Advancing Electronic Reporting

Reportable ICD-10-CM Codes
  • Core List [XLS-67KB] (reportable to all states)
  • Expanded List [XLS-36KB] (reportable to California, Connecticut, Georgia, Hawaii, Kentucky, Louisiana, Maryland, Michigan, Minnesota, New Mexico, Rhode Island, Tennessee, Utah, and Washington)

The National Program of Cancer Registries (NPCR) defines data reporting standards and develops models and tools to advance electronic reporting of cancer cases.

CDC has been a pioneer in electronic capture and transmission of cancer data into population-based registries. In 2006, NPCR launched the Electronic Pathology (ePath) Implementation Project to test a model for automated electronic capture and reporting of cancer registry data to central cancer registries. It involved The College of American Pathologists (CAP), CDC’s National Center for Public Health Informatics Public Health Information Network (PHIN), the North American Association of Central Cancer Registries (NAACCR), Laboratory Corporation of America® Holdings (LabCorp®), and 18 state cancer registries.

Due to its success, the ePath Implementation Project has gone from pilot to practice. Electronic pathology reporting into cancer registries has expanded to all 50 states and includes many more national and regional laboratories. Reporting is done through CDC’s secure PHIN Messaging System (PHINMS) to transport information to state public health information systems in most states. This is the same system for electronic laboratory reporting used by states for infectious diseases and biosurveillance.

To streamline cancer pathology reporting, this project is migrating cancer pathology reporting to use the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) platform, a secure cloud-based platform that provides shared infrastructure for public health reporting for infectious disease, biosurveillance, and other public health domains. The APHL AIMS platform reduces the burden on laboratories and cancer registries by providing a single point for reporting and supports real-time data exchange that will improve cancer reporting and public health surveillance. All central cancer registries except those in Vermont and Wyoming are connected to the APHL AIMS platform. CDC has added four laboratories to this project: Quest Diagnostics, PathGroup Laboratories, QDx Pathology, and ICM Diagnostics.

Electronic Pathology (ePath) Reporting

Direct ePath reporting into cancer registries can improve the completeness, timeliness, quality, and impact of cancer registry data. NPCR has developed software, eMaRC Plus, to receive and process the cancer data from laboratories to state cancer registries via Health Level 7 (HL7) files.

Guidance for electronic reporting of anatomic pathology reports from laboratories to state cancer registries is provided in the NAACCR Volume V Standard for Pathology Laboratory Electronic Reporting.

Program Highlight: California Cancer Registry Meets Deadline for 100% Electronic Reporting

As of January 1, 2019, all pathologists in California were required to submit reports directly to the state in an electronic format. Before this policy change, electronic pathology reporting in California was voluntary and lacked standards or a centralized approach. The central registry’s ability to perform surveillance and research in real time or near real time was limited by delays in data capture by registries.

To meet the new requirement quickly, the California Cancer Registry used the reporting standards in NAACCR Volume V along with specified constraints. This allowed California to support narrative, synoptic, and synoptically structured message formats using CAP eCC, ensuring data consistency.

Lessons learned: The more discrete cancer data that can be retrieved from the reporting source, the faster central registries can include the records in the final database. The California Cancer Registry found that synoptically structured data are essential to ease of cancer surveillance data use and sharing.

How Pathology Labs Can Start Using Electronic Reporting

NPCR encourages laboratories to submit reportable cancer data directly to registries. Participating laboratories benefit from ePath reporting by—

  • Satisfying reporting requirements.
  • Using CDC’s PHINMS for secure data transport to registries for free, reducing cost.
  • Reducing time spent generating reports as electronic reporting is implemented.

Electronic Pathology Reporting Implementation Process

Pathology Laboratory
  • Expresses interest in electronic reporting.
  • Requirements for implementing electronic pathology reports using the NAACCR Volume V standard.
Guidance on Health Level 7 (HL7) Message
  • Development of HL7 v.2.5.1 observation report—unsolicited mode message.
Guidance on Secure Data Transport
  • APHL AIMS tools can be used to report to public health agencies.
Testing and Validation of HL7 Message
  • Test data sent from laboratories to the registry, finalize the HL7 structure, and ensure that the filtering method used to pull cancer cases works properly.
Central Cancer Registry
  • Several central cancer registries validate the content using the previous reporting mechanism before the laboratory begins reporting to all cancer registries.

Who to Contact to Get Started

  • If your laboratory serves residents in one state or territory, contact your central cancer registry.
  • If your laboratory serves residents in multiple states or territories, contact NPCR.

The following information will be helpful to assess your laboratory’s readiness to report cases electronically—

  • Laboratory information system (LIS).
  • Ability to report using HL7 2.5.1 with SPM segment.
  • Ability to assign an ICD-10-CM code to cancer cases.
  • Use of CAP electronic cancer checklists (eCC).
  • Estimated annual volume of cancer cases.
  • Ability to filter cancer cases by patient address (state of residence) or location of ordering provider or facility.
  • Ability to send batched reports and how often (daily, weekly, or monthly).
  • Does your laboratory serve residents of one state or territory, or multiple states or territories?