Advancing Electronic Reporting

At a glance

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

A pathology laboratory technician looking at a specimen under a microscope


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 following partners:

  • College of American Pathologists (CAP)
  • Public Health Information Network (PHIN), National Center for Public Health Informatics, CDC
  • North American Association of Central Cancer Registries (NAACCR)
  • Laboratory Corporation of America® Holdings (LabCorp®)
  • 18 state cancer registries

This pilot moved to production in all 50 states and the District of Columbia, with many more national and regional laboratories participating.

To streamline cancer pathology reporting, the ePath Implementation Project is migrating cancer pathology reporting to using the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) platform. This secure cloud-based platform that provides shared infrastructure for public health reporting for infectious disease, biosurveillance, and other public health domains.

The AIMS platform reduces the burden on laboratories and cancer registries by providing a single point for reporting. It also supports real-time data exchange that will improve cancer reporting and public health surveillance. All central cancer registries are connected to the AIMS platform.

CDC has implemented daily cancer pathology reporting from 35 laboratories to this project: Quest Diagnostics, PathGroup Laboratories, QDx Pathology, ICM Diagnostics, and 31 laboratories that use the VitalAxis laboratory system, for a total of 157 CLIA-certified facilities. The goal for next year is to implement real-time reporting from as many as 10 more laboratories.

Reportable ICD-10-CM codes

  • Core list (reportable to all states)
  • Expanded list (reportable to California, Connecticut, Georgia, Hawaii, Kentucky, Louisiana, Maryland, Michigan, Minnesota, New Mexico, Rhode Island, Tennessee, Utah, and Washington)

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.

NPCR staff have collaborated with APHL, the CAP, SNOMED International, and the cancer registry community to prepare for implementation of FHIR® (HL7 Fast Healthcare Interoperability Resources) by developing and publishing the HL7 FHIR® Cancer Pathology Data Sharing implementation guide.

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?