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Texas Cancer Registry update

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TEXAS CANCER REGISTRY UPDATE Non-Hospital Reporting and Comparative Effectiveness Research September 20, 2013 Melanie Williams, Ph.D. Texas Cancer Registry – PowerPoint PPT presentation

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Title: Texas Cancer Registry update


1
Texas Cancer Registry update
  • Non-Hospital Reporting and Comparative
    Effectiveness Research
  • September 20, 2013
  • Melanie Williams, Ph.D.
  • Texas Cancer Registry
  • Texas Department of State Health Services

2
Overview
  • National Program of Cancer Registries Update
  • Increasing Non Hospital Reporting and Stage 2
    Meaningful Use
  • Challenges and Opportunities
  • Planning Processes
  • Recent Texas Cancer Registry Activities
  • Comparative Effectiveness Research Project
  • Successes and Lessons Learned
  • Questions

3
National Program of Central Cancer Registries
Update
  • The big news, Collaborative Stage (CS) is not
    sustainable
  • Acknowledged as an innovative idea and the
    efforts of those who tried to save it
  • Too complex to create, manage, and maintain
  • Significant burden on registries to collect,
    edit, and consolidate
  • Cost over 2 million in 2009 alone for CSv2
  • Does not include the costs of central and
    hospital-based registries for software changes,
    database conversions, training, reference
    materials, and staff time
  • Multiple efforts to simplify CS have failed

4
National Program of Central Cancer Registries
Update
  • Administratively it was not sustainable
  • The system became so complex, only a few
    individuals understood it fully
  • Lack of agreement or ability to make changes
    readily
  • CSv3 was estimated to cost over 1.2 million, and
    there was a significant shortfall of needed funds
  • CDC received funding reductions in 2013, and will
    likely receive additional ones in 2014 and 2015

5
National Program of Central Cancer Registries
Update
  • CS for state registries ending in 2016, and there
    will be a multi-year transition
  • Consistent with other national standard setters
    (National Cancer Institute, Commission on Cancer,
    American Joint Committee on Cancer
  • Directly coded AJCC
  • Clinical and pathological
  • Stage group
  • TNM
  • With necessary biomarkers and prognostic factors
  • Directly coded Seer Summary Stage
  • Goal is to collect as much AJCC staging as
    possible, but recognize that some state
    registries may not be able to do it
  • Texas will likely collect both

6
National Program of Central Cancer Registries
Update
  • Why attempt collecting AJCC at the state level?
  • Used by physicians
  • Desirable for many types of research
  • e.g., evaluating quality of care
  • Clinical and Pathological Stage provide two
    different aspects of patient staging
  • Clinical drives initial treatment
  • Pathological more precise prognosis estimates
    defines subsequent therapy
  • Sustainable
  • There will always be resources for AJCC staging
  • Infrastructure is in place to update AJCC
    regularly
  • Physicians volunteer readily to participate,
    knowledge is wide-spread across individuals and
    specialties
  • No central cancer registry data base conversions
    for changes or new versions of stage

7
National Program of Central Cancer Registries
Update
  • Why keep Seer Summary Stage at the state level?
  • Still desirable for many uses, including research
  • When collecting Seer Summary Stage will also need
    to collect auxiliary data
  • Tumor size
  • Number of lymph nodes examined
  • Number of lymph nodes positive
  • Relevant prognostic factors or biomarkers (e.g.,
    HER2)
  • Also sustainable
  • Provides continuity across Nation and across time

8
National Program of Central Cancer Registries
Update
2015 diagnoses
2016 diagnoses
2014 diagnoses
Directly coded TNMc,p required as available CS
used for staging
Directly coded TNMc,p required as
available Directly coded Summary Stage
required CS used for staging (will end as soon
as possible)
Directly coded TNMc,p required Directly coded
Summary Stage required
9
Other National and Texas Cancer Registry
priorities
  • Increasing non-hospital reporting
  • Supporting Stage 2 Meaningful Use
  • Sustaining some additional data collection in
    support of comparative effectiveness research,
    e.g., the forever seven
  • Increasing data acquisition through data linkage
    or other sustainable methods, such as direct
    reporting through EHRs and claims data
  • Further building state electronic reporting
    capacity and health information exchange

