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Alena Headd, MSIT, Software Support Analyst,

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

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Alena Headd, MSIT, Software Support Analyst,

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  1. Alena Headd, MSIT, Software Support Analyst, Missouri Cancer Registry and Research Center (MCR-ARC) University of Missouri School of Medicine, Health Management & Informatics Department Achieving increased cancer reporting from clinicians to public health: A local success with global implications

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

  3. Co-authors • 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

  4. Acknowledgments • 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 (#U58/DP003924-01/02)

  5. Presentation Objectives • 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

  6. Background • 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

  7. Methods • 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)

  8. Methods (Cont’d) • 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

  9. Methods (Cont’d) • 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

  10. Methods(Cont’d) • Added a specialty physician (urologist) • Trying two options: • Pros

  11. Methods (Cont’d) • Cons

  12. Results: C/PO Participation • 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 2nd 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

  13. Results: Specialist C/PO Participation • 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 3rd in country to be ONC certified for MU Stage 2 Cancer Reporting (June 2013)

  14. Results: Project Status - Urologist • Implementation completed, September 2013 • Live data anticipated November 2013 • Analysis of data will begin immediately upon receipt of live data • Practice averages between 50-100 cases per year

  15. Results: CAH Participation • Three CAHs • Selected EHR: 3 • Implemented: 0 • Since none have implemented their EHRs, no preliminary findings

  16. Challenges - CCR • 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

  17. Challenges – CCR (cont’d) • (NPCR) By 29 June ‘17, EHR reporting to CCR should include 80% of: • Urologists, dermatologists, gastroenterologists, medical & radiation oncologists, hematologists • Number of above specialty C/POs: • Radiation oncologists in Missouri practice within Radiation facilities so individual physicians are not included

  18. Challenges – CCR (cont’d) • 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

  19. Challenges – CCR (cont’d) • Breakdown of 598 C/POs that have achieved MU Stage 1

  20. Challenges – CCR (cont’d) • 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

  21. Challenges – CCR (cont’d) • Processing data and internal workflow • Storage • Consolidation of reports • Funding cuts • Staffing deficits (4core positions) • Limits CCR’s ability to implement EHR reporting by C/POs not in pilot

  22. Discussion • 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

  23. Questions? 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 65211 573-882-7775 headda@health.missouri.edu http://mcr.umh.edu

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