Version 2 Development and Implementation CSv2 Process Review Session March 23-24, 2010 Chicago, IL

CS Process Review Session What Worked Well

Communication –Broad input from various stakeholders –Communication among and between CSv2 work groups and management team –Opportunity to share information, open communication –Use of technology to enhance communication –Relations with vendors

What Worked Well Training –Using web-based training –Identification of trainers for CSv2 –Dedicated web site for support –High quality educational materials

What Worked Well Organization of the Project –Structure worked well Project Leader Committees with specific tasks Reporting back to project management team –Team structure-others’ expertise contributed new ideas, concepts, perspectives –Informatics structure-programming and testing

What Worked Well People –Many dedicated people with subject matter expertise –AJCC staff support –Willingness of most team members to work together –Talented and experienced technical leadership –Major players were involved

CS Process Review Session What Didn’t Work Well

Communication –Not enough communication with cancer registry and surveillance community, vendors about progress –Not an open dialogue, power imbalance Scope of Project –Project was bigger than most imagined—huge workloads

What Didn’t Work Well People –Too much reliance on volunteer staff Project Management/Leadership Structure –Reporting structure-Decision-making process within teams/ authority/consensus/ problem- solving

What Didn’t Work Well Project Management/Leadership Structure (continued) –No change request process in place—formal log, tracking system, parking for issues in the future –Project management-resolving issues, not an open dialogue –Ineffective team management/leadership –Lack of defined authority structure

What Didn’t Work Well The Process –Repeatedly missed deadlines –Unrealistic schedule—lack of adequate time for all the steps in the process –Prep of AJCC chapters missed expected deadlines –From the beginning, lack of input from registrars

What Didn’t Work Well The Process (continued) –Needed early triggers to help make decisions about the process –Who can make decision to delay implementation deadlines –Recommendations for individual teams-set up a process for change requests –Style manual for mapping team

What Didn’t Work Well Training –Training and materials were developed too early

CS Process Review Session What To Do Differently

Project Management –Create formal project management structure and plan –Hire staff –Identify resources Timeline –Refine timeline and stick to it, with milestones to trigger decisions –More lead time-begin process earlier

What To Do Differently In the Beginning –Involve registrars –Responsiveness from AJCC authors, more control over the chapters to ensure consistency –Analyze what can be collected and how it can be collected prior to starting the process –Determine balance between being up to date clinically and burdening the registries

What To Do Differently In the Beginning (continued) –Assess who is using registry data and for what purpose. –Evaluate the cost benefit of additional data items.

CS Process Review Session Concurrent Development of AJCC 7 th Edition and CSv2

Concurrent Development Yes –Many questions could be answered before the chapter was complete –Back and forth clarification/synchronization lead to better products on both ends –AJCC 7 and CSv2 linked together by item number and site-specific factors –CSv2 software includes new staging algorithms based on the AJCC 7 th edition

Concurrent Development Yes, if…. –Registrar on each AJCC task force would have lead to the AJCC manual and CS being more in line –Chapter authors were more available to answer mapping team members’ questions –More involvement of data users in assessing the feasibility and usefulness of future changes

Concurrent Development No –CSv2 mapping was impeded by constant changes –At no point was there a stable system to test adequately –Large time burden on the CS project at the very end –Caused extreme hardship and difficulties in system development and testing

Total Resources for CS Total Financial Contributions for 2009 –2,097,107 est. Total in-kind Contributions for 2009 –$50,000 est. Total project hours –24,000 est./600 work weeks/12 full-time staff working 52 weeks per year –Doesn’t include team member meeting participation 2009 Direct Dollars and In-kind Contributions

Moving Forward AJCC Perspectives/CSv2 Maintenance –6 FTEs + contractor support 2 mappers 1 programmer/IT specialist 1 educator/trainer 1 study specialist/analyst.5 project manager.5 admin asst. Contracted team leads/clinical advisor Volunteer team members –$620,000 est. $520,000 salary and benefits $25,000 contractor fees $75,000 general operating expenses (meetings, conf. calls, etc.)

Moving Forward AJCC Perspectives/Resources for CSv3 –13 FTEs + contractor support 4-5 mappers 2-3 programmer/IT specialist 1 educator/trainer 1 documentation developer/specialist 1 study specialist/analyst 1 project manager 1 admin asst. Contracted team leads/clinical advisor Volunteer team members –$1,269,000 est. $1,144,000 salary and benefits $50,000 contractor fees $75,000 general operating expenses (meetings, conf. calls, etc.)

Moving Forward …..with current funds –CSv2 Maintenance $602,00 estimated $322,019 available $297,981 deficit –CSv3 Development $1,269,000 estimated $322,019 available $946,981 deficit

Next Steps –Hire a program manager and additional core/dedicated staff –Flow chart/define all components of CSv2 development process –Collaborate more closely with AJCC on staging system revision process –Develop a comprehensive project plan for annual vs. major version releases –Define budgetary needs –Develop pools of expertise around mapping and IT tasks –Evaluate and redefine teams and members –Train AJCC task force members/clinicians about CS –Define feasibility criteria and evaluate scope of changes –Engage the registrar and vendor communities early in the development process –Build in vetting, feasibility, and pilot testing of new concepts/major changes –Evaluate new technology environments for CS architecture

Next Steps in 2010 Data Validation Project –Review of site-specific schemas and tables for consistency, completeness and accuracy –Will result in some code changes and new codes –Conversion designed to handle majority of changes Next major version release – Fall 2010 –Will incorporate all changes from data validation Implementation Guide Revision –Posted on CS Web site this week –Clarifications to data items and processing of 2010 cases collected under CSv1 Education and Training continues –Part 1, Section 1 Coding Instructions –Part 1, Section 2 Site-Specific Factors –Additional topics being developed Field Test being planned for 2011

CSv2 Tools SEER Abstract Addendum Generator –For 2010 cases abstracted under CSv2 –Tool lists CS fields and space to abstract CSv2 pending software updates CSv2 case exercises and answer sheets –Available for self-study on CS Website –Breast, prostate, colorectal Printed Manual –NCRA planning mid-summer release of coding instructions and schemas –Price is $145 for NCRA members –Visit NCRA Web site Site-specific schema in pdf –Available from CS Web site –Grouped by anatomic site, i.e., lower GI includes appendix, carcinoid appendix, GIST, etc. –Download schemas as needed, versus ALL