Ovarian cancer affects 2,400 women annually in Canada with a case fatality ratio of 0.70. There are several practice guidelines that indicate women with early stage ovarian cancer should be appropriately staged including removal of the gynecologic organs, multiple peritoneal biopsies, and pelvic and paraaortic lymphadenectomy. In advanced disease, removing as much disease as possible and leaving less than a centimeter of residual disease in any one area improves overall duration of survival in cohort studies. Single institution studies and now work using administrative datasets in many high resource countries, show that women are not receiving adequate surgical staging or debulking. Cancer Care Ontario has used the RAND approach for defining quality indicators as a step for evaluating quality of care for several cancers including the management of women with ovarian cancer. The difficulty with current administrative datasets in the province is the lack of specific information such as stage, grade, histology, and size of residual disease. In this chapter, we will elaborate on the research that has brought ovarian cancer care to this juncture. We will highlight the importance of gathering information at the point of procedures and specifically in ovarian cancer at the point of the operation. Problems with the operative note and mechanisms to overcome these using templates, checklists, and synoptic notes will be reviewed. We will provide examples of pilot studies in Canada using synoptic operative notes in Cancer Care Alberta and Princess Margaret Hospital. We will also provide examples of computerized data entry across the spectrum of care from three projects in Ontario, Canada. Issues in building a disease site-specific electronic medical record will be discussed. The problems experienced in attempting to generalize such a system provincially will be addressed. We will elaborate on the potential benefits to the individual patient, the hospital and the province from such information system.
