CDCNPCR Pilot Projects Using SNOMED CT Encoded CAP Cancer Checklists - PowerPoint PPT Presentation

Title: CDCNPCR Pilot Projects Using SNOMED CT Encoded CAP Cancer Checklists


1
CDC-NPCR Pilot Projects Using SNOMED CT Encoded
CAP Cancer Checklists

• APIII Annual Conference
• Vancouver, British Columbia
• Ken Gerlach, MPH, CTR
• August 18, 2006

2
Role of Federal Government inHealth Data
Standards

• The needed intervention is not for the
• government to set the standards, but
• rather for them to convene the key
• players and to mediate.
• Donald W. Simborg
• J Am Med Informatics Assoc
• 19963(4)250

3
Federally Funded Cancer Registries, 2006
Seattle/ Puget Sound
Detroit
CT
IA
San Francisco/ Oakland
NJ
UT
San Jose/ Monterey
Los Angeles
NM
Atlanta
ALASKA
HAWAII
NPCR

REPUBLIC OF PALAU
PUERTO RICO
SEER
National Program of Cancer Registries
(CDC) Surveillance, Epidemiology, and End
Results Program (NCI)
VIRGIN ISLANDS
NPCR/SEER
4
United States Cancer Statistics 2003 Incidence
and Mortality

• Covers 96 of US population for incidence, 100
  for mortality
• State, regional, and national data
• Rates for whites, blacks, Asians/Pacific
  Islanders, Native Americans, and Hispanics
• http//www.cdc.gov/cancer/npcr/uscs

5
Geographic Coverage of USCS, 2003
Seattle/Puget Sound
WA
ME
MT
ND
MN
VT
OR
NH
WI
ID
MI
SD
NY
MA
WY
CT
Detroit
RI
PN
IA
San Francisco/Oakland
NE
NJ
NV
OH
IN
UT
IL
DE
MD
San Jose/ Monterey
CO
WV
VA
DC
KS
MO
CA
KY
Los Angeles
NC
TN
OK
AZ
SC
NM
AR
Atlanta
MS
AL
GA
LA
TX
AK
REPUBLIC of Palau
FL
HAWAII
Registry contributed incidence data all states
contributed mortality data
PUERTO RICO
6
Importance of Pathology Data for Cancer
Surveillance

• gt 92 cancer histologically-confirmed in
  pathology laboratories
• Histology and Cytology
• Key for complete and timely data
• Rapid Case-Ascertainment
• For cancers of special interest
• Case-control studies
• Clinical Trials

7
Proposed Cancer Registry Data Flow
Hospital A
8
North American Association of Central Cancer
Registries (NAACCR)

• Umbrella organization
• Population-based cancer registries
• Governmental agencies
• Professional associations
• Private groups
• Purpose To improve quality and use of cancer
  data
• www.naaccr.org

9
Cancer Protocols Project Workflow
Laboratory System
Hospital Cancer Registry
Central Cancer Registry
Receive Specimen from Surgeon
Receive Report ______________________ Exit/Send
acknowledgement
Receive Report ______________________ Exit/Send
acknowledgement
Prepare and Analyze Specimen
Cancer?
Yes
Input Data into CAP Checklist
Format Checklist PHIN Standards
Transmit Checklist
To physician
10

• A CDC-led effort to improve
• public health communications
• by using and promoting health
• data and technology standards
• that electronically enable
• - detection and monitoring
• - data analysis
• - knowledge management
• - alerting
• - response

11
Reporting Pathology Protocols (RPP)

• Demonstration projects funded by CDC NPCR
• Implement SNOMED CT Encoded CAP Cancer Checklists
• In 2001
• California and Ohio
• Cancers of the colon and rectum
• In 2004
• California, Maine, and Pennsylvania
• Cancers of the breast, prostate, and melanoma of
  the skin

12
RPP2 Laboratory Participants

• Funded in 2004
• California
• City of Hope Hospital National Medical Center,
  California
• Maine
• Maine Medical Center and
• Dahl Chase Labs
• Pennsylvania
• University of Pittsburg Medical Center

13
CoC Cancer Program - Standard 4.6

• The CoC requires that 90 percent of pathology
  reports that include a cancer diagnosis will
  contain the scientifically validated data
  elements outlined on the surgical case summary
  checklist of the College of American Pathologists
  (CAP) publication, Reporting on Cancer Specimens.
  
