Reporting Pathology Protocols Reporting Pathology Protocols for Colorectal Cancer for Colorectal Cancer 2005 NAACCR Conference: June 9, 2005 2005 NAACCR Conference: June 9, 2005 Ken Gerlach: CDC Ken Gerlach: CDC - - NPCR NPCR Bette Smith: Ohio Cancer Registry Bette Smith: Ohio Cancer Registry Kathleen Davidson Kathleen Davidson - - Allen: PHI/California Allen: PHI/California Cancer Registry Cancer Registry
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Reporting Pathology Protocols Reporting Pathology Protocols for Colorectal Cancerfor Colorectal Cancer
2005 NAACCR Conference: June 9, 20052005 NAACCR Conference: June 9, 2005
Ken Gerlach: CDCKen Gerlach: CDC--NPCRNPCRBette Smith: Ohio Cancer RegistryBette Smith: Ohio Cancer Registry
Kathleen DavidsonKathleen Davidson--Allen: PHI/California Allen: PHI/California Cancer RegistryCancer Registry
PurposePurposeEncourage standard exchange of data between Encourage standard exchange of data between two key public health partners two key public health partners
Cancer Registries: California and OhioCancer Registries: California and Ohio
Evaluate the use of national data standards to Evaluate the use of national data standards to transmit data: HL7 with LOINC/SNOMED CTtransmit data: HL7 with LOINC/SNOMED CT
Evaluate completeness, timeliness, and quality Evaluate completeness, timeliness, and quality of cancer checklists with textof cancer checklists with text--based narrative based narrative reportsreports
CollaboratorsCollaboratorsState and hospital cancer registriesState and hospital cancer registriesCancer registry information system vendorsCancer registry information system vendorsPathologists and pathology labsPathologists and pathology labsAnatomical pathology laboratory information Anatomical pathology laboratory information system vendors (AP LIS)system vendors (AP LIS)College of American Pathologists (CAP)College of American Pathologists (CAP)
Principal organization of boardPrincipal organization of board--certified certified pathologistspathologists
SNOMED International SNOMED International Experts in vocabulary and messaging standardsExperts in vocabulary and messaging standards
Colon and Rectum Cancer Colon and Rectum Cancer ChecklistChecklist
Colon and RectumColon and RectumProtocol applies to all invasive carcinomas Protocol applies to all invasive carcinomas of the colon and rectum. Carcinoid tumors, of the colon and rectum. Carcinoid tumors, lymphomas, sarcomas, and tumors of the lymphomas, sarcomas, and tumors of the vermiform appendix are excluded.vermiform appendix are excluded.
Protocol revision date: January 2004Protocol revision date: January 2004Based on AJCC/UICC TNM, 6th editionBased on AJCC/UICC TNM, 6th edition
ProceduresProcedures• Incisional Biopsy (No Accompanying Checklist)• Incisional Biopsy (No Accompanying Checklist)• Excisional Biopsy, Polypectomy• Excisional Biopsy, Polypectomy• Local Excision (Transanal Disk Excision)• Local Excision (Transanal Disk Excision)• Segmental Resection• Segmental Resection• Rectal Resection (Low Anterior Resection; Abdominoperineal Res• Rectal Resection (Low Anterior Resection; Abdominoperineal Resection)ection)
Colon and Rectum Cancer Colon and Rectum Cancer ChecklistChecklist
COLON AND RECTUM: PolypectomyCOLON AND RECTUM: PolypectomyPatient name:Patient name:Surgical pathology number:Surgical pathology number:
structure)structure)___ Splenic flexure ___ Splenic flexure [T[T--59442, 72592005] Structure of left colic flexure 59442, 72592005] Structure of left colic flexure
(body structure)(body structure)___ Left (descending) colon ___ Left (descending) colon [T[T--59450, 55572008] Left colon structure 59450, 55572008] Left colon structure
Does using the checklist format enhance the Does using the checklist format enhance the quality of the data?quality of the data?
Process: Using narrative pathology reports from Process: Using narrative pathology reports from the previous year, complete a checklist for each the previous year, complete a checklist for each reportreport
Analysis: Identify the data items on the checklist Analysis: Identify the data items on the checklist that could not be completed using the narrative that could not be completed using the narrative
California Preliminary ResultsCalifornia Preliminary Results
Analysis: Identify data items on checklist Analysis: Identify data items on checklist that could not be completed using narrative that could not be completed using narrative
Number of Reports by Missing Number of Reports by Missing Data ItemsData Items
1001005050TotalTotal
221144442233
16168822
18189911
60603030NoneNone
PercentagePercentageNumberNumberMissing Required Data Missing Required Data ItemsItems
California: Quality/AccuracyCalifornia: Quality/AccuracyAre the codes generated for certain data Are the codes generated for certain data items from the CAP checklist as accurate as items from the CAP checklist as accurate as the codes produced by cancer registry staff?the codes produced by cancer registry staff?
Process: Compare cancer registrar staff coded Process: Compare cancer registrar staff coded data items with the synoptic reports created by data items with the synoptic reports created by the pathologist: primary site, histology, and the pathologist: primary site, histology, and AJCC staging (T and N only)AJCC staging (T and N only)
Analysis: Compare data items using 15 reports.Analysis: Compare data items using 15 reports.
