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Frequently Asked Questions About Meaningful Use: State Cancer Registry Processing of Physician Reports

  1. Will the software that vendors sell to physician practices use the formatting required by cancer registries?
  2. What should we do if we can’t validate the messages?
  3. Does CDC provide software?
  4. Do state cancer registries need to review and map the data elements included in the national HL7 CDA implementation guide to the appropriate elements within their state cancer registry databases?
  5. Do cancer registries have to find their own solutions for programming, or can they work with a health information technology (IT) agency?
  6. The EHR will look for ICD-9-CM codes that indicate cancer, and transmit a report every time chemotherapy is given, for example. What is the plan for handling the potential large number of reports? What happens after eMaRC Plus merges the physician records?
  7. We are an incidence cancer registry, so we receive treatment data at the 6-month time point and do not do follow-up. How would we handle this issue with the physician reports coming in for every encounter?
  8. Will eMaRC Plus perform consolidation?
  9. Will eMaRC Plus consolidate physician reports from different facilities?
  10. Since the reports are cumulative, can we wait a certain number of months and then use the most recent report?
  11. Can eMaRC Plus send communication to the provider automatically?
  12. Does CDC plan to create user documentation for eMaRC Plus regarding the physician reporting Health Level Seven (HL7) CDA document processes?
  13. How will record consolidation be handled for the new physician reports within eMaRC Plus, and how will cancer registries handle consolidation into their main database?
  14. Will the data be as complete and high-quality as before?
  15. What staff are needed for registries using eMaRC Plus?
  16. When will CDC distribute eMaRC Plus?
  1. Will the software that vendors sell to physician practices use the formatting required by cancer registries?

Vendors aren’t required to know about cancer registries’ required formatting; eMaRC Plus will map the Clinical Document Architecture (CDA) record into North American Association of Central Cancer Registries (NAACCR) format.

To be certified for meaningful use (MU), any electronic health record (EHR) system must adhere to the specifications outlined in the Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries [PDF-1.9MB] (commonly called the Cancer Implementation Guide). The structure in this guide is the CDA format that eMaRC Plus will translate to the NAACCR format.

The National Institute of Standards and Technology (NIST) developed a structural validation tool for vendors to test the structure of their CDA reports.

  1. What should we do if we can’t validate the messages?

MU Stage 2 regulations require providers to be “active” in the onboarding process; each state decides what that means. The state could ask for test messages, and then wait until there are enough messages to verify. Providers would be waiting, but still meeting the onboarding requirements. States decide how fast they want to proceed.

To meet the requirements for ongoing submission, providers must:

  • Register within 30 days of the start of the reporting period.
  • Register that they will report.
  • Respond to any request from the state within 30 days.

For example, if providers have registered, but the state cannot get back to them for 6 months, they have met the onboarding requirements.

States should officially announce when they have the capacity to accept data for each MU public health objective, develop a process, accept registrations, and let providers know when to proceed. Then providers cannot claim an exemption because their state does not have capacity.

  1. Does CDC provide software?

CDC’s eMaRC Plus software for electronic pathology reporting receives CDA cancer reports that are formatted according to the Cancer Implementation Guide specifications. It is available to all cancer registries at no charge.

  1. Do state cancer registries need to review and map the data elements included in the national HL7 CDA implementation guide to the appropriate elements within their state cancer registry databases?

CDC will provide documentation to map CDA elements to the NAACCR Record Layout and to translate the CDA coded values to the NAACCR standard coded values. eMaRC Plus will implement these mappings and translations, so state registries that use eMaRC Plus will not need to perform this work themselves. State registries should become familiar with the data elements in CDA cancer reports.

  1. Do cancer registries have to find their own solutions for programming, or can they work with a health information technology (IT) agency?

eMaRC Plus will receive data from the physician’s EHR in accordance with the implementation guide adopted by the Office of the National Coordinator for Health Information Technology (ONC) for cancer reporting. Kentucky and Missouri are testing this functionality; it will be offered as soon as it is ready.

CDC is evaluating the possibility of developing a content validation tool for state cancer registries.

