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

BACKGROUND: The Missouri Cancer Registry and Research Center (MCR-ARC) is one of two central cancer registries (CCRs) to receive American Recovery and Reinvestment Act (ARRA) funding through the Centers for Disease Control and Prevention (CDC) to facilitate improving cancer reporting utilizing electronic health record (EHR) interfaces. Special Project (SP) #3 activities began in December 2010 with funding continuing through September 2013. PURPOSE: Describe how a CCR is receiving and processing EHR records from clinics/physician offices (C/POs) and critical access hospitals (CAHs) to increase cancer reporting in the State of Missouri. METHODS: We identified possible pilot sites (C/POs CAHs). MCR-ARC staff conducted several recruiting visits. After written confirmation that a site would participate in SP #3, we contacted EHR vendors and began working with each site's vendor to facilitate receipt of complete cancer case reporting from C/POs and CAHs to our CCR. We requested a test file from each site. Initial test files were submitted in a CCD or other format. We sent test files to CDC for review and comment. Vendors made changes as needed. In early 2013 we began receiving test files in the CDA format required for compliance with MU Stage 2 and repeated the review process. RESULTS: By mid-2013, with interfaces and secure transport mechanisms in place, the first C/POs began submitting cancer cases in a CDA format. EHR data are stored in a separate database pending determination of whether it is a new case or supplemental information on an existing case, after which needed data elements are imported into the CCR main database. DISCUSSION: This project demonstrated our ability to increase the number of new cancer cases reported to the CCR and to improve the completeness of information on existing cases. Capturing unreported cases reduces bias and may lead to disparity reduction. Funding challenges remain.