Electronic CAP Cancer Checklists and Cancer Registries A Pilot Project

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Electronic CAP Cancer Checklists and Cancer
Registries A Pilot Project

• 2009 NAACCR Conference
• Ken Gerlach, MPH, CTR
• Castine Verrill, MS, CTR
• CDC-National Program of Cancer Registries
• June 16, 2009

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Reporting Pathology Protocols (RPP)

• Demonstration projects funded by CDC NPCR
• Implement CAP Cancer Checklists with SNOMED CT
  Codes
• In 2001
• California and Ohio were funded for RPP1
• Cancers of the colon and rectum
• In 2004
• California, Maine, and Pennsylvania funded for
  RPP2
• Cancers of the breast, prostate, and melanoma of
  the skin

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Collaborators

• State and hospital cancer registries
• Cancer registry information system vendors
• Pathologists and pathology laboratories
• Anatomical pathology laboratory information
  system vendors (AP LIS)
• College of American Pathologists (CAP)
• Principal organization of board-certified
  pathologists
• Experts in HL7 vocabulary and messaging standards

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Project Purpose

• Encourage a standard exchange of data between two
  key public health partners
• Anatomical Pathology (AP) Laboratories
• Cancer Registries
• Use the SNOMED CT encoded CAP Cancer Checklists
  to promote an exchange of data
• Compare completeness, timeliness, and quality of
  cancer checklists with text-based narrative
  reports

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College of American Pathologists (CAP)

• In 1999, the CAP Cancer Committee published
• Reporting on Cancer Specimens Protocols and Case
  Summaries
• Purpose
• To aid pathologists with completeness, accuracy,
  and uniformity in reporting of malignant tumors
• The cancer protocols - site-specific
• The associated checklist - synoptic format

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Breast Cancer Checklist Protocol applies to all
invasive carcinomas of the breast. Protocol
revision date January 2005 Based on AJCC/UICC
TNM, 6th edition Procedures Cytology (No
Accompanying Checklist) Biopsy (Incisional,
Core Needle) (No Accompanying Checklist)
Complete Excision Less Than Total Mastectomy
(With or Without Axillary Contents) Mastectomy
(Total, Modified Radical, Radical)
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Breast Cancer Checklist

• Modified Radical Mastectomy, Radical Mastectomy
• Note Check 1 response unless otherwise
  indicated.
• MACROSCOPIC
• Tumor Site (check all that apply)
• ___ Upper outer quadrant
• ___ Lower outer quadrant
• ___ Upper inner quadrant
• ___ Lower inner quadrant
• ___ Central
• ___ Not specified

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SNOMED CT Encoded CAP Cancer Checklist (SECCC)

• TUMOR SITE (check all that apply) R-0025A,
  371480007 Tumor site (observable entity)
• ___ Upper outer quadrant T-04004, 76365002
  Structure of upper outer quadrant of breast (body
  structure)
• ___ Lower outer quadrant T-04005, 33564002
  Structure of lower outer quadrant of breast (body
  structure)
• ___ Upper inner quadrant T-04002, 77831004
  Structure of upper inner quadrant of breast (body
  structure)
• ___ Lower inner quadrant T-04003, 19100000
  Structure of lower inner quadrant of breast (body
  structure)
• ___ Central T-04001, 49058007 Structure of
  central portion of breast (body structure)
• ___ Not specified T-04000, 76752008 Breast
  structure (body structure)

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Technical Specifications

• January 2005 version of the CAP Checklists
• January 2006 version of the SNOMED CT Encoded CAP
  Cancer Checklists (SECCC)
• Agreed upon common format consistent with HL7
  Version 2.3.1 and developed an Implementation
  Guide
• Checklists designed for paper systems

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Cancer Registry Data Items

• CAP Checklist Mappings
• NAACCR Data Items
• Collaborative Stage

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Mapping Table
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Issues with Mapping

• Mapping between SNOMED and NAACCR codes
• Laterality maps easily
• Tumor site maps with one business rule
• Extension maps with multiple rules

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Findings

• Checklist data items - transmitted successfully
• Checklist reports generally equal data found in
  text-based pathology reports
• Discrepancies between checklist and text-based
  reports appeared to be minimal
• CAP checklists use reduces time to prepare cancer
  abstracts
• Electronic version of checklists and lab
  procedures impact pathologists use

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Findings

• Number of tumors is not a CAP Checklist data item
  Issue
• Project - multiple cancers on a single path
  report but no existing national standards
• Clinical history information is not routinely in
  Checklists
• Histology codes on checklist limited, with
  free-text choice - pathologists not using this
  feature - Software could facilitate more detailed
  encoding
• Cancer registry collection e-Checklist labor
  intensive

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Conclusions

• Future Shock 2004 Today
• SECCC eCC
• CAP Cancer Checklists Major Updates
• AJCC 7th Edition
• Collaborative Stage
• Pathology Electronic Reporting Taskforce (PERT)
• SNOMED CT LOINC
• Cancer Registry Mappings
• XML Representation
• NAACCR Volume V

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Thank you

• Ken Gerlach
• kgerlach_at_cdc.gov
• Castine Verrill
• cverrill_at_cdc.gov
• Acknowledgements RPP Project Teams
• The findings and conclusions in this presentation
  are those of the author(s) and do not necessarily
  represent the official position of the Centers
  for Disease Control and Prevention