Hello, and welcome to the January 2023 edition of the GI QUIC QuickBytes webinar series. My name is Laurie Parker, and I am the Executive Director of the GI Quality Improvement Consortium, or in short, GI QUIC. As many of you know, GI QUIC holds monthly webinars focusing on specific and pertinent topics associated with the Registry and allowing ample time for questions and answers. The recording of those webinars in the past are available on the homepage of the Registry site under the News section. This webinar will also be recorded and posted as well. Today's webinar will focus on the updated recommendation guidance for screening colonoscopies to include adults aged 45 through 49 and the impact this has to the adenoma detection rate measure and practical ways to implement this measure change in your practice. Now to review the agenda and the speakers, our presenters for today's webinar are Dr. Katie Farah, Rita Cole, and Luke Williams. Dr. Katie Farah is the Chief Medical Officer at Wexford Hospital in the Allegheny Health Network. Dr. Farah is an Associate Professor of Medicine at Drexel University and is in the Division of Gastroenterology, Hepatology, and Nutrition. Dr. Farah will provide an update with regard to the why behind the change in colorectal cancer screening now beginning at age 45 and its impact on adenoma detection rate. Rita Cole is the Program Manager for GI Quality at Allegheny Health Network in the Division of Gastroenterology, Hepatology, and Nutrition. Rita and Dr. Farah will provide practical insight and a first-hand example of how they are implementing this change and impact on ADR in their practice. We will conclude then with Luke Williams, who is Senior Manager of Data Quality and Analytics at GI-QUIC. Luke will demonstrate in the GI-QUIC Registry how to run this updated adenoma detection rate measure by going to the Reports section of the GI-QUIC Registry. As I said, there will be a question and answer session at the conclusion of the presentation. Questions can be typed in and submitted online anytime during the presentation by using the question box on the right-hand side of your screen. I will now turn the presentation over to Dr. Katie Farah. Thank you, everyone, and thank you for this opportunity. We're here to talk to you tonight about the new updated guidelines of age 45 for colorectal cancer screening. So with that, we can start. So why are we measuring ADRs? What is it and why? Essentially, we are all aware of the rise in incidence of early-onset colorectal cancer in specifically areas such as North America, Europe, and Asia. The American Cancer Society and the United States Preventive Task Force and U.S. Multi-Society Task Force have updated their guidelines, as we are all aware. The increase in colorectal cancer mortality amongst younger individuals is something that we have noticed for the last several years, and the data suggests that the yield of screening for 45- to 49-year-olds is similar to the yield of 50- to 59-year-olds. And so the benefit of screening younger patients outweighs the harm and cost based on initial modeling studies that had been performed. Around 10- to 10.5% of new colorectal cancer cases occur in patients younger than 50 years old, and the incidence of colorectal cancer in patients 45- to 49-years-old has increased by almost 15% from 2000 to 2016. And so the prevalence of colorectal cancer in patients younger than 50 has really not been well-established, and the quality benchmarks for detection rates of advanced neoplasia have also not been established in this young population. I'm going to draw your attention to a couple of studies here for reference, and the first one that I'll draw your attention to is Peter Lang et al., and this was essentially out of New York, where they used the GI Quick Registry to calculate the age-stratified prevalence in predictors of colorectal cancer. Between the years of 2010 and 2020, close to 4 million outpatient screening colonoscopies were evaluated in the GI Quick Registry, and approximately 130,000 were performed on average-risk patients less than 50 years old. And they measured prevalence by age, sex, race, and ethnicity, as well as the prevalence of neoplasia compared to the 50- to 54-year-old group of patients, and they found a substantial increase in prevalence of neoplasia in patients less than 50 years old. They also found that white patients had a much higher odds of advanced neoplasia when compared to Black, Hispanic, and Asian populations in both groups of patients. And then there was another study of Dr. Bilal et al. that you can see here that I have for reference for your review, and essentially examined close to 3 million screening colonoscopies in the U.S. on average-risk screening colonoscopies submitted to GI Quick between the years of 2014 and 2020, and they looked at patients age 45 through 75, and primarily placed them in three different categories, as you can see, age 45 to 49, age 50 to 54, and age 50 to 75. And we all are all aware of current benchmarks for ADRs for men and women being 30 and 20, respectively, with the overall ADRs currently 25%. With this new guideline and recommendation, we will see a drop in ADRs, and we'll also likely see a drop in ADRs in women more than men. And we're going to refer to this in more detail on this slide, showing that, really, a couple of takeaways. The overall mean ADR, and it's really important that we prepare our physicians for this, is going to drop, and you can see what they found here is dropped to 28.6% versus what you see in the older age groups at close to 32% and 36%. And then when you stratify it, mean ADRs in men compared to women, you can see that the mean ADR in women was a lot lower than the mean ADRs in men that they found in the younger age group. And, again, we have the comparisons for the older age group, 50 to 54, as well as 50 to 75 in the subsequent columns to the right. And so Rita and I are going to talk to you a little bit about how we implemented GI Quick in a very large health network, an integrated health network, and how we started from essentially nothing and had to really get physicians on the bandwagon with respect to engagement and the culture of quality. So we're based in Pittsburgh, and we have many satellite hospitals and endocenters northeast, southwest, and south of the city. And we have a 10-hospital academic medical system, plus several surgery centers surrounding. It was really important for us to establish really a culture of quality, because who likes to be measured, right? And so physician engagement was very important. We needed to have that physician buy-in. One of the things that we developed at the time, and this was a few years ago, was having really a physician champion, which ended up being myself, to be able to go around and educate the physicians and really get that buy-in and inform them about the importance of being measured prior to really a lot of the value-based care issues that we see today. And so we had to have a data manager that was not only highly engaged, an individual who the physicians could feel comfortable going to, who they respected, who they actually looked for for guidance, and as a result, really did not have to engage much with myself. And so I'd say a lot of times they preferred Rita over myself. And so what Rita did is she did an extensive amount of side-by-side training, which really required one-on-one training so that the physician had Rita to themselves in real time while they were doing procedures to help with things such as documentation, accuracy, and being able to perform how Rita needed him or her to for purposes of documentation. She also developed tip sheets for them, which was emailed to all of the providers, and also hard copies were provided in several of our GI labs. Once we generated scorecards, and you will see an example of this in one of the upcoming slides, they were de-identified to start. And the information was presented with each physician being designated to a specific letter in the alphabet, and the information was shared with the group at our group meetings. And the physicians were proactively informed and, I guess you could say, warned about this occurring, and actually overall it was taken very well. Initially, we started with quarterly reviews after the first several weeks of implementation where Rita would help figure out areas of documentation that was lacking and so forth, and then subsequently moved to every six months. This is an example of one of the tip sheets that she generated with the help of GIQuick and really outlining areas with our specific endoriter at the time, areas that needed to be documented in completion. A couple of the areas you see circled here were not able to be implemented as hard stops, so particular attention was made to certain areas, which made the physicians' lives pretty easy, and we outlined it for them. This is just a brief overview of, maybe not so brief, overview of the entire schedule for our very large health system that we implemented. And you can see there are many, many steps from prior to going live and prior to education of physicians that are needed. And we developed a timeline, and when we went from each hospital to hospital, we would show them where they were in the schedule, how they related to other hospitals, and kind of what the completion timeline was expected to be. Our feedback process was that of letting the physicians know that they would be receiving their own scorecards, which nobody else would visualize except for the division chief as well as the chair of medicine. And these scorecards were independently emailed to each provider on a quarterly basis. The reporting, like I indicated, then eventually moved to six months once everybody was in a routine, and the review of their performance did occur with the division chief prior to distribution. If there was an issue with a provider or if there were areas for opportunity for improvement, we provided tools for improvement. And this could range from anywhere, including watching a webinar, utilizing several toolkits that are actually provided on the ASGE website. Often, it could involve proctoring and so forth. And this worked very well for our group. On the next slide, you're going to see an example of one of our scorecards that we created. And I'm not sure, Rita, here if you want to chime in. But briefly, you can see all of the performance measures that we were using on the left-hand column. And each physician got their scorecard. And you were in the green if you were above that measure and you met the measure, in the yellow if you were borderline, and certainly red if you were below the measure. Rita, do you want to add anything to the scorecard information? I just want to add that we also include the goal, of course, for comparison. So you can see we look at the six months of data, the current six months of data here on the scorecard. We also provide the goal and we also provide the previous time period so the physicians can see how they have improved. And then we also include our core practice for comparison as well as the entire study. Just to let you know, I run the scorecards from GI Quick through the reporting system and I generate it at a provider level. So as far as addressing the new ADR measure, as always, it's important to communicate with the physicians. Let them know what's coming. Let them know what to expect and certain trends that we expect to see with the ADRs being lower and perhaps even lower in women. Rita, if you want to go forward and talk about your timeline for the new ADR measures. Yes, so as Dr. Fair mentioned, the information has been communicated to our physicians. Our plan is then for the time period of January through June 2023, for that scorecard, we will include the new ADR measure. And along with that, we will also include the archive ADR measure. So just to show the physicians how they are comparing the new measure to the previous measure. Our plan is to then after three cycles of data and then in June 2024, we will trend at a group level the new ADR measure to see how we are performing. And as necessary, if any feedback or information, additional information regarding the measure and the measure change from 50 to 45 needs communicated, we will do that with our physicians. And also, as Dr. Fair mentioned about ADR and what may expect between women and men and how that may look. We also will look at that to see how that is working with the new ADR measure for our physicians. We will trend that on a gender level also. And I will mention that I cannot take any credit for going forward. Dr. Simran Kochhar is our new division chief for GI, and he is working very closely with Rita Cole on this exciting new next adventure. I think overall, our strengths during this process was that we were able to engage employed and independent gastroenterologists, colorectal surgeons and general surgeons. But it took an extensive amount of time and trust building for that to happen. Our scorecards allowed us to be able to show objective data. And once a physician, always the physician, you know, being competitive with each other and themselves, it worked pretty well. There was a strong collaboration, of course, between GI Quick, Big MD and the endoriders. And as always, engagement and trust, as I mentioned, I think was the key to success in our very large group. Our challenges, you know, not every physician and most of us really don't like to be measured initially. There's an apprehension that we all face. Some of the challenges we had initially were missing documentation or even duplicative documentation. And those first few weeks of implementation were very important because Rita was going through and watching in real time what mistakes were occurring. And she was able to correct that effectively with each physician. We did include surgeons and independent physicians. But I think one of our challenges initially was if a physician had a low volume for their screening colonoscopy and also being able to obtain follow-up intervals for their next colonoscopy when it was an outside private practice. We did have two and still do have two endoriders. And sometimes that makes that challenging. And of course, Rita would say having only one data manager is a challenge because she gets stuck with all the work. So our lessons learned from listening to some of the physicians, the tip sheets were very valuable. Having the one-on-one teaching as well with Rita and explaining the tip sheets was also very helpful. Again, physician engagement cannot be emphasized enough. And once it happens, the momentum picks up. And now it's kind of just a way of life in our group. And everybody expects to be measured. It's an expectation. The important thing I wanted to point out was even though we're a very large academic center and have multiple sites, implementation should be and is just as easy if you have a small single endoscopy center with just a couple of providers. And so our illustration is of a massive network. But again, this has also been implemented very easily at single sites. Today, we have about 17 sites and 70 physicians, and it continues to grow. And we really appreciate the relationship with G.I. Quick and Lori's team and ASGE as well. Great. Thank you, Dr. Farah. Thank you, Rita. This is Luke from G.I. Quick. And what we're going to do now is just a quick demonstration of the new ADR measure. And in fact, as far as these quick bites go and the demos that we will occasionally do on them, this will be a pretty brief one because the change, while it is an important one, not a particularly complex one in terms of how it's going to impact your use of the registry. And so you'll see here I'm logged in to a test account. And what I'm going to do is run a report here. I'm on the real time reports page, which should be pretty familiar to all of those G.I. Quick data managers who are currently on the webinar. I'm going to run a report, actually, for my test data for January of actually last year, the January of 2022. The reason I'm doing that is because that is actually