Achieving increased cancer reporting from clinicians to public health: A local success with global implications

Alena Headd, MSIT, Software Support Analyst, Missouri Cancer Registry and Research Center (MCR-ARC)University of Missouri School of Medicine, Health Management & Informatics Department

Presenter Disclosure

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

No relationships to disclose

Co-authors

Jeannette Jackson-Thompson, MSPH, PhD

Director, Missouri Cancer Registry & Research Center (MCR-ARC) & Research Associate Professor, Health Management & Informatics (HMI)

Iris Zachary, PhD, MSHI, CTR Assistant DBA, MCR-ARC & Assistant HI Professor, HMI

Nancy Cole, BS, CTROperations Manager, MCR-ARC

Acknowledgments

This project was funded as part of American Recovery and Reinvestment Act (ARRA) Comparative Effectiveness Research activities through the Centers for Disease Control and Prevention (CDC)

MCR-ARC data collection activities are supported by a Cooperative Agreement between the Missouri Department of Health and Senior Services (DHSS) and the CDC and a Surveillance Contract between DHSS and the University of Missouri (#U58/DP003924-01/02)

Presentation Objectives

Discuss the significance to public health of obtaining new cancer case information from physician office electronic health records (EHRs)

Explain how EHR reporting to a central cancer registry can reduce reporting bias and contribute to disparity reduction

List barriers for clinicians and public health entities in implementing EHR reporting

Background

Changes in medical practice and health care delivery have increased the incidence of cancers being diagnosed/treated outside a hospital setting

MCR-ARC is one of two CCRs that participated in an ARRA-funded pilot project to improve cancer reporting by importing real-time data directly from EHRs to CCR

Methods

To increase case completeness by obtaining previously unreported cases and treatment information from EHRs, we: Partnered with the Missouri Health Information Technology (MO HIT) Assistance Center to identify potential:▪Clinic/physician offices (C/POs)▪Critical access hospitals (CAHs)

Methods (Cont’d)

Conducted site visits▪Recruited 6 C/PO & CAH participants

Identified and collaborated with:▪Facility EHR vendors▪CDC software developers▪Export files▪Develop interfaces▪ Import, store and process data

Methods (Cont’d)

Worked with other state and national groups/organizations to: Identify & assess software options that

allow secure transfer of encrypted data via the Internet▪ MU’s secure messaging software MoveIT

(preferred)▪ Direct, PHIN-MS (acceptable)

Develop /standardize processes▪ Data elements ▪ Formats▪ Triggers

Trigger Event Physician-driven

Automated Physician decides when to send

More data CCR gets critical data

Easier to process at CCR

Added a specialty physician (urologist)

Trying two options: Pros

Methods (Cont’d)

Cons

Trigger Event Physician-driven

May overwhelm CCR Some detailed data may not be sent

Methods (Cont’d)

Results: C/PO Participation

Rural clinic – completely electronic throughout: Approached their EHR vendor (MediTech) at HIMSS 2012▪ MediTech began working on changing reports to CDA formatted reports▪ Clinic developed implementation strategy of new cancer-reporting module

Received test data that was analyzed and feedback given to MediTech ▪ Changes made to reports

EHR 2nd in country to be certified for MU Stage 2 - Cancer Reporting by Office of National Coordinator (ONC) (Feb 2013)▪ MCR-ARC expected to receive live data Summer 2013▪ Revised date is November 2013

Results: Specialist C/PO Participation

Urologist Joined project in 2012 Received test data that was form-based EMR▪ Contacted EMR vendor (BuildYourEMR) to adapt their

reports for cancer-reporting to CDA formatted reports Received subsequent test data that was analyzed▪ BuildYourEMR changed some formatting issues

EHR vendor 3rd in country to be ONC certified for MU Stage 2 Cancer Reporting (June 2013)

Results: Project Status - Urologist

Implementation completed, September 2013 Live data anticipated November 2013

Analysis of data will begin immediately upon receipt of live data

Practice averages between 50-100 cases per year

Results: CAH Participation

Three CAHs Selected EHR: 3 ▪ Implemented: 0

Since none have implemented their EHRs, no preliminary findings

Challenges - CCR

Interoperability between C/PO and CCR software

Convincing EHR vendors to change to CDA format before Stage 2 (1/1/14)

Convincing C/POs to choose cancer reporting as one of three options in MU Stage 2

Challenges – CCR (cont’d)

(NPCR) By 29 June ‘17, EHR reporting to CCR should include 80% of: Urologists, dermatologists, gastroenterologists, medical

& radiation oncologists, hematologists Number of above specialty C/POs:

Radiation oncologists in Missouri practice within Radiation facilities so individual physicians are not included

Specialty # in MO # reporting

Urologists TBD 0 (1 in pilot)

Dermatologists 217 120

Gastroenterologists 293 0

Medical Oncologists 235 0

Hematologists 100 0

Challenges – CCR (cont’d)

C/POs enrolled by MO HIT Assistance Center: 1,276 (initially); 1,167 (1 November 13) Implemented EHR: 100% Achieved MU Stage 1: 66%▪ Number of EHR Vendors/Software

identified: 23 ▪ EHR Vendor/Software not stated: 5

Challenges – CCR (cont’d)

Breakdown of 598 C/POs that have achieved MU Stage 1

Specialty # of Physicians MU Stage 1

Family Practice 381

Geriatrics 4

Gynecology 1

Internal Medicine 113

OB-GYN 53

Pediatrics 46

Challenges – CCR (cont’d)

On-boarding additional C/POs Targeted specialties ▪ Need to determine #s

Other specialties that diagnose/treat cancer▪ Parts of state have few practitioners in targeted

specialties Additional resources will be needed

Challenges – CCR (cont’d)

Processing data and internal workflow Storage Consolidation of reports

Funding cuts Staffing deficits (4 core positions) Limits CCR’s ability to implement EHR reporting by C/POs not in pilot

Discussion

MCR-ARC’s ability to increase the number of new cancer cases reported to a CCR and to improve the completeness of information on existing cases

Capture of unreported cases to reduce bias and lead to disparity reduction

Funding challenges remain

Questions?

Contact info:Alena Headd, MSIT, Software Support

Analyst,Missouri Cancer Registry and Research

Center,Health Management & Informatics, School of Medicine, University of MissouriColumbia, MO 65211 573-882-7775headda@health.missouri.eduhttp://mcr.umh.edu