NPCR-AERRO Clinic/Physician Office Reporting Workgroup
Purpose and Goals
Traditionally, cancer patients received diagnostic testing, work-up, and treatment in hospitals. However, medical advances now allow patients to obtain care outside the acute care hospital setting.
Until recently, high-quality cancer reporting has been achieved primarily by hospital cancer registries and pathology laboratories. Data from other sources are not as consistent, leading to under-reporting of cancer types frequently diagnosed and treated outside the hospital setting. Melanomas and prostate cancers, for example, have been shown to be under-reported when central registries rely only on hospital reporting.
In many states, non-hospital data sources are involved minimally in reporting data to the central cancer registry. When reporting does occur, it may be through a manual process of identifying reportable cases and submitting copies of the medical record, or the central registry may send registrars to abstract the information manually from paper medical records. These processes are very resource-intensive, time-consuming, and vulnerable to errors in transcription. The need to use limited resources to access the data contained in clinics/physician offices* drives the effort to develop an automated electronic process to identify and report cancer cases using the clinic/physician office electronic medical record (EMR).
The goal of this initiative is to move the cancer registry community forward in using consistent standards for electronic clinic/physician office reporting to improve the completeness, timeliness, and quality of cancer registry data by—
- Implementing consistent electronic reporting from one or more medical clinics or physician offices to participating central cancer registries.
- Providing guidance to central cancer registries and clinics/physician offices for implementing electronic reporting in their environments.
- Providing the participating central cancer registries with new abilities to use clinic/physician office reports as a source of cancer information.
*For purposes of this initiative, we are defining clinic/physician offices as any health care practitioner who is required by state regulation to report a cancer case to the central cancer registry.
Activities and Timeline
|Review existing clinician reporting use cases/models that can serve as the foundation for development.||Complete||January 2010|
|Develop domain and business use case diagrams for Clinician/Physician Office Reporting.||Complete||March 2010|
|Develop use cases, including workflow and data flow diagrams, for functions identified in the business use case diagram.||In progress||September 2010|
|Identify and evaluate existing standards for clinical data exchange (e.g., Health Level Seven (HL7) Clinical Document Architecture (CDA), security standards).||Complete||June 2010|
|Identify appropriate data elements to include on clinician reporting form.||Complete||June 2010|
|Identify and evaluate use of vocabulary standards and tools for vocabulary access and distribution (e.g., Public Health Information Network (PHIN) Vocabulary Access and Distribution System (VADS), Cancer Data Standards Repository (caDSR), Canada Health Infoway).||In progress||July 2010|
Identify Integrating the Healthcare Enterprise (IHE) profiles and transactions that may be applicable to the use case. Examples include—
|In progress||August 2010|
|Modify existing or develop new standard format using IHE constructs and other relevant eHealth standards that are consistent with North American Association of Central Cancer Registries, Inc. (NAACCR) standards, and present to NAACCR for consideration.||In progress||August 2010|
|Identify and evaluate tools for secure data exchange.||In progress||October 2010|
|Identify functional needs of central cancer registries to receive and process clinician data.||Future development||December 2010|
|Test initial data exchange format for content and format and modify as needed. Review and analyze data transmitted to ensure it will meet central cancer registry data requirements.||Future development||November 2010|
|Develop a tool to validate the format produced by the EMR applications.||Future development||December 2010|
|Implement clinician reporting form.||Future development||January 2011|
|Develop implementation guidelines for clinician reporting.||Future development||January 2011|
|Enhance Electronic Mapping, Reporting, and Coding (eMaRC) Plus to convert data from data exchange format to the standard NAACCR file format.||Future development||January 2011|
|Enhance eMaRC Plus to process clinician/physician office data, including message verification, data validation, and other quality control measures.||Future development||January 2011|
|Implement or expand the existing data transmission software or other tools for the secure transmission of messages (e.g., Public Health Information Network Messaging System (PHINMS), Move It, Web Plus, etc.)||Future development||April 2011|