Manitoba Cervical Cancer Screening Program CancerCare Manitoba June 2009 MCCSP Registry Infrastructure and Evaluation

Presentation Overview Program Overview Registry Infrastructure –Business Process –Database Linkages –Support and Maintenance –Upgrades and Change Requests Information Utilization –Operations –Surveillance & Monitoring –Evaluation –Research

MCCSP Overview Established January 2000 Program of Manitoba Health Managed by CancerCare Manitoba Public Health Act Regulation (2009 & 2001) 398,770 women age ( ) 7 cytology laboratory partners 27 Colposcopists

MCCSP Program Guidelines Screening starts with sexual activity May stop at age 70 Pap test annually x 3 3 Negative  2 years Unsatisfactory/Low Grade = repeat 6-9 months Persistent Unsat/Low Grade = colposcopy High Grade = colposcopy

MCCSP Registry is…. A confidential centralized database of all cervical cancer screening test results –Includes cytology, colposcopy, associated pathology –Demographic information on all females –Regulated by the Cervical Cancer Screening Registry Regulation 31/2009

Registry Infrastructure Screening Reports –Cytology (April 2001) –Colposcopy (January 2003) Standardized nomenclature and dictionaries Manitoba Health Population (18-69) Hysterectomy tariff codes Cancer Registry – cervical cancers In Process –Population expansion (10-17) –Vaccination status (MIMS, DPIN/Health Admin –All Gynecological cancers

Information Systems Computerized and automated –Manage dataflow and information needs Information comes from –Laboratory test results –Colposcopy reports –Demographic data –Health care providers –Cancer Registry –Manitoba Health databases Gather and consolidate data Relies on the cooperation of the health care community

System Infrastructure (Literally) Database Server –Linux –Oracle 10 EDI Server –M/S Windows NT LAN network HUB (10/100 Base T Ethernet) IP Routers –To external laboratories Modem to modem communication –To Manitoba Health WAN

Business Processes Acquire report data (electronic and manual) Enter/edit report data Process reports Edit/check and validate Link data on individuals Determine follow up events Perform QA Query individual’s screening histories

Business Processes Cont’d Generate follow up reminders Generate standard reports Consolidate –Cancer data –Hysterectomy data –Population data –Duplicates Perform data queries Perform system administration Provide electronic histories to cytology laboratories

Electronic Transmissions from Laboratories

File Upload Process Population Upload –Data from Manitoba Health –Modem to modem connection –Data is FTPd to Cervical Cancer Screening Server –ISIS software Population upload function –Match by PHIN, surname, DOB –Update patient demographics –Population Table

File Upload Process Cont’d Cancer Upload Process –Data from Cancer Registry system Maxon Database (Sybase) SQL script –Extracted data is FTPd to Cervical Cancer Screening Server –ISIS software Cancer Upload Function –Match by PHIN, surname, DOB/ Cancer Number/Dx Date –Updates patient cancer information –Cancer Table

Reports ISIS software generated reports CCSP reporting –PowerBuilder programs Extracted from Oracle Database –Population based –RHA/FSA –Health Care Provider Reports Ad-hoc reports extracted to EXCEL (also Comma Separated Values, ASCII text, dBase 2/3, Data Interchange Format, Lotus)

Database Linkages Cytology Laboratories (electronic transmission) –PHIA compliant –Results –CPSM MANQAP Quality Standards Manitoba Health –Population –Administrative Databases –MIMS –DPIN Cancer Registry Future Pathology Laboratory Linkage through E-Path (AIM)

Support & Maintenance CCMB Health Information Services –Project management/application support and development –System administration –Database management –Hardware maintenance for Cytology laboratory systems –Electronic linkage (Transmed) MCCSP Team –Program management –Data entry –Quality assurance –Development of Requests for Change –User acceptance testing Artificial Intelligence in Medicine (AIM) –Upgrades –New developments –Support for Laboratory Data Interface Improvements at laboratories

Support & Maintenance Cont’d ISIS Production Database ISIS Production Patient Inquiry ISIS Test Database ISIS Test Patient Inquiry Transmed FTP Script Database SQL Scripts Cancer Extract SQL Script PowerBuilder Reporting Application

Upgrades and Change Requests Annual support maintenance (AIM) Quarterly submissions Quarterly upgrades Testing at AIM Remote testing by AIM User acceptance testing at MCCSP Production implementation by CCMB HIS

Information Utilization Operations Surveillance/Monitoring Recruitment and Promotion Evaluation Research

Operations Opt out (21) Screening Results to –Women (empowers and educates) –Cytology laboratories (MANQAP Reporting/QA) –Health care providers (improves clinical management and educates on screening guidelines) Follow Up and Monitoring –High Grade Abnormal Results (January 2003) –Low Grade Abnormal Results (April 2006) –Letters to health care providers –Letters to women

Surveillance Screening patterns by –Age –RHA –FSA –Time Abnormal Pap test management and follow up Workload –Cytology –Colposcopy –Provider Impact on participation, abnormalities, cancer incidence

Recruitment and Promotion Definition of eligible population Recruitment letters Reminder letters Target populations and communities Pap Test Learning Module

Evaluation Reaching target populations Statistical reports Pap Clinic Week

Research Cancer incidence and screening participation HPV Pilot Study (2006) HPV Surveillance (2008) Pap test utilization and impact of recruitment letters (2010)

Future Questions Manitoba Cervical Cancer Screening Program – – EveryTwoYears.ca TellEveryWoman.ca Women can call for copies of their own results