1. NAACCR CDA Pilot Project - Overview, Status, and Findings 2009 NAACCR Conference Ken Gerlach, Co-Chair, NAACCR Clinical Data Work Group; Health Scientist, CDC-NPCR Lori Havener, NAACCR Director of Standards Jim Martin, Co-Chair NAACCR Clinical Data Work Group; Director, Virginia Cancer Registry June 18, 2009

2. NAACCR’s Number One Priority Achieve syntactic and semantic interoperability of cancer registration standards with national standards by 2010 or at the earliest possible time.

3. Clinical Data Work Group Goal: Explore alternate mechanisms or messages to transmit and receive (within and outside the cancer registry community) the cancer abstract (Volume II) to ensure consistency with national standards-related organizations

4. Selection Criteria Core Criteria Ability to handle repetitions and other structures Ability to transmit large text data Ease of visually reviewing data without special tools Consistency with national healthcare industry formats Ease of adding/revising data items (cost) Self-identifying Internet friendly Availability of development tools Software-Specific Criteria Compatibility with statistical software Compatible with Edits Compatible with SEER*Prep Compatible with Cancer Registry software Compatible with GIS software

5. Decision Health Level Seven (HL7) Clinical Document Architecture (CDA) HL7 CDA

6. Why HL7 CDA Self documenting Web-friendly Easy to change / add / subtract Programmer current New data models: multiple treatments Consistent with National Electronic Health Records –Nationally & Internationally

7. What is HL7 CDA Representation, E-Clinical documents for exchange Medical records reports e.g. D/C summary, operative reports, and radiology reports XML encoded (Extensible Markup Language) Human readable & machine processable Header and body Specifications flexible - covers broad range of clinical documents Implementation guides - specifies the level of structure and coding

8. Pilot Project

9. Design & Method Transmit cancer abstracts using HL7 CDA from a hospital registry to a central registry –Dummy Data –NAACCR Record Type A (full case abstract), Version 11.1 –All Required (R) and Required when available (R*) Data Items –Expanded text – in text-based Data Items

10. Participants California –Sender Software: C/NExT –Receiver Software: Eureka Virginia –Sender Software: Abstract Plus* –Receiver Software: Rocky Mountain Cancer Data System (RMCDS) *Virginia Commonwealth University Health System

11. Strategy Implementation Guide (IG) Software to translate Column-Delimited Format to CDA and vice versa Transmit and Receive Test Messages Compile Lessons Learned, Advantages, and Disadvantages Recommendation to Board

12. Implementation Guide (IG) A guide describes how to code CDA documents –Specific encoding NAACCR HL7 CDA R2 Implementation Guide for Cancer Registry Reporting Tool for implementers: senders and receivers

13. Translation Software For potential phase-in of implementation Not all vendors/developers will be at the same level Allows concurrent formats for a period of time e.g. 2 years Done – Being tested by participants

14. Vocabulary NAACCR Data Items (Question Codes): –Use LOINC Codes NAACCR Data Items Values (Answer Codes) –Use NAACCR Codes Future - map NAACCR codes to other National Standards National Standards SNOMED CT LOINC National Cancer Institute (NCI) Thesaurus Public Health Information Network (PHIN) Vocabulary Access and Distribution System (VADS)

15. Status - Today Implementation Guide – Done Transform Software & Tools – Done Software Deployment – In progress Transmissions of Dummy Data – In progress & Incremental

16. Issues Raised EDITS use in HL7 CDA State-Specific Data Items Large data files –Hospital to State – 1,000 per week –State to National – 2,000,000 per submission

17. Next Steps Continue deployment and testing Compile findings, costs and benefits Make Recommendations to Board –Report to the Board Education and Training

18. Thank you  Ken Gerlach  kgerlach@cdc.gov kgerlach@cdc.gov  Jim Martin  Jim.martin@vdh.virginia.gov Jim.martin@vdh.virginia.gov  Lori Havener  lhavener@naaccr.org lhavener@naaccr.org The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention

19. Acknowledgements Alschuler Associates, LCC CDC-NPCR NAACCR Board and Staff NAACCR Clinical Data Work Group

20. Thank you