American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Options for Synoptic Operative Reporting for Commission on Cancer (CoC) Standards 5.3-5.6

While compliance with CoC Standards 5.3 - 5.6 will not take effect until 2023, many programs are aware that it will take time to get electronic medical record synoptic reporting solutions in place and have surgeons using them routinely. For that reason, many programs are reaching out to us, asking about new options available for synoptic operative reporting. In response to those inquiries, we have provided below the most current information about synoptic reporting solutions. This is the first of many communications on synoptic reports. We expect an additional communication and webinar in March.

  • Please note, CoC programs are welcome to develop their own synoptic operative reports as long as they meet CoC requirements.
  • CoC-accredited cancer programs are not required to use the synoptic operative report templates developed by the Cancer Surgery Standards Program (CSSP) of the American College of Surgeons, although use of the CSSP synoptic operative reports would facilitate compliance with CoC requirements.
  • A brief Frequently Asked Questions (FAQ) provides additional information on what is considered a synoptic report.
  • The following information applies to CoC institutions only. Non-CoC institutions are requested to seek permission for use of ACS content and may contact to do so.

There are three mechanisms by which a center can use synoptic operative reports that conform to CoC Standards:

#1: You may create a synoptic report that captures just the required CoC elements and response options:

To achieve compliance, accredited programs must include the required elements and response options in a synoptic format in operative reports for Standards 5.3-5.6 as outlined in the CoC’s Optimal Resources for Cancer Care (2020 Standards). To qualify as a synoptic report, the required data elements must be part of a structured checklist or template and the information formatted in such a manner that it can be collected, stored and retrieved.

Many electronic medical records can create such templates. CoC accredited programs or programs seeking CoC accreditation may use the exact language from the manual to create synoptic reports that can complement the traditional narrative operative report. If this is your approach, you should use the exact wording of the required elements and responses to build individual solutions at your institution. There are no fees associated with use of the content in the manual.

You are welcome to share the required elements content with your institutional IT team and with your electronic medical record support team, as needed, to build a synoptic solution for your facility. Since the content of the Optimal Resources for Cancer Care (2020 Standards) is copyright of the American College of Surgeons, we would appreciate where possible that you acknowledge the ACS copyright: Copyright © 2019 American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611-3295. All rights reserved.

Because the material is copyright, you may not share the material or tools built using this material with commercial vendors or with other institutions.

#2 You may create a synoptic operative report that is built using Cancer Surgery Standards Program (CSSP) templates:

The CSSP has developed synoptic operative reporting templates for the documentation of melanoma, breast, and colon cancer surgery. The synoptic operative reporting templates contain a comprehensive list of data fields with intent of replacing the need for narrative reports. Data elements in these templates include fields required for compliance with CoC Standards 5.3-5.6 as well as universal surgical elements and elements required by other accrediting organizations. The templates, developed by surgeons with abundant user input, include American Joint Committee on Cancer (AJCC) TNM staging and National Cancer Database (NCDB) codes, where appropriate. These templates will soon be provided to CoC-accredited cancer programs and will be accessible to facility-designated CoC contacts at a password-protected site.

Viewing these CSSP templates will allow each institution to decide whether they want to build these templates inside the electronic medical record (EMR) used by their facility, encourage their EMR vendor to offer the templates, or pursue commercial options (see #3).

For CoC-accredited facilities wishing to create their own synoptic solutions using the CSSP template material, the material for electronic tool development will be made available for a nominal fee and access will be provided through an Application Programming Interface (API) that will link an institution's software to the CSSP’s electronic content. The API provides not only the content but the formatting and logic model of the content that will simplify institutional IT development. Details on access to the API and associated licensure will be released in the coming weeks. Permission and copyright acknowledgement will be required for any facility that uses the CSSP material to build their own electronic synoptic operative reporting tools.

There is an intent to have CSSP synoptic operative reports to be available within EMR vendor software so that programs have direct access to the synoptic elements via their EMRs, but this capability is not yet fully developed. Discussions with EMR vendors are ongoing regarding the integration of CSSP synoptic operative reporting templates directly into the EMRs. Your EMR vendor will appreciate hearing from you as to your interest in having these tools built inside the EMR your facility employs. EMRs wishing to incorporate the CSSP template content can reach out to the CSSP staff (, who will license template content to them and provide them with the template protocols and access to the API.

