caEHR Domain SME Meeting

1. caEHR Domain SME Meeting May 19, 2010

2. Agenda • Introductions, Agenda Review (5min) • Doug Fisher • Joginder Madra • caEHR Business Capability Scope Document (15 min) postpone until next meeting • Outcomes Management (1 h 10 min) • Scope Discussion • Define Data Elements • Q & A Session for Analysis/Arch Stream Activities (5 min) continue at May F2F • Clinical Document Exchange Discussion (20 min) postpone until May F2F • Wrap-up and next meeting confirmation (5 min) • Homework review

3. caEHR Business Capabilities Marti Velezis

4. Outcomes Management

5. Outcomes Management • Scope Discussion • Resulted in a diagram depicting flows of information between caEHR, Outcomes Repositories and other registries • Picture Cecil and the Executive Sponsors see is substantially wider than what our team has been discussing • Need to define de-identified data, anonymized data, aggregate data and document the role this plays in the collection of data • Next week at F2F we will walk thru the diagram as it will be more fleshed out than the draft being used for the purpose for today’s call

6. Outcomes Management Conceptual Diagram - DRAFT 3 AO Clinic EHR Oncology Clinical Trial System 1 Cancer Outcomes Repository 4 2 Regional Tumor Registry 6 5

7. Outcomes Management Conceptual Diagram - DRAFT • Ambulatory Oncology EHR sends information to the Cancer Outcomes Repository • Information is patient and provider identifiable. • Ambulatory Oncology EHR queries Cancer Outcomes Repository for provider/patient specific information (e.g. Direct care) • Ambulatory Oncology EHR submits Clinical Trial Report to Oncology Clinical Trial System for patient on the clinical trial. • Oncology Clinical Trial System queries Cancer Outcomes Repository for provider/patient specific information • Ambulatory Oncology EHR submits Registry Report to Regional Tumour Registry. • Regional Tumour Registry queries Cancer Outcomes Repository for provider/patient specific information or Cancer Outcomes Repository sends unsolicited information to Regional Tumour Registry. • Transaction #3 would be replaced by combination of #1 and #4 • Transaction #5 would be replaced by combination of #1 and #6

8. Registries Identified by Domain SME Team • In Michigan there are two required by law.

9. Michigan Dept of Community Health – Tumor Registry • We are obligated to report a new cancer in a patient that we see, particularly if no one else (another provider or hospital) has seen the patient. • The report goes to our local Tumor Registry which in turn passes the information to the Michigan Department of Community Health and eventually the information goes into the national database. • The patient does not know of the reporting process and is not obligated to be told (though it is not a secret). Likewise, therefore, there is no consent, specific consent to the fact or a general consent, which needs to be signed by the patient.

10. Michigan Department of Community Health • We are obligated to report the discovery of a new diagnosis of certain reportable infectious disease (e.g. tuberculosis, AIDS, syphilis etc.) in a patient that we see, particularly if no one else (another provider or hospital) has seen the patient. Not de-identified data in the local registry, needs to support follow up care • The report goes to our county Health Department which in turn passes the information to the Michigan Department of Community Health and eventually the information goes into our national Center for Disease Control in Atlanta Georgia. ( Is there a level at which the information is de-identified?) • The patient does not know of the reporting process and is not obligated to be told (though it is not a secret). Likewise, therefore, there is no consent, a specific consent to the fact or a general consent, which needs to be signed by the patient.

11. Outcomes Management Data Elements • Basis is NAACCR – North American Association of Central Cancer Registries • Sections • Record ID • Demographic * • Cancer Identification • Hospital-Specific • Stage/Prognostic Factors • Treatment-1st Course • Treatment-Subsequent & Other • Follow-up/Recurrence/Death • Patient-Confidential* • Hospital-Confidential* • Other-Confidential * • Pathology • Text-Diagnosis • Text-Treatment • Text-Miscellaneous

12. Outcomes Data Elements – Demographics (at time of Dx) • Address - City • Address - State • Address - Postal Code • County • Census Tract applied at the registry level • Census Block Group • Census Code System • Census Tract Certainty • Marital Status • Race (mulitple) • Race Coding System • Ethnicity • Computed Ethnicity • Computed Ethnicity Algorithm • Sex/ Gender (Administrative Gender • Age at Diagnosis • Date of Birth • Date of Birth Flag • Birthplace(city, city/state?) • Occupation Code(captured as codified data? Could be) • Industry Code

13. Outcomes Data Elements – Patient Confidential • Telephone • Death Certificate State File Number (after death no longer covered by HIPAA) • Follow-Up Contact—Name • Follow-Up Contact--No&St • Follow-Up Contact—Suppl • Latitude • Longitude • Name--Last • Name--First • Name--Middle • Name--Prefix • Name--SuffixName--Alias • Name--Maiden • Name--Spouse/Parent • Medical Record Number • Military Record No Suffix (could be used to support hx query) • Social Security Number • Addr at DX--No & Street • Addr at DX--Supplementl • Addr Current--No & Street • Addr Current—Supplementl

14. Outcomes Data Elements – Hospital Confidential • NPI--Following Registry • Following Registry • NPI--Inst Referred From • Institution Referred From • NPI--Inst Referred To • Institution Referred To

15. Outcomes Data Elements – Other Confidential • NPI--Physician—Managing • Physician--Managing • NPI--Physician--Follow-Up • Physician--Follow-Up • NPI--Physician--Primary Surg • Physician--Primary Surg • NPI--Physician 3 • Physician 3 • NPI--Physician 4 • Physician 4

16. Clinical Document Exchange Scope Helen Stevens Love

17. Clinical Document Exchange Discussion • Identify potential scenarios

18. Meetings and Follow-up • Upcoming Meetings and Follow-up • Weekly Teleconference June 2nd 12 – 2:00 ET ***Meeting Requests sent via email contains updated phone in details and Web Ex links • Holiday Plans • F2F Meeting #5 May 25th – 26th Las Vegas, NV • Agenda and Meeting Logistics to follow • AD HOC Meetings TBD