when I have some kind of robust test data set up. So just to look at a single month, typing in my dates here under the filter type, I'm going to just do it for the facility as a whole, my test facility, rather than making it too complicated. And then a measure type, I'm going to choose colonoscopy performance measure, which is where we would typically find ADR. And you all may have noticed this already if you've run reports recently, but it was about a week or so ago we rolled out this new measure. So you'll see here that we really, at the top, we have three ADR measures, and in the past we've had two. Right now we have three, and the new addition is the second one here that you can see in my list, where it says screening colonoscopy adenoma detection rate age 45 to 75. And we've kind of labeled the old measure to say age 50 to 75 to kind of clarify between, you know, what's the difference between these two. Currently we do have this third measure that looks at sessile serrative polyps also being included in the numerator. That one is still limited to 50 to 75, but we'll be releasing a change to that eventually where it does expand that age range to be consistent with this 45 to 75 change. So what I'm going to do today for this demonstration is just run these two measures concurrently. So I've selected these top two, the 50 to 75, the 45 to 75, and I'll hit show report. And it should load, yep, pretty quickly here. And you'll see I get measure results. It shows up as six results really here in the table because we provide sort of rolled up measure performance and sex stratified results. So you'll see here my screening colonoscopy adenoma detection rate age 50 to 75. So this is the old measure. My test practice for this one test month is at 39.5%, 15 out of 38. And then you can see my rate in males and females was 50% and 34.6%. These are pretty typical numbers, maybe slightly high, but pretty typical numbers of what we see across the registry. And then I'm just going to scroll a little bit over to the right, but you'll see then I have over here with this column, this is screening colonoscopy adenoma detection rate for ages 45 to 75. So this is the new measure. And you'll see that it is at 37% approximately. So comparing it back to this first one, it is about 2.5% lower. And so that's the kind of change that you might expect to see as you transition to using this measure instead. You'll see my counts are higher because we've expanded the criteria, right? So the denominator wise, we're looking at 46 patients instead of 38. Just because we've added in those screening, those patients undergoing screening in between ages 45 to 49. And so then again, we have our age or I'm sorry, our sex specific results here of 47% roughly for males and 32.3% for females. Now we can do a really quick change to this analysis, right? I look at this compared to the entire registry. And I think this is really helpful. This may take about 10 to 20 seconds, hopefully not much longer than that, because we are just looking at one month's worth of data in GI Quick. But when I run this report, I am now comparing it to the entire registry for again, that time period of January of 2022. And so what I'd like to show once this does the finish loading is that we do see this change in the overall ADR between these two measures. And I'm actually going to make a quick change to this just to make it a little bit easier to see. I'm going to filter out the sex specific results. And that way we just get our rolled up measure performance. So you'll see here my ADR 50 to 75. I still have my test practice data, but I also have the entire registry data. So the 50 to 75, the old ADR, the registry average in January 2022 was 42%. And now, pardon me, when I run that same measure for the same, I'm sorry, the 45 to 75 measure for that same time period, you see that it is about 1.5% or so lower. It's at 40.4%. So that is a very real finding that we're seeing in live registry data. You can, even though we just released the measure a week or so ago, you can run this measure to look at your ADR in patients age 45 to 75 going back all the way back to whenever your site started participating in the registry. So you can use this to look at historic performance. The last thing I'll add before we stop this part of the presentation and go on to a Q&A session is that eventually that's going to be later in the spring, most likely in early April. We are going to be moving the 50 to the 75 ADR measure to our archive section. That's still, that means it's still accessible to you, still available, it's just found in a different area which is a little bit more behind the scenes and you access those by, in the measure type section of our real-time reports, choosing archive quality measure. And that's where we put our quality measures which have somehow changed substantively and really shouldn't be necessarily part of a regular quality improvement program moving forward. But we like to have those available for transparency so you can look back and see your performance on any measure that was ever in the registry. So with that, I'm going to go back to our slides. And I'll pass it over back to you, Lori, for the Q&A. That sounds great. Thank you very much, Luke. And thank you, Dr. Farah and Rita. So at this time, we will address any questions from the attendees. And as a reminder, you