Clinician-Dermatopathologist Communication via the Requisition Form in the Era of Electronic Medical Records: A Review of the Literature

Main Article Content

Haley Danielle Heibel
Clay J. Cockerell

Keywords

Dermatopathology, skin biopsy, requisition form, electronic medical records, communication, review

Abstract

Background:  There are shortcomings in the quality and accuracy of submitted clinical information on skin biopsy requisition forms (SBRFs).  Most SBRFs are completed via electronic medical records (EMR), and the effect of this on the work flow and the quality of submitted clinical information must be evaluated to identify targets in clinician-dermatopathologist communication for improvement.

Objective: This review of the literature explored how SBRFs are currently handled by clinicians in the context of EMR, barriers to effective clinician-dermatopathologist communication, and suggestions for improvement.

Methods: A literature search was conducted on Medline, Cinahl, and Scopus including the keywords of dermatology*, dermapatholog*, dermatopathology*, and requisition*.  20 articles were retrieved.  17 articles were included from this search and from cross-referencing articles.

Results:  This review reaffirmed the inadequacy of clinical information provided to dermatopathologists.  Standardization of and formal education in completing SBRFs, along with dermatopathologist access to information and images via shared EMR may improve histopathologic interpretation of specimens and allow for cost-effective patient care.

Limitations: This review was restricted to the English language.  Previous studies have primarily been retrospective study designs and survey studies.

Conclusion: The development of user-friendly standardized SBRFs with validated criteria are necessary.  Clinician awareness of how to appropriately convey information and terminology on the SBRF may significantly improve the work flow of both clinicians and dermatopathologists and patient outcomes.

References

1. Chismar LA, Umanoff N, Murphy B, Viola KV, Amin B. The dermatopathology requisition form: Attitudes and practices of dermatologists. J Am Acad Dermatol. 2015;72(2):353-355.
2. Comfere NI, Peters MS, Jenkins S, Lackore K, Yost K, Tilburt J. Dermatopathologists' concerns and challenges with clinical information in the skin biopsy requisition form: A mixed-methods study. J Cutan Pathol. 2015;42(5):333-345.
3. Olson MA, Lohse CM, Comfere NI. Rates of provision of clinical information in the skin biopsy requisition form and corresponding encounter visit note. J Pathol Inform. 2016;7:40-40.

4. Aslan C, Göktay F, Mansur AT, Aydingöz IE, Günes P, Ekmekçi TR. Clinicopathological consistency in skin disorders: A retrospective study of 3949 pathological reports. J Am Acad Dermatol. 2012;66(3):393-400.

5. Sellheyer K, Bergfeld WF. "Lesion," "rule out...," and other vagaries of filling out pathology requisition forms. J Am Acad Dermatol. 2005;52(5):914-915.

6. Comfere NI, Sokumbi O, Montori VM, et al. Provider-to-provider communication in dermatology and implications of missing clinical information in skin biopsy requisition forms: A systematic review. Int J Dermatol. 2014;53(5):549-557.

7. Trotter MJ, Au S, Naert KA. Practical strategies to improve the clinical utility of the dermatopathology report. Arch Pathol Lab Med. 2016;140(8):759-765.

8. Wong C, Peters M, Tilburt J, Comfere N. Dermatopathologists' opinions about the quality of clinical information in the skin biopsy requisition form and the skin biopsy care process: A semiqualitative assessment. Am J Clin Pathol. 2015;143(4):593-597.

9. Romano RC, Novotny PJ, Sloan JA, Comfere NI. Measures of completeness and accuracy of clinical information in skin biopsy requisition forms: An analysis of 249 cases. Am J Clin Pathol. 2016;146(6):727-735.

10. Waller JM, Zedek DC. How informative are dermatopathology requisition forms completed by dermatologists? A review of the clinical information provided for 100 consecutive melanocytic lesions. J Am Acad Dermatol. 2010;62(2):257-261.

11. Kinonen CL, Watkin WG, Gleason BC, Johnson CEJ, Thomas AB, Cibull TL. An audit of dermatopathology requisitions: Hand written vs. electronic medical record data entry accuracy. J Cutan Pathol. 2012;39(9):850-852.

12. Abdou Y, Lohse C, Comfere NI. Use of the term "rule out" in requisition forms may cause diagnostic delays in dermatopathology practice. Int J Dermatol. 2017;56(1):86-91.

13. Maley A, Swerlick R, Stoff B. Comparison of electronic and handwritten pathology requisition forms for cutaneous melanoma. J Am Acad Dermatol. 2015;72(5):916-917.

14. Dai H, Machan M, Fraga GR. How accurate are the suggested diagnoses on biopsy requisitions for inflammatory skin disease? A retrospective study of 348 cases. Am J Dermatopathol. 2014;36(4):298-302.

15. Yelamos O, Braun RP, Liopyris K, et al. Usefulness of dermoscopy to improve the clinical and histopathologic diagnosis of skin cancers. J Am Acad Dermatol. 2019;80(2):365-377.

16. Yélamos O, Braun RP, Liopyris K, et al. Dermoscopy and dermatopathology correlates of cutaneous neoplasms. J Am Acad Dermatol. 2019;80(2):341-363.

17. Zohar Y, Shreberk-Hassidim R, Elia J, et al. Clinical description of skin lesions in pathology requisition forms completed by plastic surgeons is lacking: A retrospective study of 499 lesions. Eur J Plast Surg. 2018;41(2):249-252.