#3 Commercial Options for synoptic operative reports that integrate into the Electronic Medical Record:

The CSSP synoptic operative reporting templates described above were used as the foundation for creating digital synoptic operative reporting tools. These tools are sufficiently comprehensive to replace the need for narrative reports and they were built to seamlessly integrate into the EMR. Third-party vendors are pilot testing these web-based tools and will be supporting implementation of such tools with anticipated availability in the coming months. We expect that several third-party vendors will license the synoptic operative reporting content from the American College of Surgeons. CoC-accredited cancer programs may opt to work with one of these third-party vendors to integrate their tool into the EMR. The CSSP will maintain a list of all third-party vendors with the appropriate licensure in place. Working with these third-party vendors may involve an additional cost to programs.

Please contact for additional information on copyright acknowledgement, permissions, or licensure. Please see the FAQ below for additional information on synoptic reporting and permissions.

The CSSP will continue to release educational resources to support these standards in the coming months via Cancer Programs News. Questions should be directed to


What is a synoptic report?

A synoptic report is a document that has standardized data elements organized as a structured checklist or template. The value for each data element is “filled in” using a pre-specified format. The purpose of the synoptic report is to format information in a manner where information can be easily collected, stored and retrieved.

Examples of synoptic reports can be found at:
College of American Pathologists: Cancer Protocol Templates, 2018. Google Scholar

Is the use of routine phrases the same as a synoptic report?

In contrast to narrative reporting, synoptic reporting uses a checklist format—though synoptic reports may have data elements that allow for free form text to be entered. Routine narrative phrases are most commonly used to reduce the burden of reporting in narrative format when an activity or description is the same from one surgery to the next, and typically consist of sentences copied into a narrative operative report. Such phrases may include information about routine placement of incisions or ports or they may be used to repeat information that is also documented by anesthesia or nurse providers. Although synoptic reports can be constructed using “smart text” phrases, routine phrases used within a narrative report generally do not serve the same function, nor do they typically ensure that information unique to the patient is captured in a standardized format.

Why is synoptic reporting important?

Synoptic reporting has repeatedly been shown to improve both the completeness and the accuracy of clinical documentation. Reporting accuracy and completeness is of particular importance in cancer care where multiple providers are involved in the care of a single patient and any omissions or inaccuracies in surgery or pathology reporting may adversely impact downstream decisions. It has also been shown to improve the ability for downstream functions such as registry extraction and compliance. While more long-term experience and critical assessment is available for synoptic pathology reports, there are also abundant reports showing the benefits of synoptic operative reports.

Pertinent References

  1. Eryigit O, van de Graaf FW, Lange JF: A Systematic Review on the Synoptic Operative Report Versus the Narrative Operative Report in Surgery. World J Surg 43: 2175-2185; 2019.
  2. Ellis DW, Srigley J: Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. Virchows Arch 468:51-59, 2016 Crossref, Medline, Google Scholar
  3. Messenger DE, McLeod RS, Kirsch R: What impact has the introduction of a synoptic report for rectal cancer had on reporting outcomes for specialist gastrointestinal and nongastrointestinal pathologists? Arch Pathol Lab Med 135:1471-1475, 2011 Crossref, Medline, Google Scholar
  4. Casati B, Bjugn R: Structured electronic template for histopathology reporting on colorectal carcinoma resections: Five-year follow-up shows sustainable long-term quality improvement. Arch Pathol Lab Med 136:652-656, 2012 Crossref, Medline, Google Scholar
  5. Valenstein PN: Formatting pathology reports: Applying four design principles to improve communication and patient safety. Arch Pathol Lab Med 132:84-94, 2008 Medline, Google Scholar
  6. Renshaw MA, Renshaw SA, Mena-Allauca M, et al: Performance of a Web-based method for generating synoptic reports. J Pathol Inform 8:13, 2017 Crossref, Medline, Google Scholar

What is an API?

An Application Programming Interface (API) is a software intermediary that allows two applications to talk to each other. The American College of Surgeons has developed an API that will deliver the CSSP’s electronic content for direct integration into software and applications. The API provides not only the content but the formatting and logic model of the content that will simplify institutional IT development. Details on access to the API and associated licensure will be released in the coming weeks.