10
Increasing Non Hospital Reporting and Stage 2
Meaningful Use
  • Objective Improve completeness, data quality, of
    certain under-reported cancer sites and types of
    treatment
  • Goal/Method Primarily through direct electronic
    health record reporting from ambulatory/non-hospit
    al sources
  • Who Reports
  • Emphasis on certain physician specialties, cancer
    treatment centers, free-standing radiation, and
    ambulatory surgery centers
  • Where there are medical and radiation
    oncologists, hematologists, urologists,
    dermatologists, and gastroenterologists
  • Currently, self-identified by contacting the TCR
  • Working on other data-driven identification
    methods, such as analyses of claims data, Stage 1
    meaningful use attestations

11
The increasing role of non-hospital reporting
Diagnosis year 2011 not yet complete.
12
Increasing Non Hospital Reporting and Stage 2
Meaningful Use
  • Opportunities
  • All new activity and many new relationships
  • A whole lot more data
  • Improve completeness for cases diagnosed and
    treated primarily in an outpatient setting,
    missed treatment
  • Supporting physicians qualifying for financial
    incentives to report electronically in a standard
    format
  • Hopeful that HL7 CDA documents will be more
    complete than pathology reports
  • Reducing work load for active case-collection,
    need for follow-back, and improving quality
    assurance activities
  • Revolution, transformation, major paradigm shift,
    and more!?

13
Increasing Non Hospital Reporting and Stage 2
Meaningful Use
  • Challenges
  • All new activity and many new relationships
  • A whole lot more data
  • Complexity and newness of HL7 CDA
  • Competing priorities
  • Lack of funding

14
Pre-Planning Processes
  • Conducted environmental scan including
  • Texas Immunizations and Electronic Laboratory
    Reporting who were involved in Stage 1 Meaningful
    Use, and
  • 9 state cancer registries engaged in electronic
    pathology reporting, had similar size and
    infrastructure, and/or who had mature Health
    Information Exchange systems
  • Reviewed Lessons Learned Stage 1 Meaningful Use
    (MU) presentations and materials provided by
    NPCR and the Office of the National Coordinator
    for HIT (ONC) Public Health Coordinator
  • Consulted Advisory Committee to the Texas Cancer
    Registry and Texas Medical Association Cancer
    Committee
  • Studied HIT and MU, State HIT, HIE, and Medicaid
    plans, what groups and individuals were
    responsible for what HIT activities

15
Work Groups
  • Co-chairing NAACCR Physician Reporting Workgroup
  • Participating in Stage 2 Meaningful Use Public
    Health Reporting Requirements Task Force
  • Participated in CDC Stage 3 Meaningful Use
    Workgroup
  • Attends state DSHS HIT Executive Steering
    Committee meetings
  • Attends state Medicaid HIT Advisory Committee
    meetings

16
Important Partnerships
  • Identified key partnerships, made introductions,
    and wherever possible, secured agreement to
    support and promote Stage 2 MU Cancer Reporting
  • Department public health agency HIT Coordinator
  • State Medicaid Health IT Group responsible for
    the Electronic Health Records Incentive Program
  • State Health IT Coordinator
  • Texas Medical Association
  • EHR Vendors
  • Regional Extension Centers
  • 3 Health Information Exchanges

17
Business Process Mapping
  • Completed proposed business process mapping
  • Registration
  • On-boarding
  • Testing/validation
  • Acknowledgement of ongoing submission
  • Benefits of business process mapping include
  • Providing a visual step-by-step diagram of
    business process and workflow
  • Indicating who is responsible for each step
  • Assisting in determining to what standard a
    process should be completed
  • Indicating how to measure success/results of
    processes
  • Making it easier to identify gaps and if needed,
    trouble shooting workflow
  • Standardizing processes, and allowing staff to
    have a broader understanding of work

