W hy E-path Reporting is Important The Role of Standards and Inform atics

Transcription

W hy E-path Reporting
is Important
The Role of Standards and
Inform atics
June 9, 2002 NAACCR Informatics
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Presenters

Barry Gordon, Ph.D.

W arren Williams, MPH

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C/NET Solutions and the Calif. Cancer
Registry
Centers for Disease Control
Contents of this talk

W hy E-path reporting is important
Role of Standards in E-Path
Role of Informatics in E-Path
Illustrations taken fro m :

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C/NET’s CAS Software
Reporting Pathology Protocols Pilot
W hy is E-path is important?

W hich is faster?

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Reading paper path reports
or scanning electronic docu ments?
W hy standards for E-Path?
(1)

The many-to-many connections proble m

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Assu me 10 nationwide labs need to talk to 50
states
That’s 500 different connections to manage
W ouldn’t it be nice if they all used the sam e
m ethod?
W hy standards for
E-Path? (2)

The one-to-many connections problem

Labs usually report to many different
departments and agencies

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To Hospital m edical records
To billing syste ms
To the ordering physician
To State Health Departments for many diseases
W ouldn’t it be nice if they all used the sam e
m ethod too?
Hospital Messaging --

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A whim sical look
Health Care Industry Standards

Support the medical records com m unity
Pencils are out: Alm ost all data are on
so mebody’s co mputer syste m
Pro mote co mputer-co mputer co m m unication.
Local approaches are important, but aligning
local solutions with industry standards builds
s moother e-co m m unication.
M apping to defined data elements.

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Co m m unication structures are in parallel with industry.
‘Standards for Du m mies’ Rules

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Use existing standards if present
W ork to improve the m if they are
deficient
Propose the m if they are non-existent
Avoid the ‘Not Invented Here’
syndrom e
Current E-Path Standards

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HL7: OR U results message now used
for routine path reports .
NAACCR: Path HL7 Record Layout
defines the specifics we need
NAACCR Standard
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Exa m ple of Using
Standards:

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California’s multiple-vendor E-Path
Goals for California’s
m ultiple-vendor E-path:

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Imple m ent E-path
using open rules and procedures
allowing multiple solutions
For adapting to varied environm ents
Analyze the need

Stand-alone path labs required too
m uch m anual casefinding
Hospitals path labs have different
environm ent:

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Existing m essaging
Hospital registry key custo mer
State registry also key custo mer
Current imple m entations in
California

AIM using HL7

CAS using HL7

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(next talk)
(Wednesday A M breakout session ‘Beyond
Epath’)
California E-Path
Another State
R egistry
H ospital
H L7
cases
C A S Path
H L7 Path
O utofState
Path Lab
R egionalO ffice
H L7
H L7 Path
Path Lab
H L7
R egional
O ffice
H L7
H L7
cases
H ospital
H L7
Path Lab
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Exa m ple: CAS E-Path System

Intercepts Hospital HL7

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Pathology reports
Discharges
Selects potential cancers
Integrates into registry software
(CNExT)
Forwards E-Path to central registry
W hat’s added by CAS E-Path
D is c h a rg e
S ys te m
P a th o lo g y
S ys te m
H L 7 R o u te r
CAS
H o s p ita l R e g is try
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R e g io n a l R e g is try
CAS E-Path
H L7
R o u te r
A d m is s io n
P a th o lo g y R e p o rt
H L7
C A S L is te n e r
C A S C an cer
S e le c to r
C A S S to re
W o rd L is t
C A S E n c ry p t
& S end
C A S Log
XM L
XM L
C AS
R e c e iv e
C A S Log
P o te n tia l
C ases
XM L
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C N E xT H osp.
P o te n tia l
C ases
XM L O R
N AAC C R
E u re k a / R e g io n a l S y s te m
A look at the Industry
Standards Used in These
De monstrations

M essage:

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Health Level Seven (HL7)
ANSI Standards Body to support health
care
W W W.HL7.ORG
Two approaches Version 2.x and Version 3
Large organization of vendors, public
organizations.
HL7 Exa m ple Structure
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MSH|^~\&|CoPathC/S||Meditech||20000331094000||ORU^R01|4400000009957|P|2.2
[0D]ID|1||99999999||LAST^FIRST^MIDDLE^^Ms.||19270816|F|||626 ANY
ST^^ALBANY^CA^94706^United States||(510)555-9999||||||444-44-4444[0D]
PV1|1||L14|||||||ENT||||||||IP|3289195|B|||||||||||||||||||1^Hospital|
||||200003280600[0D]
ORC|RE||S00441^CoPathC/||CM||||200003280815|^Welby^Marcus||12345^DOCTOR^THATSME
[0D]
OBR|1||S00-3441^CoPath C/S|S^Surgical
Pathology|||200003280814|||||||200003280814|^^Lymph node, biopsy, submandibular,
fs|59223^SINGER^MARK||||||200003310940||S\S\Surgical Pathology Parnassus|F|||||||89743^KLEIN^HARVEY[0D]
OBX|1|CE|S00-3441\T\ANT|A|||||||F[0D]
OBX|2|TX|S00-3441\T\CDX||The patient is a 73 year old woman with history of
pharyngeal carcinoma,||||||F[0D]
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W hat Inform atics Brings to
Electronic Pathology
Reporting

Pro motes a system atic evaluation of the
proble m and the solutions

Don’t just apply technology, strategically apply
solutions based on need. “Think Globally, act
locally”
Pro mote standards-based solutions
M odel; vocabulary models, messaging, other
Critical eye towards content and analysis

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Narrative search string evaluation, checklist review,
coding evaluation
Industry Coding and
Vocabulary Applied in EPathology Reporting

Logical Observations Nam es and Codes
(LOINC)

Syste matized Nom enclature of Medicine
(SNO M E D)

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w w w.regenstrife.org
Identifies key sections of the narrative
pathology report
w w w.sno m ed.org
Codifies relevant information Morphology,
Topography, Procedures …..
Exa m ple: Inform atics in
the Reporting Path
Protocol pilot

Goal: im ple m ent CAP synoptic
checklist via electronic reporting
(colorectal pilot)
Informatics Proble m:

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protocol too a mbiguous to imple m ent
cleanly
Required review for consistency, logic,
hierarchy, required responses.
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Revised checklist item
Polyp configuration: (choose 1 response)
___ Pedunculated with Stalk (stalk length: ___ cm)
___ Pedunculated No stalk
___ Sessile
___ Frag mented (configuration indeterminate)
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In Sum m a ry

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M essaging standards are crucial to EPath Reporting
M odeling and Vocubulary standards
crucial as well
E-Path syste m s must integrate with
both hospital and central registries
For More Information on these topics:

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E mail barryg@ askcnet.org