Reporting Pathology Protocols

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Reporting Pathology Protocols

• Missy Jamison, MPH
• National Program of Cancer Registries
• Division of Cancer Prevention and Control

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Outline of Talk

• Background
• Purpose of Reporting Pathology Protocols (RPP)
• Pathology labs
• Changes in the environment
• Advances in pathology lab data collection
• Public Health Information Network (PHIN)
• Update on RPP1 and RPP2 activities
• Challenges and Opportunities

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Reporting Pathology Protocols (RPP)

• Purpose of RPP
• Encourage a new data exchange system between
• Pathology labs
• NPCR cancer registries
• Promote and evaluate the use of PHIN standards in
  a cancer surveillance setting
• Evaluate data from RPP and compare with
  traditional pathology lab narrative reports

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Reporting Pathology Protocols (RPP)

• In 2001, NPCR funded
• California and Ohio for RPP1
• Cancers of the colon and rectum
• In 2004, NPCR funded
• California, Maine, and Pennsylvania for RPP2
• Cancers of the breast, prostate, and melanoma of
  the skin
• RPP2 needed to
• Increase expertise and acceptance in the cancer
  community and the pathology community

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Pathology Data

• gt 90 of cancers diagnosed in pathology
  laboratories
• Pathology reports key for exact identification of
  cancer
• Potential for rapid reporting for special studies
• However, path reports traditionally paper-based
  in a term paper format
• Challenges to use in a computer environment

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Changes in the Environment

• More cancers diagnosed in non-hospital settings
• Growth of independent pathology labs
• Standardization of pathology reporting by the
  College of American Pathologists (CAP)
• Public Health Information Network (PHIN)
• Commission on Cancer (CoC)
• As of 2004, requiring accredited cancer treatment
  centers to incorporate the CAP checklists
• For 90 of pathology reports

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• An electronic system that supports monitoring the
  publics health
• A live, secure, Internet-based network for
  exchanging comparable health information between
  all levels of public health

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What does PHIN mean for this Project

• Messaging standard
• Health Level 7 (HL7), Version 2.3.1
• LOINC codes for the question
• Logical Observations and Identifiers Names and
  Codes (LOINC)
• What is the primary site of the cancer
• SNOMET CT codes for the answer
• Systematic Nomenclature of Medicine, Clinical
  Terms (SNOMED CT)
• The primary site is the right ascending colon

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Key Partners

• College of American Pathologists (CAP)
• Principal organization of board-certified
  pathologists
• Pathologists and pathology labs
• Pathology laboratory software vendors
• Cancer registries and software vendors
• SNOMED International
• Experts in PHIN vocabulary and messaging
  standards

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College of American Pathologists (CAP)

• In 1999, the CAP Cancer Committee published new
  protocols
• Aid pathologists with completeness, accuracy, and
  uniformity in reporting of malignant tumors
• Methods
• Create cancer checklists using SNOMED-CT codes
• Supplement the narrative report with structured
  data entry

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Colon and Rectum Cancer Checklist

• COLON AND RECTUM Resection
• Patient name
• Surgical pathology number
• .
• MACROSCOPIC
• Tumor Site
• ___ Cecum
• _X_ Right (ascending) colon
• ___ Hepatic flexure
• ___ Transverse colon
• ___ Splenic flexure
• ___ Left (descending) colon
• ___ Sigmoid colon
• ___ Rectum
• ___ Not specified

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Colon and Rectum Cancer Checklist

• Histologic Type
• ___ Adenocarcinoma
• X Mucinous adenocarcinoma (greater than 50
  mucinous)
• ___ Medullary carcinoma
• ___ Signet-ring cell carcinoma (greater than 50
  signet-ring cells)
• ___ Small cell carcinoma
• ___ Undifferentiated carcinoma
• ___ Other (specify) __________________________
• ___ Carcinoma, type cannot be determined
• Histologic Grade
• ___ Not applicable
• ___ Cannot be determined
• _X_ Low-grade (well to moderately differentiated)
• ___ High-grade (poorly differentiated to
  undifferentiated)

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Pathologists and Pathology Labs

• RPP1
• University of California at Irvine
• University Hospitals of Cleveland
• RPP2
• University of California at Loma Linda
• Maine Medical Center and Dahl Chase Labs
• University of Pittsburg Medical Center
• Key issues
• Integrate new process into the normal work flow
• Bring added value to pathology lab

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RPP Project Workflow
Laboratory System
Hospital Cancer Registry
Central Cancer Registry
Receive Specimen from Surgeon
Receive Report ______________________ Exit/Send
acknowledgement
Receive Report ______________________ Exit/Send
acknowledgement
Prepare and Analyze Specimen
Cancer?
Yes
Input Data into CAP Checklist Software
Format Checklist PHIN Standards
Transmit Checklist
To physician
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Pathology Lab Software Vendors

• RPP1
• California C/NET solutions
• Ohio - Cerner
• RPP2
• California Cerner
• Maine Impac
• Pennsylvania Cerner
• Key issues
• Participation at an affordable price
• Acceptance of the vocabulary and messaging
  standards

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Central Registry Software Vendors

• RPP1
• California C/NET Solutions
• Ohio Rocky Mountain Software
• RPP2
• California C/Net Solutions
• Maine MRS
• Pennsylvania CRS
• Key issues
• Integrate new approach in a cost effective manner
• Bring value added to registry

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RPP Project - Activities

• Key partners collaborate
• Develop a guide for collection and transmittal of
  data
• Identify concepts without a LOINC code
• Revise checklists with the CAP Cancer Committee
• Identify appropriate HL7 segments for cancer data
• Work with pathologists and their software vendors
  
• Develop evaluation measures

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Implementation Tables with SNOMED and LOINC codes
CE Coded Element CWE Coded with exceptions
Table prepared by Barry Gordon
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Evaluation from RPP1

• Are the data from RPP more
• Complete
• Timely
• Of higher Quality
• Do we have a process that works well for the
  major partners
• Pathologists
• Cancer registries
• Is this method of data collection and
  transmission ready for a wider audience

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Evaluation from RPP1

• Completeness of data items is good
• Timeliness of data receipt is good
• The narrative reports contain information
  unavailable in the checklist
• Adenocarcinoma in a tubulovillous adenoma
• Adenocarcinoma in a tubular adenoma (8210)
• California evaluated availability of EOD data
• Checklist lacked information on location of
  involved regional lymph nodes

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Evaluation from RPP1

• Additional work needs to be done to tailor the
  process in the pathology labs
• Comments from pathologist
• Software well designed
• Tool needs a fair amount of free time
• Could not be used for biopsy specimens and for
  certain histologic types

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Evaluation from RPP1

• Comments from cancer registries
• What about in situ cases
• What about sites without a checklist
• All parties felt it worthwhile to pursue a second
  demonstration project

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Update on RPP2

• First face to face meeting in December, 2004
• Messaging workgroup
• Create the implementation tables
• Evaluation workgroup
• Common evaluation measures for the project
• State specific evaluation measures
• Second face to face at the NAACCR meeting in
  Boston
• Review the progress on the implementation tables
• Discuss evaluation measures

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Contacts

• Ken Gerlach
• 770-488-3008
• kgerlach_at_cdc.gov
• Missy Jamison
• 770-488-3154
• mjamison_at_cdc.gov
• National Program of Cancer Registries