• Protocols not Checklists

14
RPP1 Project - Process

• Identify question concepts on Checklist without a
  LOINC code
• Presentation to LOINC for codes
• Clarify Content and Suggest Revisions to the
  Checklist with CAP Cancer Committee
• Development and Consensus on Implementation
  Tables
• Development of Evaluation Measures

15
RPP1 Vocabulary

• Logical Observations and Identifiers Names and
  Codes (LOINC)
• Question Metadata - Header - Data Item Name
• Systematic Nomenclature of Medicine, Clinical
  Terms (SNOMED CT)
• Answer Data - Checkable line item - Data Item
  Codes

16
RPP2 Vocabulary

• Systematic Nomenclature of Medicine, Clinical
  Terms (SNOMED CT)
• Question Metadata - Header - Data Item Name
• Systematic Nomenclature of Medicine, Clinical
  Terms (SNOMED CT)
• Answer Data - Checkable line item - Data Item
  Codes

17
SNOMED CT Encoded CAP Checklist

• TUMOR SITE R-0025A, 371480007 Tumor site
  (observable entity)
• ___ Cecum T-59100, 32713005 Cecum structure
  (body structure)
• ___ Right (ascending) colon T-59400, 51342009
  Right colon structure (body structure)
• ___ Hepatic flexure T-59438, 48338005 Structure
  of right colic flexure (body structure)
• ___ Transverse colon T-59440, 485005 Transverse
  colon structure (body structure)
• ___ Splenic flexure T-59442, 72592005 Structure
  of left colic flexure (body structure)
• ___ Left (descending) colon T-59450, 55572008
  Left colon structure (body structure)
• ___ Sigmoid colon T-59470, 60184004 Sigmoid
  colon structure (body structure)
• ___ Rectum T-59600, 34402009 Rectum structure
  (body structure)
• ___ Not specified T-59000, 14742008 Large
  intestinal structure (body structure)

18
Why HL7 Version 2.3.1?

• In 2001 For First Project Reasonable,
  National Standard
• For Second Project, proposed HL7 Version 2.5
  Vendor pushback
• Vendors using Version 2.3.1 and Version 2
• AP Laboratory community appears to be using this
  Version
• Challenge Transition to More Robust Formats

19
RPP Messaging Tables

• HL7 Version 2.3.1
• Field Guide Table
• OBX Table (CAP Checklist Concepts)
• Maps of CAP Checklists Concepts to NAACCR Data
  Items
• Map from Collaborative Stage to CAP Checklist
  Concepts

20
Field Guide Table
21
OBX Table
22
Mapping Table
23
Specimen Type Business Rule
24
Collaborative Stage - CAP Checklist
25
Messaging Issues

• Versioning
• Nested questions
• Multiple primaries message structure
• How handle text

26
Types of Versioning

• SNOMED CT updated every January and July
• CAP Cancer Checklists may be updated every
  January and July
• Date of Checklist for major changes
• SNOMED CT Encoded CAP Cancer Checklists may be
  updated every January and July
• No mechanism

