Meaningful Use in Iowa

1. Meaningful Usein Iowa James Robinson Application Developer Iowa Cancer Registry james-robinson@uiowa.edu October 19, 2016

2. Iowa Cancer Registry • Founding member of NCI’s SEER Program • Most SEER registries are located within research institutions; ours is U. Iowa • State law requires cancer to be reported • ICR designated by Iowa state government as the state cancer registry

3. Our Model • Wait approximately 9-12 months before collecting data for a given year • There are hundreds of different cancers, discovery and treatment can take months • Correct and complete data is most valuable to researchers • Match the incoming data to existing data and consolidate any new information manually • Submit data to NCI and share with IDPH

4. Adapting to Meaningful Use • Real time data is incomplete • Most reliable information is who, what, when, and where

5. Integrating MU Data • Questions: • Do we know about this person? • Do we know about this disease? • Do we know about this treatment? • If the answer to any of the above questions is ‘no,’ we have new information to abstract • If the answer to all of the above question is ‘yes,’ we have a new date of last contact

7. Unexplored Territory • There are potential uses for real-time information about cancer type, extent and treatment: special studies • Getting data on diseases not seen in conventional hospitals, e.g., some melanomas, leukemias • Waiting for enough data to come in to allow us to see what we have and whether we have enough • Production CDAs range in size from 29k to 6,548k

8. The Onboarding Process • Recruitment of EPs is supervised by IDPH • Targeting EPs specialized in dermatology, urology, and hematology • We have neither recruited nor onboarded any eligible provider that already sends us cancer abstracts

9. Onboarding • Onboarding is a collaboration between ICR and IDPH • Testing is done between ICR and EP • At conclusion of testing, ICR contacts IDPH, who works with EP to connect to IHIN

10. Production • Iowa’s HIE, IHIN, is an SFTP server run by a third party contractor, ICA • Participants upload CDAs to IHIN with SFTP clients • Iowa receives files within 24 hours • 5,985 CDAs received to date from 4 EPs

11. Challenges • We have no way of dealing with SNOMED • Plan is to import CDAs directly into our data management system, which already has matching and consolidation built in • Whether CDAs are consolidated with prior CDAs for the same incidence varies from EHR installation to EHR installation • This complicates the process of determining how to handle incoming CDAs

13. Workflow Integration • Data management system (SEER*DMS) is third party (IMS), still designing MU integration interface • Volume and difficulty of reconciling are the major issues • Planned integration is generation of new leads as a consequence of matching against our consolidated data

14. Lessons Learned • Continuously monitor quality • Production data missing critical fields such as date of procedure • Turnkey solution for uploading CDAs is absolutely critical for supporting small EPs • 1 for 5 with EPs that have no IT support staff • The small (1-2 physician) specialty EPs are the ones whose data we want the most • When outsourcing service, maintain a clear chain of responsibility

15. Questions? • Links: • Iowa Cancer Registry: http://www.public-health.uiowa.edu/shri/ • NCI SEER program: http://seer.cancer.gov/ • Iowa Department of Public Health: http://idph.iowa.gov/ • ICA: http://ica-carealign.com/ • Information Management Services: http://www.imsweb.com/ • SEER*DMS: http://seer.cancer.gov/seerdms/ • Your humble servant: james-robinson@uiowa.edu