California Preliminary Result California Preliminary Result ––Histologic TypeHistologic Type
Cancer Registrar Codes from NarrativeCancer Registrar Codes from Narrative3 Cases: Adenocarcinoma arising in an adenoma3 Cases: Adenocarcinoma arising in an adenoma
2 2 –– Adenocarcinoma arising in a tubulovillous adenoma Adenocarcinoma arising in a tubulovillous adenoma (8263/3)(8263/3)1 1 –– Adenocarcinoma in a tubular adenoma (8210/3)Adenocarcinoma in a tubular adenoma (8210/3)
Pathologist Codes from ChecklistPathologist Codes from Checklist3 3 -- Adenocarcinoma (8140/3)Adenocarcinoma (8140/3)
1 1 –– Contained the more specific code in a narrative Contained the more specific code in a narrative sectionsection
Ohio Evaluation MeasuresOhio Evaluation Measures
Completeness/QualityCompleteness/Quality::Lab/OCISS Assessment of Quality, CompletenessLab/OCISS Assessment of Quality, Completeness
Physician Assessment of Quality Physician Assessment of Quality
Pathologists Assessment of QualityPathologists Assessment of Quality
Timeliness:Timeliness:Survey pathology staff and cancer registrars entering Survey pathology staff and cancer registrars entering data to determine time saved by using checklistsdata to determine time saved by using checklists
Ohio Data Field Quality ReviewOhio Data Field Quality Review
Two Certified Cancer Registrars coded four data Two Certified Cancer Registrars coded four data items from retrospective narrative pathology reportsitems from retrospective narrative pathology reports
Cerner sent the HL7 messages to Rocky MountainCerner sent the HL7 messages to Rocky Mountain
Rocky converted to the NAACCR format and sent a Rocky converted to the NAACCR format and sent a line listing for each case to the OCISSline listing for each case to the OCISS
OCISS staff compared the registrars coded data and OCISS staff compared the registrars coded data and the checklist datathe checklist data
Survey physicians, pathologists and Survey physicians, pathologists and registrars to determine if the checklist report registrars to determine if the checklist report would save time. would save time.
Timed studies not performedTimed studies not performed
An Ad hoc survey was conducted in four An Ad hoc survey was conducted in four hospitals and OCISS staff hospitals and OCISS staff
Unanimous agreement that the checklist format saves Unanimous agreement that the checklist format saves timetime
Ohio Unresolved IssuesOhio Unresolved IssuesHL7 messages contained a 2HL7 messages contained a 2--digit pT category digit pT category
Discrepancy between Checklist pT codes and Discrepancy between Checklist pT codes and AJCC Cancer Staging Manual AJCC Cancer Staging Manual
NeuroendocrineNeuroendocrine tumor, transfer was texttumor, transfer was textOther (specify) has no associated codeOther (specify) has no associated codeNeeds human interventionNeeds human intervention
HL7 message for 2 records for HL7 message for 2 records for pTpNpTpN stagestagewas blankwas blank
Need Need intrafieldintrafield editedit
Lessons Learned Lessons Learned -- QuestionsQuestionsNot all procedures or cancers included in the Not all procedures or cancers included in the Colorectal Checklists Colorectal Checklists
Incisional Biopsy Incisional Biopsy –– not includednot includedIn In situssitus, , carcinoidscarcinoids, sarcomas, lymphomas , sarcomas, lymphomas -- not includednot includedCannot use exclusively for caseCannot use exclusively for case--findingfinding
Checklists evolved: e.g. Checklist Identifier, Type of Checklists evolved: e.g. Checklist Identifier, Type of Polyp Polyp pTpNpTpN Stage DifferencesStage DifferencesWhat type of text? Clinical History? What type of text? Clinical History? Loss of histology, lymph node chain specificityLoss of histology, lymph node chain specificity
Kathleen DavidsonKathleen Davidson--Allen, Allen, PHI/California Cancer PHI/California Cancer RegistryRegistryBarry Gordon, C/NeXT Barry Gordon, C/NeXT Software Software –– LOINC Clinical LOINC Clinical CommitteeCommitteeLinda Jund, Linda Jund, LouellaLouellaHerrmann, Fritz Lin, Herrmann, Fritz Lin, University of California, IrvineUniversity of California, Irvine
OhioOhioMichele Connors, Zeke Michele Connors, Zeke Holland, Linda Coles, Mark Holland, Linda Coles, Mark Jordan, and Dieter Thum, Jordan, and Dieter Thum, Cerner CorporationCerner CorporationLarry Derrick, Rocky Larry Derrick, Rocky Mountain Cancer Data Mountain Cancer Data SystemSystem
Ohio (continued) Ohio (continued) Georgette Haydu and Bette Georgette Haydu and Bette Smith, OCISSSmith, OCISSPat Patterson, Mary Abbuhl, Pat Patterson, Mary Abbuhl, Joseph Willis, University Joseph Willis, University Hospitals of ClevelandHospitals of Cleveland
SNOMEDSNOMEDMary Kennedy, Monique van Mary Kennedy, Monique van Berkum, and John Kilborne, Berkum, and John Kilborne, SNOMED InternationalSNOMED International
CDCCDC--NPCRNPCRWarren Williams, Ken Warren Williams, Ken Gerlach Gerlach