27
Melanoma Issue Nested Concepts

• SPECIMEN TYPE R-00254, 371439000 Specimen type
  (observable entity)
• ___ Excision, ellipse G-81FD, 396353007
  Specimen from skin obtained by elliptical
  excision (specimen)
• ___ Excision, wide G-81FE, 396354001 Specimen
  from skin obtained by wide excision (specimen)
• ___ Excision, other (specify) ____ G-81FF,
  396355000 Specimen from skin obtained by
  excision (specimen) (specify) ____ not coded
• ___ Re-excision, ellipse G-8202, 396357008
  Specimen from skin obtained by elliptical
  re-excision (specimen)
• ___ Re-excision, wide G-8203, 396358003
  Specimen from skin obtained by wide re-excision
  (specimen)
• ___ Re-excision, other (specify) _____ G-8201,
  396356004 Specimen from skin obtained by
  re-excision (specimen) (specify) ____ not coded
• ___ Lymphadenectomy, sentinel node(s) R-003AF,
  373193000 Lymph node from sentinel lymph node
  dissection (specimen)
• _X_ Lymphadenectomy, regional nodes (specify)
  _axillary_ G-8204, 396359006 Lymph node from
  regional lymph node dissection (specimen)
  (specify) ____ not coded
• ___ Other (specify) ____ not coded
• ___ Not specified G-8110, 119325001 Skin
  (tissue) specimen (specimen)

28
CWE With Repeating Segments

• _X_ Lymphadenectomy, regional nodes (specify)
  _axillary_ G-8204, 396359006 Lymph node from
  regional lymph node dissection (specimen)
  (specify) ____ not coded
• OBX1CWE371439000Specimen type (observable
  entity)SCTSPECIMEN TYPE396359006Lymph
  node from regional lymph node dissection
  (specimen)SCTLymphadenectomy, regional
  nodes (specify)axillaryF

29
Multiple Specimen/Cancers Scenarios

• One specimen to two or more cancers with the same
  primary site
• One specimen to two or more cancers with
  different primary sites
• Many specimens to two or more cancers with the
  same primary site
• Many specimens to two or more cancers with
  different primary sites

30
Multiple Primary - Structure
MSH/PID/PV1 ORC - Specimen         OBR Part 1
and Worksheet 1 (type)                OBX
Heading/Question and Value                OBX
" " " "       
        OBX " " "
"        OBR Part 1 and Worksheet 2
(type)                OBX Heading/Question and
Value                OBX " "
" "                OBX "
" " "        OBR
Part 3 and Worksheet 3 (type)                OBX
Heading/Question and Value                OBX
" " "
"                OBX " "
" "      
31
Incorporate Text

• For the transmission of text data, RPP2 will rely
  upon the NAACCR E-Path transmission standards as
  noted in NAACCR Volume V

32
Recommendations

• All cancers are not reported via an existing
  checklist
• Need strategy for the remainder
• Multiple histology and primary rules may differ
• Examine coding rules used by pathologists for
  consistency with cancer registry rules
• Checklists need to be assessed for stage
  information
• Collaborative stage

33
Recommendations

• Cancer registry community needs to evaluate
• Expand NAACCR E-Path standards to synoptic
• Establish mapping between checklist data items
  and NAACCR data items
• Informatics community needs to assess vocabulary
  and mapping issues
• Establish the question and answer vocabulary

34
Recommendations

• Examine costs associated with synoptic reporting
• Cost for pathology lab software (AP LIS)
• Cost for SNOMED CT Encoded CAP Checklists
• Pathology lab software vendors
• Add text fields to synoptic reports
• Add drop-down menus for histology codes

35
Potential

• Reduce coding from narrative text
• Facilitate the abstracting process
• Capture intent of pathologists
• Improve rapid case-ascertainment systems
• Create more complete case reports
• Improve completeness of reporting

36
An idea whose time has come?

• Work through issues of vocabulary and mapping
• Work through staging issues
• Implement checklists more quickly
• Integrate into cancer registry software
• Abstract
• Rapid Case-Ascertainment

37
RPP Report

• Published on the NPCR web site
• www.cdc.gov/cancer/npcr/

38
Contacts

• Ken Gerlach 770-488-3008 kgerlach_at_cdc.gov
• Missy Jamison 770-488-7154 mjamison_at_cdc.gov
• Sharon Winters 412-647-6390 winterssb_at_upmc.edu
• Anil Parwani 412-623-1326 parwaniav_at_upmc.edu

39
Thank you

• Ken Gerlach
• 770-488-3008
• kgerlach_at_cdc.gov

The findings and conclusions in this presentation
are those of the author(s) and do not necessarily
represent the views of the Centers for Disease
Control and Prevention