  1. The EHR will look for ICD-9-CM codes that indicate cancer, and transmit a report every time chemotherapy is given, for example. What is the plan for handling the potential large number of reports? What happens after eMaRC Plus merges the physician records?

eMaRC Plus will allow state cancer registries to set criteria to choose when multiple reports for the same patient on the same cancer from the same physician are merged (for example, process cancers not likely to be reported by hospitals sooner than patients having multiple chemotherapy visits). eMaRC Plus can export the merged reports in a format that is ready for import into central cancer registry applications. Registries can then consolidate the physician report with the hospital abstracts and other data as usual.

  1. We are an incidence cancer registry, so we receive treatment data at the 6-month time point and do not do follow-up. How would we handle this issue with the physician reports coming in for every encounter?

You can configure eMaRC Plus to wait a certain period of time (such as 4–6 months) before merging and exporting, so you have only one physician record for each patient and tumor. eMaRC Plus will create a single abstract that is based on all of the information from multiple reports and that can be imported into the registry database for consolidation.

  1. Will eMaRC Plus perform consolidation?

Yes, but only for physician reports for the same patient on the same cancer from the same facility. Cancer registries can perform this merging function within eMaRC Plus or export physician reports as they are received, without merging.

  1. Will eMaRC Plus consolidate physician reports from different facilities?

No. eMaRC Plus will merge reports only for the same patient on the same cancer from the same facility. eMaRC Plus’ physician reporting module is intended to prepare physician reports to be imported into the main cancer registry database, not to replace registries’ normal consolidation procedures.

  1. Since the reports are cumulative, can we wait a certain number of months and then use the most recent report?

All EHR vendors may not interpret “cumulative” as a full report of the entire history of the patient, so it may not be possible to use only the most recent report.

  1. Can eMaRC Plus send communication to the provider automatically?

eMaRC Plus does not have this functionality because individualized communications may be needed. The Stage 2 Meaningful Use Public Health Reporting Task Force is developing a guidance document on this topic, and we will use their guidance. Fact sheets are available on PH Connect.

  1. Does CDC plan to create user documentation for eMaRC Plus regarding the physician reporting Health Level Seven (HL7) CDA document processes?

Yes. We expect to have draft user documentation available in September 2013 when the beta version of eMaRC Plus is released. Full documentation will be released with the production release of eMaRC Plus.

  1. How will record consolidation be handled for the new physician reports within eMaRC Plus, and how will cancer registries handle consolidation into their main database?

eMaRC Plus will generate a NAACCR abstract for each imported CDA record and automatically map information from the CDA record into the NAACCR file format and codes. All abstracts received from the same provider for the same patient and tumor will be consolidated into a single abstract automatically. Consolidation will go on continually as new CDA records are received and mapped for the same patient and tumor from the same provider.

Registries will be able to export the consolidated abstract at the desired level of completeness or length of time from the first report received. The consolidated abstract can be exported multiple times to accommodate rapid case ascertainment efforts, as well as additional information that is submitted over time. Consolidated abstracts that are exported from eMaRC Plus should be processed as regular cancer reports in the central registry system. Consolidation of abstracts reported from different reporting sources will be handled the same way registries handle consolidation now.

  1. Will the data be as complete and high-quality as before?

The focus for MU Stage 2 was primarily to identify cases that have been missed or traditionally underreported. Implementation of the EHR systems should provide more complete data. Cancer registries also should see an improvement in the amount of treatment data received.

  1. What staff are needed for registries using eMaRC Plus?

The onboarding process requires one person to communicate and coordinate with vendors and providers. Additional staff will be needed to process the data. The total number of staff members required will depend on the number of vendors and providers who are implementing cancer reporting and the magnitude of data received. eMaRC Plus will automate as much of the processing as possible.

  1. When will CDC distribute eMaRC Plus?

eMaRC Plus’ new physician reporting module is in alpha testing. The first beta version will be released at the end of September 2013, with a production version in January 2014. If EHR vendors are looking for states to test with early, they can contact meaningfuluse@cdc.gov.

 
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