can submit a question through the question box of the webinar tool. Luke, one of your last points about this new ADR measure including age 45 and above, you actually addressed in literally like one of your last sentences, but I will ask it because a user asked it and I think it is going to be important to reiterate. And that is, does the measure that includes age 45 patients include past records? Yeah, it absolutely does. And that's the case with all of our quality measures. When we release a new measure or make a change to our measure logic, it always still, our real-time reports tool has that ability where if you run the measure for historic data, it's still looking at the same kind of data fields and applying that measure criteria to the old measures. Sometimes that's a little bit unfair. Like for example, if, you know, for those measures that we have that look at appropriate follow-up interval, you know, the guidelines change. And so if you were to run the new measure on old procedures, you might see really poor performance. Like for example, you know, for one or two adenomas, a follow-up of that used to be recommended as five to 10 years. Now it's seven to 10. And so if you run the measure that's now archived for old data pre-2020, performance is very low. With this measure, it will be a little bit more subtle of a change, but yes, always, always have those historic results available to our users. Another question came about when will the screening or the ADR screening measure that includes serrated lesions for age 45 to 49 be released? And I will just answer that and say I'm fairly soon. It's hard for me to give an exact date. What we worked with on our support and development team was to have the traditional adenoma detection rate measure available right at the beginning of the year. And soon to follow will be the measure for those that include serrated lesions. So you will see that exact same situation where there will be the ADR including serrated lesions for 50 to 75. And then there will be the one that includes 45 to 49. And I would say that it shouldn't be, again, I hate to give up a date here, but probably within the next few weeks, you will see that measure added. Another thing that I will just add with respect to the adenoma detection rate measure and one of the reasons why we wanted to make sure that we had the traditional ADR age 45 and above available now is because it is part of what's considered the measure set that is reportable to CMS for the merit-based incentive payment system or the MIPS system. So for those on the call and for those listening to the recording, if you do have physicians or if you are a physician that will be wanting to report data to the CMS program, then it will be the measure that includes age 45 and above, again, the traditional ADR measure that will be reported. I guess Rita and Dr. Farah, this probably goes more to you, but you mentioned doing the report cards with individual providers by themselves, but have you ever done a measure review with your physicians as a group? And if not, why not? And if yes, how did that go? Dr. Farah mentioned in the past, we de-identify all of our physicians that are assigned a letter and we have at our faculty meetings shown graphical representations of the measure results. So all the physicians are on the graph for the ADR measure and they were all identified by the letter and they all know their letter. So they know where they're performing at with others. And we've done that with ADRs and a few other of the measures. Dr. Farah, do you want to share how that went with the group? It was quite comical. So after a couple of rounds, everybody figured out who had the highest adenoma detection rates. So they were kind of being very comical about it while they were looking at it. And we didn't reveal the identity, of course. I will say there was an extensive amount of education that was done on Rita's part and myself prior to GI Quick going live and all throughout. So any updates, any announcements, any email blasts, we had to do a lot of education with respect to each measure, because as you may remember, the issue with CES-ulcerated adenomas and hyperplastic polyps in the right colon, these discussions can get heated, especially when you're being measured. And so we did a tremendous amount of education on what each measure means, what the numerator and denominator is, what that means, and so forth in a short period of time. Our faculty meetings are typically around 90 minutes, and we would take about 30 minutes to review this on about a quarterly basis. So I hope that answers the question, but we didn't go into all of the education that we did for purposes of time for this talk. Yeah, and actually one other thing. Thank you very much, both Rita and Dr. Farah. The other thing that I would say is if you have specific situational questions that you want to send in to us, you can either feel free just to email those to myself or probably better off to actually open a service desk ticket and send in your questions or any best practices that you have as well, because we can always share, especially with a group like Dr. Farah and Rita's, who's had some success in, and some challenges too, but kind of going through the challenges in order to make it as successful as they can, and we're always wanting to hear the questions and the challenges that