W hy E-path Reporting is Important The Role of Standards and Inform atics June 9, 2002 NAACCR Informatics 1 Presenters Barry Gordon, Ph.D. W arren Williams, MPH 2 C/NET Solutions and the Calif. Cancer Registry Centers for Disease Control Contents of this talk W hy E-path reporting is important Role of Standards in E-Path Role of Informatics in E-Path Illustrations taken fro m : 3 C/NET’s CAS Software Reporting Pathology Protocols Pilot W hy is E-path is important? W hich is faster? 4 Reading paper path reports or scanning electronic docu ments? W hy standards for E-Path? (1) The many-to-many connections proble m 5 Assu me 10 nationwide labs need to talk to 50 states That’s 500 different connections to manage W ouldn’t it be nice if they all used the sam e m ethod? W hy standards for E-Path? (2) The one-to-many connections problem Labs usually report to many different departments and agencies 6 To Hospital m edical records To billing syste ms To the ordering physician To State Health Departments for many diseases W ouldn’t it be nice if they all used the sam e m ethod too? Hospital Messaging -- 7 A whim sical look Health Care Industry Standards Support the medical records com m unity Pencils are out: Alm ost all data are on so mebody’s co mputer syste m Pro mote co mputer-co mputer co m m unication. Local approaches are important, but aligning local solutions with industry standards builds s moother e-co m m unication. M apping to defined data elements. 8 Co m m unication structures are in parallel with industry. ‘Standards for Du m mies’ Rules 9 Use existing standards if present W ork to improve the m if they are deficient Propose the m if they are non-existent Avoid the ‘Not Invented Here’ syndrom e Current E-Path Standards 10 HL7: OR U results message now used for routine path reports . NAACCR: Path HL7 Record Layout defines the specifics we need NAACCR Standard 11 Exa m ple of Using Standards: 12 California’s multiple-vendor E-Path Goals for California’s m ultiple-vendor E-path: 13 Imple m ent E-path using open rules and procedures allowing multiple solutions For adapting to varied environm ents Analyze the need Stand-alone path labs required too m uch m anual casefinding Hospitals path labs have different environm ent: 14 Existing m essaging Hospital registry key custo mer State registry also key custo mer Current imple m entations in California AIM using HL7 CAS using HL7 15 (next talk) (Wednesday A M breakout session ‘Beyond Epath’) California E-Path Another State R egistry H ospital H L7 cases C A S Path H L7 Path O utofState Path Lab R egionalO ffice H L7 H L7 Path Path Lab H L7 R egional O ffice H L7 H L7 cases H ospital H L7 Path Lab 16 Exa m ple: CAS E-Path System Intercepts Hospital HL7 17 Pathology reports Discharges Selects potential cancers Integrates into registry software (CNExT) Forwards E-Path to central registry W hat’s added by CAS E-Path D is c h a rg e S ys te m P a th o lo g y S ys te m H L 7 R o u te r CAS H o s p ita l R e g is try 18 R e g io n a l R e g is try CAS E-Path H L7 R o u te r A d m is s io n P a th o lo g y R e p o rt H L7 C A S L is te n e r C A S C an cer S e le c to r C A S S to re W o rd L is t C A S E n c ry p t & S end C A S Log XM L XM L C AS R e c e iv e C A S Log P o te n tia l C ases XM L 19 C N E xT H osp. P o te n tia l C ases XM L O R N AAC C R E u re k a / R e g io n a l S y s te m A look at the Industry Standards Used in These De monstrations M essage: 20 Health Level Seven (HL7) ANSI Standards Body to support health care W W W.HL7.ORG Two approaches Version 2.x and Version 3 Large organization of vendors, public organizations. HL7 Exa m ple Structure 21 22 MSH|^~\&|CoPathC/S||Meditech||20000331094000||ORU^R01|4400000009957|P|2.2 [0D]ID|1||99999999||LAST^FIRST^MIDDLE^^Ms.||19270816|F|||626 ANY ST^^ALBANY^CA^94706^United States||(510)555-9999||||||444-44-4444[0D] PV1|1||L14|||||||ENT||||||||IP|3289195|B|||||||||||||||||||1^Hospital| ||||200003280600[0D] ORC|RE||S00441^CoPathC/||CM||||200003280815|^Welby^Marcus||12345^DOCTOR^THATSME [0D] OBR|1||S00-3441^CoPath C/S|S^Surgical Pathology|||200003280814|||||||200003280814|^^Lymph node, biopsy, submandibular, fs|59223^SINGER^MARK||||||200003310940||S\S\Surgical Pathology Parnassus|F|||||||89743^KLEIN^HARVEY[0D] OBX|1|CE|S00-3441\T\ANT|A|||||||F[0D] OBX|2|TX|S00-3441\T\CDX||The patient is a 73 year old woman with history of pharyngeal carcinoma,||||||F[0D] 23 W hat Inform atics Brings to Electronic Pathology Reporting Pro motes a system atic evaluation of the proble m and the solutions Don’t just apply technology, strategically apply solutions based on need. “Think Globally, act locally” Pro mote standards-based solutions M odel; vocabulary models, messaging, other Critical eye towards content and analysis 24 Narrative search string evaluation, checklist review, coding evaluation Industry Coding and Vocabulary Applied in EPathology Reporting Logical Observations Nam es and Codes (LOINC) Syste matized Nom enclature of Medicine (SNO M E D) 25 w w w.regenstrife.org Identifies key sections of the narrative pathology report w w w.sno m ed.org Codifies relevant information Morphology, Topography, Procedures ….. Exa m ple: Inform atics in the Reporting Path Protocol pilot Goal: im ple m ent CAP synoptic checklist via electronic reporting (colorectal pilot) Informatics Proble m: 26 protocol too a mbiguous to imple m ent cleanly Required review for consistency, logic, hierarchy, required responses. 27 Revised checklist item Polyp configuration: (choose 1 response) ___ Pedunculated with Stalk (stalk length: ___ cm) ___ Pedunculated No stalk ___ Sessile ___ Frag mented (configuration indeterminate) 28 In Sum m a ry 29 M essaging standards are crucial to EPath Reporting M odeling and Vocubulary standards crucial as well E-Path syste m s must integrate with both hospital and central registries For More Information on these topics: 30 E mail barryg@ askcnet.org