18
Stage 2 MU Proposed Business process map
Registration
19
New Registration Process
Many different types of entities are reporting on
behalf of physicians.
20
Registration Step 1
Items 1-3 will assist in planning and
prioritizing on how to best manage the order for
testing/validation.
Only certified EHR technology meets MU
requirements, but the TCR offers other
alternatives for non-MU cancer reporting.
21
Analyzing physician data
22
Visualizing data for planning
23
New web pages
24
New web pages
25
New Training
  • For cancer registries and Stage 2 MU, see the
    ONCs Interoperability and Public Health
    Reporting Training

26
New Training
27
Next Steps
  • Developing 3 month project plan for remaining
    tasks that must be completed before going live
    January 1, 2014
  • Complete physician reporting Access database/MU
    tracking tool
  • Complete Detailed MU Cancer Capability Map
  • Draft more detailed data flows
  • Develop audit/additional quality assurance
    strategies and processes
  • Complete eMaRC software testing
  • Consider further and test if possible, downstream
    impact of EHR reporting
  • Develop more specific training for registry staff
    and those reporting for physicians
  • Market and further promote physician cancer
    reporting
  • Develop online dashboard for performance measures
  • Exploring web-based product (e.g., Tableau)

28
2011 Comparative Effective Research (CER)
Project Completion
  • Texas was selected as one of ten specialized
    registries to increase and improve data
    collection
  • This project was funded as part of the American
    Recovery and Reinvestment Act (ARRA) CER
    activities through the Centers for Disease
    Control
  • CER Registries collected additional detailed
    required data items on breast, colorectal, and
    chronic myeloid leukemia cases diagnosed in 2011
  • Additional goal to increase electronic health
    record reporting, and data linkages

29
2011 Comparative Effective Research (CER) Project
  • Additional data field information included
  • Additional Staging
  • Treatment focusing specifically on colorectal,
    breast, Chronic Myeloid Leukemia
  • Biomarkers for some sites
  • Comorbidities for all sites
  • Smoking history for all sites
  • Height and weight for all sites
  • Occupation for all sites

30
2011 Comparative Effective Research (CER) Project
  • Reporters were given the following options to
    provide the additional required data information
  • Provide text documentation on abstracts/Excel
    spreadsheet for TCR staff to code
  • Facility visits for TCR staff to abstract and
    code
  • Remote into their system to collect information
    and code

31
2011 Comparative Effective Research (CER) Project
  • A total of 132 facilities opted to do one of the
    following
  • - Provide text documentation on abstracts and TCR
    code
  • 9 - Provide information on Excel spreadsheet
    for TCR to code
  • - Facility visits
  • - Remote into their system to collect information
    and code

32
2011 Comparative Effective Research (CER) Project
  • TCR staff were assigned the first round of CER
    facilities to complete the coding for facilities
    who opted to provide text or an Excel spreadsheet
    with the additional treatment information.
  • Following months site visits were scheduled
  • First CER submission was due June 2013.
  • Continued data collection on cases after June
    2013, additional submissions in August and
    November 2013
  • We ran out of time

33
Cer project Successes and Lessons learned
  • Overall, we are proud of the efforts of our
    reporting community and TCR staff
  • Texas collected the most CER data of all 10
    states
  • The effort for additional data collection using
    traditional means is not sustainable, and can in
    fact be negative on overall operations
  • We are committed to sustaining our training
    efforts across the state, and are successful with
    no registrar left behind
  • Exploration of additional electronic reporting
    methods and data collection are of value and
    sustainable

34
Questions
  • Contact Information
  • Melanie Williams, Ph.D.
  • Branch Manager, Texas Cancer Registry
  • Texas Department of State Health Services
  • 512-305-8092
  • Melanie.Williams_at_dshs.state.tx.us
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