Seattle/Puget Sound SEER Registry CSv2 Implementation Stories from the Front Lines Mary Potts, RHIA, CPA, CTR, Manager Jennifer Hafterson, CTR, Field Operations Supervisor Fred Hutchinson Cancer Research Center June 2010

Setting the Seattle scene Change from abstract-centric to bit-centric Change our database management system (SEER*DMS) Change our abstracting software (SEER*Abs) Change from mostly electronic to all electronic Add CSv2 into the mix for seasoning

It takes everyone on staff Be a positive leader Believe in your team Record issues daily in a central location Respond daily to issues Make decisions daily

The Implementation Guide Print it Assign it Read it Mark it Discuss it

When did we start? Went live Feb 16, 2010 on SEER*DMS and CSv2 Our CSv2 upgrade tied to our SEER*DMS deployment Our SEER*DMS deployment was tied to our need to start 2010 cases Nearly 95% initial reporting of 2009 cases pre-upgrade Upgrading is not simply a matter of adding SSF 7 through SSF 25 fields Existing data undergoes a conversion

Our major issues - 1 Breaking the paper addiction Part II of the CSv2 Manual with all the site-specific schemes Lack of CS edits to help guide staff Edits help us understand the intention of the workgroups who drafted the new schemas

Our major issues - 2 Welcome to the Obsolete World! Obsolete Data Retained Obsolete Data Converted Obsolete Data Converted and Retained Obsolete Data Reviewed and Changed

Our major issues - 3 Bye-bye 888. Hello 987 and the twins, 988. 888 = not applicable (CSv1) 987 = SSF not applicable because the case does not meet all the conditions for its use 988 = a) SSF not applicable because not defined b) SSF not applicable because the registry has chosen not to collect a defined, but not required, SSF field Does 988b or 999 win in case consolidation? 999 = unknown or no information

Our major issues - 4 After the upgrade to CSv2 If you receive a NAACCR 11 abstract for a pre-2010 case, can you use the values in the Obsolete Data Retained fields? If you have a correction to one CS field on a pre-2010 case, do you have to bring all the fields to CSv2? Whatever does one do with the CS Version Input Current field?

Communication is key

Stop dithering, start coding Accept – Greater understanding comes with using the schemas and the manual End – The theoretical “what if” discussions Start – The practical application; code the cases Recognize – Initial coding will be less than perfect Know – Consistency will improve with every month of experience applying the rules

Breakthrough moments

Where are we now? Aiming for consistency Testing that counts CSv2, Part I, Section 1, General Rules CSv2, Part I, Section 2, Lab Tests, Tumor Markers, and Site-Specific Factor Notes 5 cases each for the 7 largest site groups One test case a day Adjust accordingly -- As CSv2 issues are addressed in I&R, we will adjust our coding practice

Successful conclusion of initial implementation

CSv2 Implementation Issues Team

Any Questions for Seattle