NPCR-AERRO ePath Reporting Initiatives
The ePath Implementation Project began in 2006 as a pilot project with the following participants: 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 cancer registries (Alabama, Arizona, California, Colorado, Florida, Georgia, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Tennessee, Texas, and Virginia). Due to its success, the pilot became an ongoing implementation project that continues to expand to additional states and laboratories. The map below identifies the participants, and a table Cdc-pdf[PDF-107KB] showing the laboratories from which each state is receiving data is available.
This project implements electronic reporting of anatomic pathology reports from national and regional laboratories to state cancer registries using two guidesExternal: the NAACCR Volume V Standard for Pathology Laboratory Electronic Reporting and the business rules defined in the NAACCR E-path Reporting Process Guide. Initial work with laboratories includes providing an orientation to the requirements for implementing electronic pathology reports using the NAACCR Volume V standard, secure transmission of data using the Public Health Information Network Messaging System (PHINMS), and providing guidance on development of the Health Level Seven (HL7) version 2.3.1 or 2.5.1 observation report— unsolicited mode message for testing and validation. CDC staff work with laboratories to test and finalize the HL7 data structure and ensures that the filtering method used to pull cancer cases for reports works properly. Several states compare the electronic files to paper pathology reports before the laboratory begins reporting to all state cancer registries. State cancer registries use the CDC-developed software, eMaRC Plus, to receive and process the HL7 files from laboratories for inclusion in their main database.
Where possible, this project implements electronic pathology reporting for cancer registries within the state infrastructure that supports electronic laboratory reporting for communicable diseases and biosurveillance. These activities implement standardized routine reporting practices from pathology laboratories to state cancer registries that improve the completeness, timeliness, and quality of cancer registry data.
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. CDC provides state cancer registries and participating laboratories support with installing, configuring, and troubleshooting the PHINMS for cancer reporting.
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.
ePath Project Implementation in Washington State
Washington State is on the ePath!
Washington is home to two central cancer registries, one statewide and one regional. The Washington State Cancer Registry is funded by CDC’s NPCR and collects cancer cases on all individuals residing in or receiving treatment in Washington State. The Seattle-Puget Sound Registry at Fred Hutchinson Cancer Research Center (FHCRC) is funded by the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program and collects case reports on residents of the 13 counties in the northwest Washington area. The Seattle-Puget Sound Registry performs quality review activities, submits the data to SEER, and transmits these cases to the Washington State Cancer Registry.
Bostwick Laboratories was providing paper reports to the Seattle-Puget Sound Registry, and in July 2010, one of its representatives referred them to NPCR-AERRO to pursue electronic reporting. The Seattle-Puget Sound Registry was eager to participate in the ePath project and receive electronic pathology reports from Bostwick as well as other national laboratories. The Seattle-Puget Sound Registry reached out to the Washington State Cancer Registry to coordinate efforts throughout the state. The Washington Department of Health began to research the availability of PHINMS at the state level and the feasibility of setting up a cancer data feed.
Through a coordinated effort between the two registries and the NPCR-AERRO team, the entire state of Washington participates in the ePath project. All cancer reports from Bostwick Laboratories are received on the Washington Department of Health’s PHINMS server. The Washington Department of Health separates the SEER registry cases from the NPCR registry cases and submits the SEER registry cases to the Seattle-Puget Sound Registry via PHINMS, a vast improvement from the paper reports received from Bostwick Laboratories.
Washington State is a great model for implementing the ePath project in states that receive funding from NPCR and SEER. This model also would succeed in states that require pathology information to be shared among multiple, approved data recipients within the state.