ePath Reporting Activities

Purpose and Goals

The information collected and included in the pathology laboratory reports represents a critical data source for state cancer registries. Currently, some registries still lack the resources either to obtain and process paper pathology reports or to implement their own electronic pathology (ePath) reporting systems. Many laboratories lack resources and infrastructure to implement ePath reporting. The need to retrieve data from the pathology report in a more efficient and timely fashion is driving the development of an automated electronic process for accessing and using pathology reports to identify cancer cases.

NPCR-AERRO's goal is to implement electronic pathology reporting from laboratories at the national, state, and local levels to the appropriate state cancer registries. Activities are focused on working with the national laboratories and laboratory information system vendors to implement electronic reporting of pathology reports according to the NAACCR Pathology Laboratory Electronic Reporting Volume V standard and the business rules defined in the NAACCR Electronic Pathology (E-Path) Reporting Guidelines.

ePath Pilot Project

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. In 2008, 10 additional state cancer registries joined the project, including Alaska, Arkansas, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Oregon, and South Carolina.

Public Health Information Network Messaging System (PHINMS) Installations in State Cancer Registries

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 is transitioning into an ePath Implementation Project to collaborate with other national laboratories and additional state cancer registries to initiate electronic reporting of cancer cases. NPCR-AERRO has begun working with Bostwick Laboratories and held discussions with U.S. Labs, Dianon Laboratories, Mayo Medical Laboratories, and Quest Diagnostics to foster future collaborations. Initial work with these labs has included providing an orientation of 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 Health Level 7 (HL7) v2.3.1 ORU message for testing and validation. NPCR-AERRO is working actively with Bostwick Laboratories to develop the HL7 message according to the NAACCR Volume V standard. NPCR-AERRO is providing guidance to Bostwick Laboratories on the appropriate filtering criteria.

eMaRC Plus

Electronic Mapping, Reporting, and Coding (eMaRC) Plus, the newest Registry Plus™ application, is a software tool developed to view and work with HL7 files and messages. The application is developed collaboratively by participants in NPCR-AERRO's ePath Pilot Project and programmed by the Registry Plus Development Team.

Known previously as Mapper Plus, this new name more accurately describes the variety of functions that the application now performs. In addition to mapping HL7 to the NAACCR record layout, it identifies reports that have a cancer-related term and recommends histology. Additionally, there is a function allowing registrars to review and confirm or modify the ICD-O-3 coding manually.nfirm or modify the ICD-O-3 coding manually.

The program includes functions to import HL7 files manually or directly from the PHINMS queue, test messages for existence of required data items, parse HL7 messages, and map HL7 data elements to NAACCR data elements. eMaRC Plus also builds a pathology lab database, storing various HL7 data elements as discrete field values into tables in the database. The program creates NAACCR-formatted abstract records from pathology reports during import into the pathology lab database. The program searches a terms table to find potential reports of cancer, and the negation terms finder algorithm (NegEx) has been built to enhance the program's text mining capabilities in terms of specificity. eMaRC Plus provides a screen to view pathology report text and a generated abstract side-by-side to allow coding of primary site and histology and allows users to override any automated decisions about reportability and coding. Further development has been planned to identify site and morphology codes or provide a list of codes to users as they work with pathology report-generated abstracts in this program.

Activities and Timeline

Modeling

Analysis and Design

Implementation

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. See the map above for the status of PHINMS installations in state cancer registries.

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.

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