you're having so that we can then identify some best practices. So by all means, if you have situational questions like that, please send us the questions. Another question that comes about is for a group with many providers, so actually more than Allegheny Health Network has, and some of these groups do tend to be larger. Some do tend to be quite a bit smaller if it's a group of, say, six to ten physicians, but for a group that in this situation, they have more than a hundred physicians, and do you have suggestions of the best way to do scorecards when there are so many providers, and I'm just going to extend this question and assume that what they're kind of getting at is how visually do you even go about that when you have so many providers and you're trying to portray each provider against their colleague in a de-identified way. So I'm not sure that Rita or Dr. Perry, you're going to have like a magical solution to this, but I would love to know what your thoughts are with having so many providers and wanting to do a scorecard for each physician. So you're talking about larger than our network, not smaller, correct? Larger, right, exactly. So your size were larger, and yeah. Yeah, so, you know, there are many ways to break it down, and we kind of did that. So typically, depending on how many sites and how many providers, again, depending on how the structure of the organization is, there is typically a way to break it down by small pods of groups within the larger network, no matter how many physicians that is. And so whether it's regional or however they're divided, usually there's some form of separation when you have groups that are greater than 100. And so you could do it. So if you took a look at one of our scorecards, we compared each physician. Our core group of physicians was only about 25 physicians, and then we compared them to the core. The core group was our 25. So each individual physician got compared to the 25 in the room in our core faculty, but then we had it compared to all of GI Quick. But then we also, on several occasions, compared it by hospital compared it by region, and so there are a lot of ways to slice it, just depending on kind of what the differentiating factors are between all of the groups, all of the groups within the group, I guess we could say. Great, thank you. Another question with respect to scorecards and providing feedback goes a little bit like one step further, and the question is, how, Rita and Dr. Farah, were you able to motivate your providers to comply with the recommendations? And then it goes on to say, certainly CMS reimbursement doesn't provide the motivations to physicians. So what kind of tricks, or I shouldn't say tricks, but what kind of best practices could you provide that you have implemented to instill these recommendations to be adopted by your physicians? Yeah, it's interesting because it's based on best practices that I actually learned in my role as chief medical officer. So you can apply it to really any form of scorecard, any form of engagement with any physician or provider. So I would probably say this, I would say that once somebody knows they're being measured, they try to do better, just inadvertently you try to do better. There were a couple of physicians who lacked documentation and just their endo reports were just incomplete. And so it probably took, I would say Rita, two to three times where everybody's scorecards was complete and this one individual's was not complete. And you know, I start rolling and people start asking questions, well, why is this physician's scorecard not complete? Oh, well, despite multiple episodes of education, the physician is still not completing it effectively. It gets a little bit embarrassing after the third round. And so eventually that behavior gets corrected. As far as wanting to do better, physicians are just inertly competitive people. And so when they see how they rank, as long as nobody else sees it, they know, and they know a couple of key people know everybody's numbers typically go up. The people who start above the bar want to go higher and they get higher. The people at the bar get higher and even people below the bar start to come up. So generally that is the case. I do have to tell the story of a couple of providers were weeded out of the network actually, when they found out that GI Quick was coming to train their physicians. One had, you know, very, very low withdrawal times, fast withdrawal times. And it kind of weeded a couple of individuals out by default, just knowing that there was a platform that we're going to measure people with. So we didn't, the short story is we didn't have to do too much for these numbers to improve. Right. And can I add that a lot of times if a physician sees themselves in the yellow, they will call me and ask me why, you know, why did they not meet the measure? Why did they not meet the goal? So, and we mentioned, you know, Dr. Farah mentioned, I mentioned, we reviewed the data prior to even producing the scorecard to ensure and to identify why someone has not met the measure. So we have that information and they do call and want to know, and we share that information. I think the other thing is we've had to, we've had physicians in the red, as we mentioned, we highlighted in green, yellow, and red. And for those physicians, we have met with a couple, you