Integrating Central and Hospital Registries To Improve Timeliness and Data Quality The Central Cance

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Integrating Central and Hospital Registries To
Improve Timeliness and Data Quality(The Central
Cancer Registry as a Hub for Data Exchange)

• David Rousseau, BS
• Director, CIS
• Hospital Association of Rhode Island
• Rhode Island Cancer Registry
• June 18, 2009
• San Diego, CA
• RICR supported by RI DoH and CDC/NPCR

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Background

• The Rhode Island Department of Health contracts
  the Hospital Association of Rhode Island to
  maintain the statewide cancer registry (RICR).
  The RICR is funded by the Rhode Island Department
  of Health and the National Program for Cancer
  Registries of the Centers for Disease Control and
  Prevention

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Central Cancer Registries in General

• Collect data from hospitals and non hospital
  sources
• File statewide reports
• Investigate areas of perceived elevation
• Submit data to NAACCR NPCR annually
• Provide data to qualified researchers
• Perform case finding and data quality audits

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Central Cancer Registries in General

• Central cancer registries have become the primary
  source of training
• Provide hospital administrators with data to make
  strategic decisions
• Provide registrars with technical assistance

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Rhode Island Cancer Registry

• Registry staff provide support to hospital
  tumor registries and promote American College of
  Surgeons approved cancer programs in acute care
  hospitals throughout the State.

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Promoting Hospital Registries

• Provide hospital cancer registries with
  diagnostic and treatment information on shared
  cases when the information isnt available in the
  patients record so the CTR can complete a
  hospital cancer registry abstract
• Provide follow-up information to hospitals when
  traditional methods failed

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Follow-up!

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Follow-up on Demand

• Reporting hospitals were already providing RICR
  with update information electronically monthly
• RICR staff were already providing follow-up
  information via telephone inquiry
• Follow-up is a labor intensive activity that does
  not require the skill set of CTR
• Lends itself to automation
• Follow-up benefits for hospitals and RICR
• Reduces CTR time spent on a clerical function
• Improves timeliness

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Hospital Follow-up Process

• Check hospital databases for recent admissions
• Generate follow-up letters for physician offices
• Generate follow-up letters for other hospitals
• Fax letters
• Generate letters to secondary sources
• Call physician offices
• Call RICR
• Update hospital abstract

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Follow-up on Demand

• RICR staff working with RMCDS developed the
  follow-up on demand process
• The hospital cancer registry creates a file of
  the cases that are due to be followed in the
  coming month that is sent electronically to RICR
• RICR conducts a match for cases to be followed
  after the monthly data submission is processed
• Cases with more current follow-up date are added
  to a file that is returned to the requesting
  hospital for review

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Follow-up Match

• Hospital code number assigned by DoH
• Accession number
• Sequence number
• Medical record number

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Follow-Up Report Layout

• Required Fields
• Pt_Accn_No (Accession Number)
• Dg_Seq_no (Sequence Number)
• Pt_Med_Rec_No (Medical Record Number)
• Pt_Last_Nm (Patient Last Name)
• Pt_First_Nm (Patient First Name)
• Dg_Init_Dx_Dt (Date Of Initial Dx)
• Dg_Site (Primary Site)
• Dg_Last_Fol_Dt (Date Of Last Follow-Up)

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Final Report

• Accession Number
• Chart
• Last Name
• First Name
• Date of Diagnosis
• Primary Site
• Date Last Seen
• Patient Status
• Cancer Status
• Death Certificate Number

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Final Report Format
Cases where the RICR has a more current Date
Last Scene Accession Rec Lst Name
First Date of Dx Site DLS
Vstat C DC 200000001-02 12345
Doe Jane 01/01/2000 C509
01/01/2009 1 1 200100002-00
21450 Smith John 01/01/2001 C349
02/01/2009 1 1 200200003-01
99999 Doe John 01/01/2002 C259
01/15/2009 0 2 200300004-00
54321 Smith Jane 01/03/2003 C509
12/15/2008 1 1
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Monthly Follow-up Results

• Monthly follow-up returns averaged 7.1
• High of 8.6
• Low of 5.6

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Time Saving

• Hospitals in Rhode Island follow 49,520 cancers
  in a given year.
• Hospitals conduct follow-up on 4501 cancers on
  average in a given year.
• The RICR provides follow-up on 3515 cancers
  statewide
• The RICR provides 78 of an average hospitals
  follow-up burden in a given year.

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Time Savings

• With hospital cancer registrars spending less
  time on follow-up they will have more time to
  spend on case finding, abstracting and internal
  quality control projects.
• The net result should be data that more timely
  and of higher quality

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Lost to Follow-up

• Hospital cancer registries consider patients that
  have not been followed for 18 months to be lost
  to follow-up and active follow-up is ended
• Since these cases can impact the CoC approval
  process we decided to include a lost to follow-up
  search

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Lost to Follow-up Results

• Lost to follow-up search found an average 12.7
• High of 18.1
• Low of 8.2
  

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Additional Cooperative Venture

• The RICR sponsored a statewide meeting to
  introduce the new METRIQ operating system that
  was presented by the Elekta Northeast Registry
  Supervisor.

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Future Plans

• RICR staff are working with RMCDS to develop a
  process that allows hospitals to share diagnostic
  and treatment data on shared cases using the RICR
  as a hub for data exchange
• Work with hospital cancer registry staff to
  promote greater use of existing software
  capabilities

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Special Thanks

• Tara Szymanski, CTR
• Rhode Island Hospital RICR
• Larry Derrick
• Rocky Mountain Cancer Data Systems
• Rhode Island Cancer Registry Community