatic data capture,” the researchers wrote. “The end result is a real-time, prospective registry of breast cancer-specific CoC metrics that are robust enough to use for quality improvement initiatives and clinical research.”

This project showed that creating and maintaining a synoptic report is feasible, and future plans are to convert operative notes on other disease sites to this type of synoptic note.

The study was limited to the collection of breast cancer surgery-specific data, although it could be scaled for other oncologic and surgical specialties. Additionally, the process was designed around the use of Epic, which is the most widely-adopted EHR system in the US but not every institution uses it.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Lyu HG, Kantor O, Laws AD, et al. Development of an electronic health record registry to facilitate collection of Commission on Cancer metrics for patients undergoing surgery for breast cancer. JCO Clin Cancer Inform. 2022;6:e2200012. doi:10.1200/CCI.22.00012