1. Electronic CAP Cancer Checklists and Cancer Registries – A Pilot Project 2009 NAACCR Conference Ken Gerlach, MPH, CTR Castine Verrill, MS, CTR CDC-National Program of Cancer Registries June 16, 2009

2. 2 Reporting Pathology Protocols (RPP)  Demonstration projects funded by CDC NPCR  Implement CAP Cancer Checklists with SNOMED CT Codes  In 2001 California and Ohio were funded for RPP1 Cancers of the colon and rectum  In 2004 California, Maine, and Pennsylvania funded for RPP2 Cancers of the breast, prostate, and melanoma of the skin

3. 3 Collaborators  State and hospital cancer registries  Cancer registry information system vendors  Pathologists and pathology laboratories  Anatomical pathology laboratory information system vendors (AP LIS)  College of American Pathologists (CAP) Principal organization of board-certified pathologists  Experts in HL7 vocabulary and messaging standards

4. 4 Project Purpose  Encourage a standard exchange of data between two key public health partners Anatomical Pathology (AP) Laboratories Cancer Registries  Use the SNOMED CT encoded CAP Cancer Checklists to promote an exchange of data  Compare completeness, timeliness, and quality of cancer checklists with text-based narrative reports

5. 5

6. 6 College of American Pathologists (CAP)  In 1999, the CAP Cancer Committee published Reporting on Cancer Specimens Protocols and Case Summaries  Purpose To aid pathologists with completeness, accuracy, and uniformity in reporting of malignant tumors  The cancer protocols - site-specific  The associated checklist - synoptic format

7. 7 Breast Cancer Checklist Protocol applies to all invasive carcinomas of the breast. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6th edition Procedures Cytology (No Accompanying Checklist) Biopsy (Incisional, Core Needle) (No Accompanying Checklist) Complete Excision Less Than Total Mastectomy (With or Without Axillary Contents) Mastectomy (Total, Modified Radical, Radical)

8. 8 Breast Cancer Checklist Modified Radical Mastectomy, Radical Mastectomy Note: Check 1 response unless otherwise indicated. MACROSCOPIC Tumor Site (check all that apply) ___ Upper outer quadrant ___ Lower outer quadrant ___ Upper inner quadrant ___ Lower inner quadrant ___ Central ___ Not specified

9. 9 SNOMED CT Encoded CAP Cancer Checklist (SECCC) TUMOR SITE (check all that apply) [R-0025A, 371480007] Tumor site (observable entity) ___ Upper outer quadrant [T-04004, 76365002] Structure of upper outer quadrant of breast (body structure) ___ Lower outer quadrant [T-04005, 33564002] Structure of lower outer quadrant of breast (body structure) ___ Upper inner quadrant [T-04002, 77831004] Structure of upper inner quadrant of breast (body structure) ___ Lower inner quadrant [T-04003, 19100000] Structure of lower inner quadrant of breast (body structure) ___ Central [T-04001, 49058007] Structure of central portion of breast (body structure) ___ Not specified [T-04000, 76752008] Breast structure (body structure)

10. 10 Technical Specifications  January 2005 version of the CAP Checklists  January 2006 version of the SNOMED CT Encoded CAP Cancer Checklists (SECCC)  Agreed upon common format consistent with HL7 Version 2.3.1 and developed an Implementation Guide  Checklists designed for paper systems

11. 11 Cancer Registry Data Items  CAP Checklist – Mappings NAACCR Data Items Collaborative Stage

12. 12 NAACCR Vol. II CAP Checklist Question SNOMED Code NAACCR Data Item Name[Num ber] NAACCR Data Item Code Business Rules/Notes /References CAP Checklist Answer SNOMED Code SPECIME N TYPE R-00254, 371439000 RX Hosp- Surg Prim Site [670]20 FORDS, page 269Excision G-8312, 122596005 80 Mastectomy G-833A, 309060009 80 Other (specify):not coded 90 Not specified G-8310, 127457009 Mapping Table

13. 13 Issues with Mapping  Mapping between SNOMED and NAACCR codes Laterality – maps easily Tumor site – maps with one business rule Extension – maps with multiple rules

14. 14 CS Extension Code 00 PTis: Melanoma in situ (i.e., not an invasive tumor; level I) Code 10 – 80No Equivalent (Clark’s level of invasion – included in path T1 fields only, in combination with Breslow depth of invasion, not as a separate data item) Code 95pT0: No evidence of primary tumor Code 99pTX: Primary tumor cannot be assessed Collaborative Staging Value CAP Checklist Answer

15. 15 Findings  Checklist data items - transmitted successfully  Checklist reports generally equal data found in text-based pathology reports  Discrepancies between checklist and text-based reports appeared to be minimal  CAP checklists use reduces time to prepare cancer abstracts  Electronic version of checklists and lab procedures impact pathologists use

16. 16 Findings  Number of tumors is not a CAP Checklist data item – Issue  Project - multiple cancers on a single path report but no existing national standards  Clinical history information is not routinely in Checklists  Histology codes on checklist limited, with free- text choice - pathologists not using this feature - Software could facilitate more detailed encoding  Cancer registry collection e-Checklist labor intensive

17. 17 Conclusions  Future Shock: 2004 – Today  SECCC – eCC  CAP Cancer Checklists – Major Updates AJCC 7 th Edition Collaborative Stage  Pathology Electronic Reporting Taskforce (PERT) SNOMED CT – LOINC Cancer Registry Mappings XML Representation  NAACCR Volume V

18. Thank you Ken Gerlach kgerlach@cdc.gov Castine Verrill cverrill@cdc.gov Acknowledgements: RPP Project Teams The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention