1. AUTOMATION IN PRACTISE: The SWCIS Experience Presentated By: Tina Ball …………Head Of Registration Gill Christmas ……Head Of IT 4th December 2002

2. Automation In Practise - SWCIS Where Did We Start From? Merging of 2 Registries – Wessex (part auto) South West (fully manual) Auto load of Clearnet for at least 8 years No auto load of either pathology or deaths data Deaths – 6 weeks to process

3. Automation In Practise - SWCIS Clearnet -700,000 -100% Pathology - 100,000+ (exp) -83% Cancer Deaths -22,000 -100% Electronic Data RecordsCoverage X-regionals - 3,500 - 95% Where Are We Now?

4. Automation In Practise - SWCIS Why Did We Go the ‘Auto’ Route? 1) Clearnet processing – 700,000+ records a year to handle - capture of clinical data 2) Speed up Registration – more timely + improve availability of information 3) Flexibility to handle constantly expanding data sources

5. Automation In Practise - SWCIS The Auto Load Process No manual intervention Overnight Batch Processing – 65 % Clearnet 80 % Cancer Deaths Manual intervention Recycled Records Auto fill of demographics, some tumour details and all treatment (Clearnet) Rapid processing of pathology text

6. Auto loaded

8. Processing Decisions – the ‘Markup’ process Report : SWCRF SWCRF Sort sequence : SWCRF SWCRF Run Number : 52 Originally reported : 07/08/2000 08:05 Report date : 09/08/2000 11:33 [1m[1MOF-NINE SEVEN [2m F 23/07/1956 Q123456 THE STARSHIP THE ENTERPRISE Dr B Crusher QAH ITUQ AA007007K/99 POST MORTEM HISTOLOGY Sections from the greater omentum show diffuse infiltration by a moderately differentiated adenocarcinoma as seen previously ………. ……………………….. Dr Test SHO in Pathology Test Hospital ALPHA QUADRANT DCT/GCS/JM 1.8.00 SNOMED CODES: Seq 2 T57000 - M81403, [1m [2m Dr I Test 847 25/05/2002 01/06/2002 [1m[1mBAGGINS BILBO [2m M 23/07/1956 P000000 Pathology word document Automation In Practise - SWCIS Strip off keep

9. End Result Q123456||19560723||F||THE STARSHIP,THE ENTERPRISE||OF- NINE|SEVEN|20020525|# Event Date: 20020525: # Hospital ENT02 : # Unit No: Q123456 # Clinician Name: B CRUSHER # Specimen Source: QAH # Pathologist Name: DR I TEST # Snomed Codes: T57000 - M81403, # Pathology Text: POST MORTEM HISTOLOGY ^ Sections from the greater omentum show diffuse infiltration by a ^ moderately differentiated adenocarcinoma as seen previously ………………^ Dr I Test ^ Test Hospital^ P000000|19560723|M|MIDDLE EARTH,THE LAND|BILBO|BAGGINS Decided to use PERL: Programming Extraction and Reporting Language Automation In Practise - SWCIS Text added to assist Registry officer

11. Data extraction Data clean & validation Definate Match & New InDefinate match Business Rules / Data Validation Auto Manual Perl Markup Database Pool Database Cancerbase Database Manual Path, pas etc Clearnet Automation In Practise - SWCIS Patient/Tumour Match NHS Number Unit Number Birth Date Surname Forename Address Post Code Morphology ICD Site Behaviour Laterality

12. Automation In Practise - SWCIS Automated Validation Rules 35 reference tables within Cancerbase On line cross validation checking, examples are - AD later than DoD - Site and Morph compatible - Site and Behaviour compatible - Stage Type and Stage Based on ONS and UKACR guidelines

13. Automation In Practise - SWCIS Burden On IT Dept CLEARNET: - no names or addresses – nsts run - different formats received within each field - cleaning, validation and de-duplication OTHER DATA SOURCES: - separate script for each data source - again scripts not static – data formats & content change - scripts not static – data formats & content change - multiple applications National GP, Consultant Hospital Codes OPCS 4 Codes ICD 10 Codes NHS no

14. Automation In Practise - SWCIS Burden On IT Dept - contd STAFF: - increase in IT staffing levels – faults/enhancements - availability & retention of skilled staff - on-going training costs

15. 3 Recommendations BEFORE developing an automated Cancer Registration System …………… 1) Do not under-estimate the complexity of automating the cancer registration process WE WISH YOU LOTS OF LUCK ! Automation In Practise - SWCIS 2) Do not under-estimate the development costs and on-going costs of support & maintenance 3) Test, test and test again