Pathology Reporting CAP Template Too Long? Try Smart Branching

As a pathologist, you know how valuable your time is. If you are using the clinical templates from the College of American Pathologists (CAP), you also know these templates tend to be quite long.  You may even have decided that because of template length, CAP Cancer Protocols don’t fit well with your style of practice or the needs of the oncologists and primary care physicians you work with who depend on your reports.

There is no getting around the fact that CAP Cancer Protocol templates are long.  It is also true that they must be this way.  The CAP template library is deeply researched and peer reviewed. The result are templates that fit the wide variety of situations that arise in pathology reporting. The challenge of the pathologist of course, is sorting out which questions are appropriate for the specific patient case they are reporting on.

Smart Branching and Pathology Reporting

Part of the solution is simply practice; the more frequently you work with a specific template the faster you become at finding your way through it.

It may also be possible to have your reporting software help you through the process through a technique known as smart branching.  Several leading software systems support it and it may be something you can ask your IT department about. Smart branching ensures that those parts of a CAP template that are irrelevant to the case you are working on are eliminated from your view based on answers you have already provided. The result is a report that is less prone to error, and is completed more quickly. Used in combination with other error reduction and summarization techniques, smart branching can improve the readability of pathology reports and decrease malpractice liability exposure.

A Simple Example: Branch on Specimen Type

Let’s consider a specific example from the Small Intestine and Ampulla Net CAP template. The very first section of the template asks you to indicate the specimen type.  Further down on the template, there are options for additional clinical documentation on the specimen, however, some of those are irrelevant based on the specimen type selected in the first question.  Without smart branching logic, those sections will still appear.

In the screen shot below, the pathology reporting software has been configured with smart branching and collapses the section of questions which don’t apply based on the specimen type selected.  If you change the specimen type, the input form automatically adjusts to show only the relevant fields.

Click to enlarge.

Smart branching.


Smart-branching is an important feature for pathology software that not only improves quality and workflow, but also decreases risk of errors.

Tell IT What You Need

Over the last several years, studies have repeatedly demonstrated that synoptic reporting benefits healthcare workflows [1–15]. The College of American Pathologists has created an outstanding resource with its Cancer Protocols and electronic Cancer Checklists.  Even still, successful implementation requires good planning and strong leadership from the pathologists who must lead the effort; including communicating their expectations to IT about software features like smart branching that are critical to good results.

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