Optimizing your EMR in the Cancer Registry Sanford USD Medical Center Cancer Registry

Objectives Attendees will understand the advantages of utilizing their EMR to perform electronic case finding. Attendees will identify potential problem areas in the use of the EMR. Attendees will be able to describe the role of EMR billing indicators in the import process.

Current EMR – EPIC One Chart Sanford has been utilizing electronic case finding since 2006. Current abstracting software – Metriq Have imported patient data into registry since 1983. Use NAACCR version – implementation guides are available on vendor website. Currently abstracting for 3 facilities.

Billing indicators Tumor Reg Import Put on when case is reviewed in the Case finding WQ and found to be eligible for the Registry. Used to drive account into regular WQs. Used to drive the account into Metriq through the import process. Removed when case is abstracted.

Billing Indicators Approximately 188 billing indicators used across the EMR system at Sanford by multiple departments Applied to the account level Means of activity tracking on accounts Means of communication between departments

Tumor Registry Billing Indicators Tumor Review Completed Put on when abstracting of case is completed. Prevents accounts from re-entering case finding WQ. Tumor Reg DO NOT CLOSE System auto action to hold cases in the queue. Removed when abstracting of case is completed.

Tumor Registry Billing Indicators Tumor Reg NA Applied to cases not eligible for the registry during case review in Case finding WQ. Prevents cases from re-entering work queue. Tumor Reg PBB Tum Reg Rad/Onc

Tumor Registry FYI flags Applied at the patient level by CTR when abstracting of case is completed in Metriq. Have been used to drive reports through EPIC One Chart.

FYI Flags As a means of communication between CTRs, FYI flags are updated during CTR follow up review. Establishes starting point for review of records for abstract updating.

Auto actions Do not close billing indicator Used to hold accounts in the WQ Accounts entering the Case finding WQ with an FYI flag automatically have Import billing indicator applied to push them to the regular WQ. Eliminates need for case finding review.

Work Queues Case finding queue All cases with an eligible ICD-10 code enter this work queue. All cases reviewed and disposed of daily by CTR. Tumor Reg NA – not eligible for collection Tumor Reg Import – import case into Metriq and regular or PBB work queues.

Work queue Listings Regular queues RQRS queues Contain majority of cases Split out alphabetically RQRS queues Breast and colorectal specific Allows for abstraction within 90 days. Worked by same CTR each month.

Work Queue Listing PBB (Provider Based Billing) Contains cases diagnosed / treated at physician’s offices. Broken out alphabetically Worked after regular work queues are completed.

Work queue Rules/ Routing Rules Items considered in the rules Location of service Discharge date Billing indicators / FYI flags Last name Charges

Work Queue View

Workqueue Rules / Routing Rules

Colon RQRS work queue rules

Each facility has a duplicate set of work queues with unique rules to those facilities. Work flows for all facilities are the same.

How to work the Queues Work queues are sorted by admit date. This assures staff are working the oldest accounts in the queue. Can then R) click on patient name and bring all of the patient accounts together. Due to having several months of patient accounts in the WQ, can work up to the current date.

Multiple accounts for 1 patient

Activity Tracking

Import of Data Sanford Cancer Registry has utilized electronic import of data since 1983. NAACCR format Cases come in as a suspense case Suspense list query is run at completion of abstracting cases in WQ as a case finding check.

Fields Imported Demographics – name, date of birth, address, social security number, phone number, Primary site ICD – O – 3 Looking to bring in occupation and industry as assigned at registration.

Electronic Import Old way – using ICD codes New way – using Tum Reg Import billing indicator. Brings in cases that through the case finding WQ process are eligible for entry into the registry. Eliminates cases that were brought in, but through record review, were not eligible.

Checks and Balances Constant evaluation of what works and what doesn’t Suspense list Path Review Option to run report through EPIC using FYI flags, billing indicators and codes.

Thumbs up! Work queues populate automatically as accounts are coded. Runs the disease index list for us. Offer flexibility in case lists Sort alphabetically Sort by site

Thumbs down! Relying heavily on technology Clitches

Electronic Staging Per Cancer Committee policy, all cases presented at Tumor Conference must have a staging form completed. Send to the MD through the EMR inbasket. Clinical and pathological staging forms are available.

Added to Problem List

Routed per EMR In basket

In basket message

Clinical Staging

Pathological Staging

Prognostic Indicators

Collaboration Relationship with your IT department. Outside the box thinking

Credits Amanda DeGroot, RHIT, CTR Bryce Hansen, RHIT, CTR Patty Mullen, RHIT, CTR Lori Severson, RHIT, CTR Karla Sorenson, RHIT, CTR Ingrid Steen, RHIT, CTR

Contact Information Denise Lutkemeier, RN, CTR Cancer Registry Supervisor Sanford USD Medical Center Denise.Lutkemeier@Sanfordhealth.org Office – 605-333-5595 Home – 605-938-4716