Alena Headd, MSIT, Software Support Analyst, Missouri Cancer Registry and Research Center (MCR-ARC) University of Missouri School of Medicine, Health Management & Informatics Department

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

 Jeannette Jackson-Thompson, MSPH, PhD  Director, Missouri Cancer Registry & Research Center (MCR- ARC) & Research Associate Professor, Health Management & Informatics (HMI)  Iris Zachary, PhD, MSHI, CTR  Assistant DBA, MCR-ARC & Assistant HI Professor, HMI  Nancy Cole, BS, CTR  Operations Manager, MCR-ARC

 This project was funded as part of American Recovery and Reinvestment Act (ARRA) Comparative Effectiveness Research activities through the Centers for Disease Control and Prevention (CDC)  MCR-ARC data collection activities are supported by a Cooperative Agreement between the Missouri Department of Health and Senior Services (DHSS) and the CDC and a Surveillance Contract between DHSS and the University of Missouri (#U 58 /DP /02 )

 Discuss the significance to public health of obtaining new cancer case information from physician office electronic health records (EHRs)  Explain how EHR reporting to a central cancer registry can reduce reporting bias and contribute to disparity reduction  List barriers for clinicians and public health entities in implementing EHR reporting

 Changes in medical practice and health care delivery have increased the incidence of cancers being diagnosed/treated outside a hospital setting  MCR-ARC is one of two CCRs that participated in an ARRA-funded pilot project to improve cancer reporting by importing real-time data directly from EHRs to CCR

 To increase case completeness by obtaining previously unreported cases and treatment information from EHRs, we:  Partnered with the Missouri Health Information Technology (MO HIT) Assistance Center to identify potential: ▪ Clinic/physician offices (C/POs) ▪ Critical access hospitals (CAHs)

 Conducted site visits ▪ Recruited 6 C/PO & CAH participants  Identified and collaborated with: ▪ Facility EHR vendors ▪ CDC software developers ▪ Export files ▪ Develop interfaces ▪ Import, store and process data

 Worked with other state and national groups/organizations to:  Identify & assess software options that allow secure transfer of encrypted data via the Internet ▪ MU’s secure messaging software MoveIT (preferred) ▪ Direct, PHIN-MS (acceptable)  Develop /standardize processes ▪ Data elements ▪ Formats ▪ Triggers

Trigger EventPhysician-driven AutomatedPhysician decides when to send More dataCCR gets critical data Easier to process at CCR  Added a specialty physician (urologist)  Trying two options:  Pros

 Cons Trigger EventPhysician-driven May overwhelm CCRSome detailed data may not be sent

 Rural clinic – completely electronic throughout:  Approached their EHR vendor (MediTech) at HIMSS 2012 ▪ MediTech began working on changing reports to CDA formatted reports ▪ Clinic developed implementation strategy of new cancer-reporting module  Received test data that was analyzed and feedback given to MediTech ▪ Changes made to reports  EHR 2 nd in country to be certified for MU Stage 2 - Cancer Reporting by Office of National Coordinator (ONC) (Feb 2013 ) ▪ MCR-ARC expected to receive live data Summer 2013 ▪ Revised date is November 2013

 Urologist  Joined project in 2012  Received test data that was form-based EMR ▪ Contacted EMR vendor (BuildYourEMR) to adapt their reports for cancer-reporting to CDA formatted reports  Received subsequent test data that was analyzed ▪ BuildYourEMR changed some formatting issues  EHR vendor 3 rd in country to be ONC certified for MU Stage 2 Cancer Reporting (June 2013)

 Implementation completed, September 2013  Live data anticipated November 2013  Analysis of data will begin immediately upon receipt of live data  Practice averages between cases per year

 Three CAHs  Selected EHR: 3 ▪ Implemented: 0  Since none have implemented their EHRs, no preliminary findings

 Interoperability between C/PO and CCR software  Convincing EHR vendors to change to CDA format before Stage 2 (1/1/14)  Convincing C/POs to choose cancer reporting as one of three options in MU Stage 2

 (NPCR) By 29 June ‘ 17, EHR reporting to CCR should include 80% of:  Urologists, dermatologists, gastroenterologists, m edical & radiation oncologists, hematologists  Number of above specialty C/POs:  Radiation oncologists in Missouri practice within Radiation facilities so individual physicians are not included Specialty# in MO# reporting UrologistsTBD 0 (1 in pilot) Dermatologists Gastroenterologists 2930 Medical Oncologists 2350 Hematologists 1000

 C/POs enrolled by MO HIT Assistance Center: 1,276 (initially); 1,167 (1 November 13)  Implemented EHR: 100%  Achieved MU Stage 1 : 66% ▪ Number of EHR Vendors/Software identified: 23 ▪ EHR Vendor/Software not stated: 5

 Breakdown of 598 C/POs that have achieved MU Stage 1 Specialty# of Physicians MU Stage 1 Family Practice 381 Geriatrics 4 Gynecology 1 Internal Medicine 113 OB-GYN 53 Pediatrics 46

 On-boarding additional C/POs  Targeted specialties ▪ Need to determine #s  Other specialties that diagnose/treat cancer ▪ Parts of state have few practitioners in targeted specialties  Additional resources will be needed

 Processing data and internal workflow  Storage  Consolidation of reports  Funding cuts  Staffing deficits ( 4 core positions)  Limits CCR’s ability to implement EHR reporting by C/POs not in pilot

 MCR-ARC’s ability to increase the number of new cancer cases reported to a CCR and to improve the completeness of information on existing cases  Capture of unreported cases to reduce bias and lead to disparity reduction  Funding challenges remain

Contact info: Alena Headd, MSIT, Software Support Analyst, Missouri Cancer Registry and Research Center, Health Management & Informatics, School of Medicine, University of Missouri Columbia, MO