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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 health record (EHR).

The goal of this initiative was 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.

In 2012, this initiative resulted in the inclusion of cancer reporting as a menu option in Meaningful Use Stage 2. At that point, NAACCR created a workgroup to continue enhancing and supporting activities for cancer reporting from physician offices to central cancer registries, using a consistent standard that was adopted for Meaningful Use Stage 2 reporting.

*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


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 November 2009
December 2009
Develop use cases, including workflow and data flow diagrams, for functions identified in the business use case diagram.
Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, August 2012 [PDF-1.9MB]
Complete August 2012

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).
Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, August 2012 [PDF-1.9MB]
Complete March 2012

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
Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, August 2012 [PDF-1.9MB]
Complete March 2012
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.
Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, August 2012 [PDF-1.9MB]
Complete August 2010
Identify and describe tools for secure data exchange.
Transport Options [PDF-309KB]
Complete July 2013
Identify functional needs of central cancer registries to receive and process clinician data. See eMaRC Plus Physician Reporting Manual in mapping rules section for a list of the functional needs. Complete June 2014


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. Complete March 2013
CDA Validation Plus tool developed to validate the CDA documents produced by the physician EHR applications. Complete November 2013
Develop implementation guidelines for clinician reporting. Future development To be decided
Electronic Mapping, Reporting, and Coding (eMaRC) Plus enhanced to convert data from HL7 CDA data exchange format to the standard NAACCR file format, including mapping and translation of data elements. Complete June 2014 (production release)
Enhance eMaRC Plus physician reporting module to include message verification, data validation, and other quality control measures. Future development 2015