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2007 NAACCR Conference Ken Gerlach, Health Scientist, CDC-NPCR June 4, 2007

NAACCR Clinical Data Work Group - Pilot to Transmit the Cancer Abstract Using HL7 Clinical Document Architecture (CDA). 2007 NAACCR Conference Ken Gerlach, Health Scientist, CDC-NPCR June 4, 2007. NAACCR Background. Number One NAACCR Priority.

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2007 NAACCR Conference Ken Gerlach, Health Scientist, CDC-NPCR June 4, 2007

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  1. NAACCR Clinical Data Work Group -Pilot to Transmit the Cancer Abstract Using HL7 Clinical Document Architecture (CDA) 2007 NAACCR Conference Ken Gerlach, Health Scientist, CDC-NPCR June 4, 2007

  2. NAACCR Background

  3. Number One NAACCR Priority • January 2007 – at NAACCR Leadership Retreat ……. • Achieve syntactic and semantic interoperability of cancer registration standards with national standards by 2010 or at the earliest possible time • Committees/Work Groups restructured • Cancer Abstract Transmission WG >> Clinical Data WG

  4. Interoperability Ad Hoc Committee Structure – 2007

  5. Clinical Data WG Charge • Explore alternate mechanisms or messages to transmit and receive the cancer abstract • Examine not only the steps to transmit and receive data within the cancer registry community, • But also consider transmissions to organizations typically outside that community

  6. Context • The current format to transmit the cancer abstract within the cancer registry community - column-delimited (fixed-width), flat-file • Used for over 10 years • Described in NAACCR Standards for Cancer Registries, Volume II, Data Standards and Data Dictionary

  7. History • Cancer Abstract Transmission WG (now Clinical Data WG) formed: October 2005 • First Meeting: November 2005 • Decision to pursue HL7 CDA: May 2006 • Pilot Project Strategy: Summer 2006 • Team’s HL7 CDA Experts: Summer 2006 • Alschuler Associates, LLC (Contract with CDC-NPCR) • Kick Off (Face-to-Face) Meeting: November 2006 • Protocol: February – April, 2007

  8. HL7 CDA

  9. Health Level Seven (HL7.org) • Standards Development Organization • Developing standards for interoperability • Patient care • Public health • Clinical trials • Reimbursement • HIPAA DSMO • 20 years, 2000 members • 30+ international affiliates • “A model community”: building standards to a single information model 11

  10. CDA • Clinical Document Architecture • ANSI/HL7 CDA R1.0-2000 • ANSI/HL7 CDA R2.0-2005 • Created & maintained by HL7 Structured Documents Technical Committee (SDTC) • A specification for document exchange using • XML, • the HL7 Reference Information Model (RIM) • Version 3 methodology • and vocabulary (SNOMED, ICD, local,…) 12

  11. XML • XML is about investing in information • information design should outlive system design • documents outlive the system on which they are created • Platform and vendor independent • Data in XML persists over time • Data in XML can move between applications 13

  12. Sample CDA 14

  13. HL7 CDA Experts

  14. Alschuler Associates, LLC • Alschuler Associates, LLC projects • Military Health System, “Documents, Files, Images” (DFI) project • HITSP Standards Harmonization • HISPC Security & Confidentiality • Center for Disease Control & Prevention (CDC)—Infections disease reporting, cancer abstract transmission • American Hospital Association use case development • Commercial software developers implementing standards-based solutions • HL7 volunteer participation • Co-editors, CDA, CRS, CCD • Co-authors, CDA & CRS Quick Start Guides • Co-chair HL7 Structured Documents TC • Member, HL7 Board of Directors • HL7 IHE Liaison • past Chair, KEG & XML SIG & HL7 Marketing Committee • XML experience • www.alschulerassociates.com 16

  15. Pilot Project Strategy • Strawman CDA Message • Implementation Guide (IG): Preliminary and Final • Software to translate Column-Delimited Format to CDA and visa versa • Participants – Alpha and Beta IG Conformant Messages • Transmit and Receive Test Messages • Compile Lessons Learned, Advantages, and Disadvantages • Recommendation – Next Steps

  16. Methodology • 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

  17. Participants • California • Sender Software: C/NExT • Receiver Software: Eureka • Virginia • Sender Software: Abstract Plus* • Receiver Software: Rocky Mountain Cancer Data System (RMCDS) * Modified - Virginia Commonwealth University Health System

  18. Transition: Flat-File to CDA and CDA to Flat-File Scenarios

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

  20. 1. Introduction 1.1. Scope 1.2. How To Read This Document 1.3. Approach 2. Document Element 3. CDA Header Representation 3.1. Realmcode 3.2. Typeid 3.3. Templateid 3.4. Id (Instance Identifier) 3.5. Code 3.6. Effectivetime 3.7. Confidentiality Code 3.8. Setid 3.9. Versionnumber 3.10. Recordtarget And Patientrole 3.11. Author/Legal Authenticator 3.12. Custodian 3.13. Information Recipient 3.14. CDA Header – Mapping Table 4. CDA Body Representation 4.1. Record ID 4.2. Demographic 4.3. Cancer Identification 4.4. Hospital-Specific 4.5. Stage/Prognostic Factors 4.6. Treatment – 1st Course 4.7. Treatment – Subsequent & Other 4.8. Edit Overrides/Conversion History/System Administration 4.9. Follow-up/Recurrence/Death 4.10. Special Use 4.11. Patient-Confidential 4.12. Hospital-Confidential 4.13. Other-Confidential 4.14. Text – Diagnosis 4.15. Text – Treatment 4.16. Text – Miscellaneous 4.17. CDA Body – Mapping Table IG Table of Contents

  21. Sampling of IG Questions • Repeating capability? • Co-morbidity/Complication 1 - 8 • Dates - Date Data Type • Author • Custodian • How assign each CDA report a unique ID? • “Effective Time”, time record creation available? Use NAACCR Date Case Completed [2090]

  22. Vocabulary • Question Codes: LOINC • Answer Codes • National Standards • SNOMED CT • LOINC • NCI Thesaurus • PHIN VADS • NAACCR Codes • Use NAACCR Codes • Future - map NAACCR codes to other vocabulary

  23. Time Line • Strawman - July 2007 • Preliminary IG - September 2007 • Translation tools - October 2007 • Pilot alpha software - December 2007 • Pilot alpha deployment - February 2008 • Final Implementation Guide - April 2008 • Document advantages/disadvantages - May 2008 • Protocol and Cost-Benefit Analysis Report to Board - May 2008

  24. Conclusions • Current NAACCR Transmission Standards: Work • Need for more powerful transmission tool • Medical Informatics – National emphasis • Transition to HL7 CDA • First Step: A Pilot to Test and Learn • If …. Full Implementations Plans • Two Concurrent Transmission Standards • Educate Cancer Registry Community

  25. Acknowledgements • Alschuler Associates, LCC • CDC-NPCR • NAACCR Board and Staff • NAACCR Clinical Data (Cancer Abstract Transmission) Work Group

  26. Baral, Sanjeev Campbell, Dave Derrick, Larry Fuchslin, Steve Gerlach, Ken Gordon, Barry Havener, Lori Hill, Ken Kosary, Carol Martin, Jim Bob McLaughlin Potts, Mary Reichman, Marsha Russell, Carol Schmidt, Beth Anne Scoppa, Steve Schneider, Althea Thames, Sandy Tsyvine, Roman WG Members: 2006-2007

  27. Ken Gerlach 770-488-3008 kgerlach@cdc.gov Thank you 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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