IT Infrastructure NHS BCSP

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• IT Infrastructure NHS BCSP
• Julietta Patnick
• November 2007

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Organisation in England
Overarching Structure

• 5 Programme Hubs across England, based on IT
  Local Service Providers (LSP) undertaking
  call/recall and lab functions
• 1 Programme Hub per LSP
• Each Programme Hub has a number of Screening
  Centres

Gateshead
Nottingham
Rugby
London
Guildford
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Bowel Cancer Screening System (BCSS)

• A single national database, written in Oracle
• Accessible from anywhere in NHS over secure
  weblinks
• Manages call, recall, results and appointments
  into local screening centres
• Collects and analyses clinical data from all
  returning a kit

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LOCAL HOSPITAL LINKS
Colonoscopy site
Colonoscopy site
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BCSS Links

• SNOMED Codes used
• Will link to
• Cancer registries
• NBOCAP
• Endoscopy systems?
• Pathology systems?
• Depends on National Programme for IT overall
  strategy

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BCSS Datasets Cancer types

• can handle synchronous tumours, each tumour
  described separately
• Malignant tumour
• Polypoid tumour
• Fungating tumour
• Frond-like/villous tumour
• Ulcerated tumour
• Infiltrative tumour
• Submucosal tumour
• Partial obstructing tumour
• Complete obstructing tumour

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BCSS Datasets Interventions
SNOMED Code Description Cancer Polyp
82035006 Polypectomy No Yes
86273004 Biopsy Yes Yes
413199002 Tissue destruction No Yes
14792009 Tattooing Yes Yes
Mucosal resection No Yes
372034000 Haemostatic technique No Yes
360017003 Clipping No Yes
119266004 Coagulation No Yes
276913007 Laser vaporisation No Yes
413240005 Chromoscopy No Yes
363105001 Dilation No Yes
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Polyp Reporting

1. IDENTIFYING THE POLYP
2. Polyp ID
3. Diagnostic Test ID
4. Polyp Location
5. Polyp Class
6. Polyp Size Estimate
7. POLYP HISTOLOGY
8. Polyp Histology ID
9. Polyp ID
10. Polyp Type
11. Polyp Microarchitecture
12. Polyp Excision Complete
13. Polyp Size
14. Polyp Dysplasia
15. Polyp Carcinoma
16. Polyp Stalk Invasion
17. Polyp Lymphovascular Invasion
18. Polyp Margin Distance

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BCSS Datasets Polyps

• Each polyp separately recorded

SNOMED Code Description Sessile Pendunculated Adenoma
Kikuchi Sm1 - tumour invades upper 300u of submucosa Yes No Yes
Kikuchi Sm2 - tumour invades upper 2/3 of submucosa Yes No Yes
Kikuchi Sm3 - tumour invades full thickness of submucosa Yes No Yes
Haggitt 1 - tumour invades into upper part of head of polyp No Yes Yes
Haggitt 2 - tumour invades into lower part of head of polyp No Yes Yes
Haggitt 3 - tumour invades into the top of the stalk No Yes Yes
Haggitt 4 - tumour invades into the submucosal at the base of the stalk No Yes Yes
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Lesion Lookup List in the Cancer Histology entity
SNOMED Code Description Differentiation Applicable NBOCAP ID NBOCAP Description
408645001 Adenocarcinoma Yes 1 Adenocarcinoma M8140/3
32048006 Adenoma No
17621005 Normal mucosa No
28899001 Squamous cell carcinoma Yes 2 Other M8000/3
21964009 Malignant lymphoma Yes 2 Other M8000/3
2092003 Malignant melanoma Yes 2 Other M8000/3
28755003 GIST Yes 2 Other M8000/3
48554007 Malignant carcinoid Yes 2 Other M8000/3
253000007 Neuro-endocrine carcinoma Yes 2 Other M8000/3
2424003 Sarcoma Yes 2 Other M8000/3
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T Category Lookup Listfor cancer audit
NBOCAP Code Procedure Pre-Treatment Pathology
1 Tx Tx Tx
2 T1 T1 pT0
3 T2 T2 pT1
4 T3 T3 pT2
5 T4 T4 pT3
6 pT4
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Changing the system
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• Thank you for listening
• www.cancerscreening.nhs.uk
• www.bcsp.nhs.uk