NPCR-AERRO ePath Reporting Activities
CDC's NPCR-AERRO, Laboratory Corporation of America® Holdings (LabCorp®), CDC's National Center for Public Health Informatics Public Health Information Network (PHIN), the North American Association of Central Cancer Registries (NAACCR), and 18 state central cancer registries, including Alabama, Arizona, California, Colorado, Florida, Georgia, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Tennessee, Texas, and Virginia, began working together on the ePath Pilot Project in early 2006. To date, additional state cancer registries have joined the project, as shown below.
ePath Project Participants as of March 15, 2011
| Status | States | |
|---|---|---|
| Dark blue | Using PHINMS for Cancer Reporting | Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Maine, Minnesota, Missouri, Nevada, New Hampshire, New York, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Vermont, Virginia, and Washington |
| Light green | PHINMS Installation in Cancer Reporting in Progress | Illinois, Michigan, Oregon, Rhode Island, and Wisconsin |
| Light blue | Participating via sFTP or Other Methods | Maryland, New Jersey, and Pennsylvania |
State Cancer Registries That Are Working with National Laboratories on ePath Project as of March 15, 2011
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This project tests the reporting of electronic anatomical pathology reports from a national laboratory to state central cancer registries using the NAACCR Volume V Standard for Pathology Laboratory Electronic Reporting and the business rules defined in the draft NAACCR E-path Reporting Process Guide. This project explores and implements electronic pathology reporting for cancer registries into the state infrastructure for electronic laboratory reporting of communicable diseases and biosurveillance, where possible. These project activities help the cancer registry community use consistent standards for electronic pathology reporting to improve the completeness, timeliness, and quality of cancer registry data.
The ePath Pilot Project has transitioned into the ePath Implementation Project to collaborate with other national laboratories and additional state cancer registries to initiate electronic reporting of cancer cases. NPCR-AERRO has been working with Bostwick Laboratories to develop the Health Level 7 (HL7) message according to the NAACCR Volume V standard and has implemented electronic pathology reporting from Bostwick to 14 states. NPCR-AERRO also has held discussions with CBL Path, Caris Laboratories, Dianon Laboratories, Mayo Medical Laboratories, Quest Diagnostics, and U.S. Labs to foster future collaborations. Initial work with these labs has included providing an orientation to the requirements for implementing electronic reporting using the NAACCR Volume V standard and the Public Health Information Network Messaging System (PHINMS), and providing guidance on the development of the HL7 v2.3.1 Observation report—Unsolicited mode (ORU) message for testing and validation.
Success Stories
PHINMS Installations
A cancer registry reporting route was integrated successfully into existing PHINMS servers at state health departments, and new instances were installed and configured when needed. The cancer data feed was integrated onto the existing PHINMS LabCorp server that is used to report data for CDC's Biosurveillance and National Electronic Disease Surveillance System (NEDSS) programs.
Implementation of ePath Reporting in a Local Laboratory
Missouri's Cancer Registry worked with a local laboratory to implement ePath reporting using the NAACCR Volume V standard and PHINMS for secure transmission. They implemented ePath reporting successfully and learned the following lessons—
- An important factor for success is to work with a laboratory that already is engaged in or actively interested in implementing electronic pathology reporting.
- Regular communication between the registry and the Missouri Department of Health and Human Services was required to ensure successful implementation.
- PHINMS version 2.8 software was very easy and straightforward to install. Having a resource at the state health department who had experience with the software and configuration was the biggest contribution to smooth and quick success in implementation.
- CDC's PHINMS Help Desk was easy to work with.
- PHINMS version 2.8 includes the ability for PHINMS to watch a folder for files. When a file appears, PHINMS sends the files using a specific routing configuration (folder polling). This made it easy to implement the application without having to modify existing interfaces.
- PHINMS documentation was adequate but needs to be updated. A single location should be provided for all documentation and help files as well as guides to include specific tasks with more details and examples.
- Use of digital certificates and Collaboration Protocol Agreement (CPA) files was a little confusing, but it helped to have someone to assist who had previous experience using certificates.
ePath Project Implementation in Washington State
Washington State is on the ePath!
Washington is home to two central cancer registries, one statewide and one regional. The Washington State Cancer Registry is funded by CDC's NPCR and collects cancer cases on all individuals residing in or receiving treatment in Washington State. The Seattle-Puget Sound Registry at Fred Hutchinson Cancer Research Center (FHCRC) is funded by the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program and collects case reports on residents of the 13 counties in the northwest Washington area. The Seattle-Puget Sound Registry performs quality review activities, submits the data to SEER, and transmits these cases to the Washington State Cancer Registry.
Bostwick Laboratories was providing paper reports to the Seattle-Puget Sound Registry, and in July 2010, one of its representatives referred them to NPCR-AERRO to pursue electronic reporting. The Seattle-Puget Sound Registry was eager to participate in the ePath project and receive electronic pathology reports from Bostwick as well as other national laboratories. The Seattle-Puget Sound Registry reached out to the Washington State Cancer Registry to coordinate efforts throughout the state. The Washington Department of Health began to research the availability of PHINMS at the state level and the feasibility of setting up a cancer data feed.
Through a coordinated effort between the two registries and the NPCR-AERRO team, the entire state of Washington participates in the ePath project. All cancer reports from Bostwick Laboratories are received on the Washington Department of Health's PHINMS server. The Washington Department of Health separates the SEER registry cases from the NPCR registry cases and submits the SEER registry cases to the Seattle-Puget Sound Registry via PHINMS, a vast improvement from the paper reports received from Bostwick Laboratories.
Washington State is a great model for implementing the ePath project in states that receive funding from NPCR and SEER. This model also would succeed in states that require pathology information to be shared among multiple, approved data recipients within the state.
Contact Us:
- Centers for Disease Control and Prevention
Division of Cancer Prevention and Control
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