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—

1. Implementing consistent electronic reporting from one or more medical clinics or physician offices to participating central cancer registries.
2. Providing guidance to central cancer registries and clinics/physician offices for implementing electronic reporting in their environments.
3. 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

Modeling

Activity	Status	Release Date
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

Analysis and Design

Activity	Status	Release Date
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— IHE Request Form for Data Capture IHE Retrieve Protocol for Execution	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

Implementation

Activity	Status	Release Date
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