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Frequently Asked Questions About Meaningful Use: Testing, Validation, and Implementation Guide (Questions 30–46)

  1. Some states have more than one cancer registry. Which registry should receive the report?
  2. Is the Tumor Node Metastases (TNM) stage information mandatory in the cancer report?
  3. Should the cancer report include all of the patients’ addresses?
  4. Can the EHR submit multiple races for a patient?
  5. What is the maximum number of races to send?
  6. Is the trigger for reporting just the first-listed diagnosis, or are there other triggers such as medications? The test procedures have six reporting scenarios; does the EHR need to use all of these triggers? For example, would a medication change trigger a report?
  7. Where are the definitions of the data types, such as “CD”?
  8. Is payer information required in the Payers section?
  9. Does this report have to be human-readable?
  10. For the “author” element of the CDA document, who should be the author? Can it be anyone in the provider’s office?
  11. Is there a minimum set of information that makes the cancer report viable? At what point is it a legitimate submission?
  12. Is payer information required in the Payers section?
  13. Will physicians and EHR vendors know that the first-listed diagnosis is the reporting trigger?
  14. Data elements may have a “SHALL” requirement in the Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, but some registries may not need them. Will registries decide what they will consider a complete report?
  15. If a patient visits a doctor and cancer is diagnosed for the first time, does this visit qualify?
  16. Is the Narrative Radiation Oncology section free text for the doctor to complete? Are there any standards or requirements for this section?
  17. Can we get some XML samples?
  1. Some states have more than one cancer registry. Which registry should receive the report?

For MU, reports should go to the state cancer registry. But state or regional cancer registries may have additional reporting requirements beyond MU, so you should check with individual states.

  1. Is the Tumor Node Metastases (TNM) stage information mandatory in the cancer report?

If it is appropriate for the patient to be staged at the point at which the report is triggered, then it is required to be in the report. Some cancers don’t have a TNM stage. In other cases, it is too early for the stage to be determined.

  1. Should the cancer report include all of the patients’ addresses?

The Cancer Implementation Guide includes an address history so that multiple addresses can be submitted by using the Usable Period, which associates start and end dates with each address.

  1. Can the EHR submit multiple races for a patient?

Yes. The Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries [PDF-1.9MB] allows more than one race to be submitted (page 26).

  1. What is the maximum number of races to send?

There is no maximum number. Please send all that you have.

  1. Is the trigger for reporting just the first-listed diagnosis, or are there other triggers such as medications? The test procedures have six reporting scenarios; does the EHR need to use all of these triggers? For example, would a medication change trigger a report?

In these six scenarios, cancer is the first-listed diagnosis, so the report is triggered.

  1. Where are the definitions of the data types, such as “CD”?

“CD” is the data type Concept Descriptor. All data types can be found in HL7 version 3.

  1. Is payer information required in the Payers section?

The Payers section is required, but the Coverage entry is optional. Registries would like to receive this information if it is collected.

  1. Does this report have to be human-readable?

All CDA documents must be human-readable.

  1. For the “author” element of the CDA document, who should be the author? Can it be anyone in the provider’s office?

For header elements, including author, the Cancer Implementation Guide uses the constraints found in the HL7 Implementation Guide for CDA Release 2: History and Physical (H&P) Notes (Draft Standard for Trial Use). We interpret these constraints to mean that a clinician is responsible for this information, so it must come from a provider.

Definition: “The author element represents the creator of the clinical document. If the role of the actor is the entry of information from his or her own knowledge or application of skills, that actor is the author. If one actor provides information to another actor who filters, reasons, or algorithmically creates new information, then that second actor is also an author, having created information from his or her own knowledge or skills. However, that determination is independent from the determination of the first actor’s authorship.”

  1. Is there a minimum set of information that makes the cancer report viable? At what point is it a legitimate submission?

It depends on the situation. With the cancer diagnosis elements specifically, stage data are not always available. Rather than base the submission on the amount of information needed to send a report, we defined the trigger for reporting according to the first-listed diagnosis code given to the encounter. Page 7 of the Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries provides use case details that explain how and when to trigger a cancer event report.

  1. If a physician lists cancer second, is a report triggered?

No. Because of strict diagnosis sequence requirements, the provider will not list the cancer diagnosis second incorrectly. If a patient is receiving chemotherapy, the code for this treatment is listed first, and we have included these codes in the cancer reportability lists.

  1. Will physicians and EHR vendors know that the first-listed diagnosis is the reporting trigger?

Yes. EHR vendors will find this documented in the Cancer Implementation Guide, and CMS has rules for determining first-listed diagnosis, and these rules have been disseminated to providers and physicians.

  1. Data elements may have a “SHALL” requirement in the Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, but some registries may not need them. Will registries decide what they will consider a complete report?

“SHALL” allows the use of a null flavor if the actual data element is not available. However, EHR vendors cannot use a null flavor to avoid collecting or populating a data element. Null flavors are used only when the information is not available. For example, if the patient did not provide his or her race, the race code is populated appropriately with the null flavor of “UNK” for “unknown.” During testing and onboarding, state cancer registries should evaluate the use of null flavors to identify possible issues with the EHR or provider implementation and ensure that data aren’t missed.

  1. If a patient visits a doctor and cancer is diagnosed for the first time, does this visit qualify?

Yes. For example, if a patient visits the provider with symptoms and a biopsy is performed, the first encounter probably will not be recorded as a cancer. The second encounter to tell the patient that he or she has cancer (visit or even a phone call) gives an updated diagnosis of cancer and triggers a report to be sent to the registry.

  1. Is the Narrative Radiation Oncology section free text for the doctor to complete? Are there any standards or requirements for this section?

This section requires only a free text narrative. Information that registries would like to see in this narrative include beginning and ending dates of radiation treatment, treatment volume, number of treatment volume, regional modality, regional dose (cGY), boost modality, boost dose (cGY), and treatment notes.

  1. Can we get some XML samples?

An XML sample is available in the NIST Google Group.

 
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