NAACCR CDA Pilot Project Overview, Status, and Findings

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NAACCR CDA Pilot Project - Overview, Status, and
Findings

• 2009 NAACCR Conference
• Ken Gerlach, Co-Chair, NAACCR Clinical Data Work
  Group Health Scientist, CDC-NPCR
• Lori Havener, NAACCR Director of Standards
• Jim Martin, Co-Chair NAACCR Clinical Data Work
  Group
• Director, Virginia Cancer Registry
• June 18, 2009

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NAACCRs Number One Priority

• Achieve syntactic and semantic interoperability
  of cancer registration standards with national
  standards by 2010 or at the earliest possible
  time.

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Clinical Data Work Group

• Goal Explore alternate mechanisms or messages to
  transmit and receive (within and outside the
  cancer registry community) the cancer abstract
  (Volume II) to ensure consistency with national
  standards-related organizations

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Selection Criteria

• Core Criteria
• Ability to handle repetitions and other
  structures
• Ability to transmit large text data
• Ease of visually reviewing data without special
  tools
• Consistency with national healthcare industry
  formats
• Ease of adding/revising data items (cost)
• Self-identifying
• Internet friendly
• Availability of development tools

• Software-Specific Criteria
• Compatibility with statistical software
• Compatible with Edits
• Compatible with SEERPrep
• Compatible with Cancer Registry software
• Compatible with GIS software

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Decision

• Health Level Seven (HL7)
• Clinical Document Architecture (CDA)
• HL7 CDA

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Why HL7 CDA

• Self documenting
• Web-friendly
• Easy to change / add / subtract
• Programmer current
• New data models multiple treatments
• Consistent with National Electronic Health
  Records
• Nationally Internationally

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What is HL7 CDA

• Representation, E-Clinical documents for exchange
  
• Medical records reports e.g. D/C summary,
  operative reports, and radiology reports
• XML encoded (Extensible Markup Language)
• Human readable machine processable
• Header and body
• Specifications flexible - covers broad range of
  clinical documents
• Implementation guides - specifies the level of
  structure and coding

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Pilot Project
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Design Method

• Transmit cancer abstracts using HL7 CDA from a
  hospital registry to a central registry
• Dummy Data
• NAACCR Record Type A (full case abstract),
  Version 11.1
• All Required (R) and Required when available (R)
  Data Items
• Expanded text in text-based Data Items

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Participants

• California
• Sender Software C/NExT
• Receiver Software Eureka
• Virginia
• Sender Software Abstract Plus
• Receiver Software Rocky Mountain Cancer Data
  System (RMCDS)
• Virginia Commonwealth University Health System

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Strategy

• Implementation Guide (IG)
• Software to translate Column-Delimited Format to
  CDA and vice versa
• Transmit and Receive Test Messages
• Compile Lessons Learned, Advantages, and
  Disadvantages
• Recommendation to Board

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Implementation Guide (IG)

• A guide describes how to code CDA documents
• Specific encoding
• NAACCR HL7 CDA R2 Implementation Guide for Cancer
  Registry Reporting
• Tool for implementers senders and receivers

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Translation Software

• For potential phase-in of implementation
• Not all vendors/developers will be at the same
  level
• Allows concurrent formats for a period of time
  e.g. 2 years
• Done Being tested by participants

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Vocabulary

• NAACCR Data Items (Question Codes)
• Use LOINC Codes
• NAACCR Data Items Values (Answer Codes)
• Use NAACCR Codes
• Future - map NAACCR codes to other National
  Standards
• National Standards
• SNOMED CT
• LOINC
• National Cancer Institute (NCI) Thesaurus
• Public Health Information Network (PHIN)
  Vocabulary Access and Distribution System (VADS)

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Status - Today

• Implementation Guide Done
• Transform Software Tools Done
• Software Deployment In progress
• Transmissions of Dummy Data In progress
  Incremental

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Issues Raised

• EDITS use in HL7 CDA
• State-Specific Data Items
• Large data files
• Hospital to State 1,000 per week
• State to National 2,000,000 per submission

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Next Steps

• Continue deployment and testing
• Compile findings, costs and benefits
• Make Recommendations to Board
• Report to the Board
• Education and Training

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Thank you

• Ken Gerlach
• kgerlach_at_cdc.gov
• Jim Martin
• Jim.martin_at_vdh.virginia.gov
• Lori Havener
• lhavener_at_naaccr.org

The findings and conclusions in this presentation
are those of the author(s) and do not necessarily
represent the views of the Centers for Disease
Control and Prevention
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Acknowledgements

• Alschuler Associates, LCC
• CDC-NPCR
• NAACCR Board and Staff
• NAACCR Clinical Data Work Group

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Thank you