know, Dr. Farah and I, and sometimes the division chief, I've met with those physicians. And I think that also gets them to try to improve and want to improve. A similar question. And I think that some of the answers that you just provided with motivating physicians to comply with recommendations or guidelines even, but another question that's come in is we have new physicians coming into our group. Do you have any suggestions for how to instill these best practices with these new physicians with respect to documentation, but also with respect to adoption of the GI quick registry? That's a great question. So we, it probably took us a few months to realize and make sure we had everybody, but when the new year came, what we did was before they were credentialed, they would have to go through mandatory GI quick training through the division so that nobody fell through. So we actually made it a divisional, just like you'd get your badge, your credentialing, your privileging, you have to have your fingerprinting, all your clearances, GI quick training was mandatory prior to start date. And it worked, it's worked pretty well. And then the other thing, this is Laurie that I will add just from the GI quick side is we spend quite a bit of time with new users upfront because we know that they're the ones who are going to have their hands in the system and be doing the process of uploading the data and running the reports. But what we will be doing more so proactively is reaching out when you do have new physicians coming on board, because we know, especially at certain times of the year, especially once a physician's graduated from fellowship and the fall comes around, new physicians are joining. And then all throughout the year, of course, physicians might be moving to practices and they may or may not have had GI quick experience, but we will be proactively doing outreach and our team, although we won't be necessarily a resource like some of their colleagues could be to them. We can be a resource with respect to like best practices and documentation. That also comes to another question that was asked of, basically this comes to us is, does GI quick have any endorider tip sheets for physicians to refer to? I am getting ready to do side-by-side training with the physicians and I would like to have some physical documentation to show them the proper way, not just for documenting things related to adenoma detection rate, but documentation in general. And that is a great question and one that we do a lot of user-specific conference calls and just calls with our users with respect to troubleshooting. We do have a, just a general tip sheet that we just recently talked about adding another layer to that, that would be endorider specific. And I will say that's one of the challenges, but it's also an opportunity that we as operational staff have is ensuring that you and the physicians are best armed with as much information without being overwhelming, that you can be, but because we work with so many different endoscopy softwares, we want to make sure we're giving the correct information. So we will be definitely working on more specific information with respect to a specific endorider documentation tips. We've also discussed, especially with a couple of our larger endoscopy report writer companies, doing a recorded session that those specific customers of that endorider could listen to, realizing that what we do on a larger scale doesn't get so specific to the endorider. And thank you to the GI Quick team for adding what was, what is now in the handout section. And that is what we call the GI Quick physician handout. Again, you won't see a lot of specificity here with respect to, you know, this is how it should be documented in probation. This is how it should be documented in G-Gastro or whatever software you use, but this document would be helpful. And it's also something that is available on our registry homepage. Okay. Another question with respect to the adenoma detection rate measure, and that is, and Dr. Ferrer, I might have you answer this. I'll start, but then if you can take this from your opinion as well, can we expect to see changes in the benchmarks for the adenoma detection rate, considering that it is expected that ADR may go down with the younger ages included? The one thing that I will say in conversations that our team has had with physician experts and also with the public reporting into CMS, is it takes time for benchmarks to be established. And one of the reasons why the GI Quick registry and CMS in turn did not immediately take that age down for ADR and other applicable measures to age 45 is because, again, it takes time to adopt new recommendations. And then it takes, again, even further time to have benchmarks be established. So my initial answer would be it's a little bit unknown as to where we will see the benchmarks go. However, evidence has shown that the adenoma detection rate benchmarks right now, where they are for male and female combined, and male and female separately, tend to be a little bit on the lower side. So it would potentially mean that those adenoma detection rate benchmarks might not in reality go down because of the age 45 addition, because again, they're set a little bit low in general. But Dr. Ferrer, do you have anything to add with that? I actually agree with all of those points. The