How one central cancer registry (CCR) navigated EHR reporting from Clinic/Physician Offices (C/POs)

BACKGROUND: In 2010, the Missouri Cancer Registry and Research Center (MCR-ARC) received American Recovery and Reinvestment Act (ARRA) funding from the Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR) through a subcontract with Macro International to demonstrate receipt and processing of electronic health records (EHRs) from C/POs. While all states have laws or statutes mandating the reporting of non-hospital as well as hospital-based cancer cases, many of the 45 states (plus the District of Columbia) funded by CDC’s NPCR have had difficulty obtaining cases diagnosed and treated in a C/PO due to staffing and funding issues for both CCRs and C/POs. With some types of cancer (e.g., melanoma skin cancer, prostate cancer, leukemia, lymphoma, in situ and localized breast cancer, etc.) increasingly being diagnosed and treated outside a hospital setting, failure to capture these cases has a negative impact on the completeness of cancer incidence data. Where you live may affect your health and well-being but if complete, timely and accurate data are not available, public health officials and other decision-makers may not know it. Implementation of Stage 2 Meaningful Use – Cancer Reporting offered an opportunity to obtain needed data.

PURPOSE: Describe steps the CCR took to facilitate receipt and processing of EHR records formatted for cancer reporting using Clinical Document Architecture (CDA) from certified Meaningful Use (MU) Stage 2 EHR vendors.

METHODS: We identified pilot sites and obtained written confirmation of participation. We worked with each site's EHR vendor to facilitate receipt of complete cancer case reporting. We requested a test file from each site. Initial test files were submitted in a non-CDA format. We sent test files to CDC for review. 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: Guidelines and procedures were created to facilitate onboarding of additional C/POs by the state health department. These procedures, adopted into the department’s and CCR’s operations, will be demonstrated.

DISCUSSION: Procedures developed to facilitate EHR reporting to one CCR can be used by other CCRs to increase C/PO reporting. These procedures make for an easier transition of CDA files to abstracts used in cancer reporting. This allows the CCR to improve completeness. How health is affected by where patients live can be assessed and disparities addressed.