adenoma detection rates that we know now, 20 and 30, again, they're lower, they're on the low side. And so I would 100% agree with that. I would also agree with the fact that, you know, we need some time to go by. We need more research on now, you know, what is really the true prevalence of any type of polyp and even colon cancer before age 50. So I agree. I think it's going to take some time for those benchmarks. With respect to the de-identification, to go back to that, of the report cards that Rita, you and Dr. Ferrer do, have you ever considered not de-identifying the data and having it be identified so physicians can see how they're comparing to which colleague with an identifiable manner? Yes. And Rita, you can chime in on this one. We actually talked about it. Really, best practices is to start with the identified data because you have to get physicians on board. You have to get the buy-in. They have to get accustomed to the fact that they're being measured. That takes typically anywhere from six to, you know, 18 months, 24 months, an easy two years. And so while best practices is to start de-identified and then go where it is transparent, that is actually the way to go. And we're actually implementing that on other levels outside of GI at our hospital with respect to quality metrics. You know, every division is different. Cultures are different. And some people still have a lot of apprehension regarding doing that. We have not done that yet in our division because we had some leadership changes and I think they just haven't gotten there. But certainly, eventual transparency, depending on how long it takes, is really best practices because, you know, pretty soon in the future, these are going to be made aware for the public on various websites. And so it is important to prepare physicians for that. We have not done it as yet. Okay. So that last statement transitioned well into what will take us our final question. And that is, have you ever made this information available to the public? If so, how, and if not, why not? And then I'll actually add kind of my own spin on that is to the public is one thing, and that's kind of a large stakeholder group. But have you ever considered making it available to referring providers or to payers? So I guess, you know, the public can be thought about in general, but also more specific stakeholders. So love to get your take on that. I'll just say a brief, no, we haven't done that yet. Again, I think there are many ways to do that. Of course, it would have to involve all the right stakeholders, depending on how big your facility is and obtaining network okay on it, compliance and potential regulatory issues. But certainly we have not as of yet. Rita, I'm not sure if in your discussions with Dr. Kochar, if that's something you guys were thinking about, but I know that it is becoming, you can see everything about your doctors on the internet these days. And so I see that happening. Right. And no, not at this time. We have not gone there yet or talked about it much going public. Yeah. I'll just add a caveat. This is Laurie again, that we know that there are various ways that endoscopy centers, more so at the center level than at the provider level, have used this information, whether it's ADR specifically. And I would say it's probably, probably is ADR with additional other metrics as well, possibly SQL innovation rate. But we know sites have put this on their websites. We also know that certain sites across the country have used the GI quick performance data in payer negotiations, also in their, well, accreditation, or more so re-accreditation with their accrediting organizations of their either ASC or hospital unit. So if you do have specific questions about the use of the registry data, there are instances where third party entities do request this information from us, as opposed to from the center, because they want it from the source. And while we would never provide anything without you requesting it, we can provide information in that realm. We also do have, just a final comment, that we do have what's called a PR or a public relations media kit. And we have been sending every one of our participating sites an updated participation certificate. But with that also, you can use our logo. So there's various types of like promotion or marketing features that you can likely take advantage of from simply letting the public know that you're participating. But again, the making the public of the data, Dr. Farah said it, that in many ways, there's not much hidden with respect to the quality performance. Again, we don't make that public, but if you do wish for us to assist you in providing this information to third parties, please do contact us. So just to wrap up, this final slide being shown is how to contact us for additional questions. The best way to get questions to us is through our service desk functionality in the registry itself, and it will get fielded to the appropriate person. I also want to thank Dr. Farah and Rita and Luke very much for their time this evening, to all of you for participating and listening in and asking questions. Thank you, everybody, and have a good rest of your day.

Laurie Parker

GI QUIC

screening colonoscopies

ADR

early-onset colorectal cancer

colorectal cancer screening guidelines

implementation

GI QUIC Registry

healthcare professionals