Cancer Outcomes and Services Data collection Implementation SIG Denise Downs, Implementation and Education Lead, UK

Still work in progress 2

Background We have a national ‘collection’ of data from all our hospitals in relation to cancer patients. These go to the National Cancer Registry Data items in relation to procedures undertaken can now be submitted in OPCS OR SNOMED CT The Board wanted a pilot project to be undertaken in relation to the incorporation of SNOMED CT 3

Inspection of data in National Register: EXCISION OF LESION OF SKIN OF HEAD OR NECK NEC1584 OTHER SPECIFIED OTHER EXCISION OF LESION OF SKIN1480 UNSPECIFIED OTHER EXCISION OF LESION OF SKIN1470 SHAVE EXCISION OF LESION OF SKIN NEC400

Specialist ‘EPR’ The data for the registry comes from solutions developed to support recording about the patient that provides the data returns to the Registry and for the various cancer audits. Evolved over time to introduce additional ‘procedures’ when clinicians not happy with the classifications – but mapped to them in the background 5

Task Given we have the registry data which has morphology and classification procedure code, we wanted a way to algorithmically generate the SNOMED CT lists. 6

Challenge Use to using OPCS-4 codes or ‘hybrid’ – recorded in clinical MDT meetings. Data entry approach is drop down lists. MDT – multi-disciplinary team 7

First Attempt Found all candidate SNOMED CT terms from the cross-maps for the OPCS-4 codes used Number of terms for each speciality area was large – for example for lung approx 775 Contained things we knew were not relevant (eg. removal of tattoo under skin) Removed all things we thought weren’t relevant with clinical guidance – still too many 8

Second attempt (Looking at Cancer of lung only) Focused on just the default maps in the classification cross-maps –Selected all the SNOMED CT concepts that have a default map to the classification Used our data migration workbench prototype to use these terms and produce a query specification so we can maintain Undertook clinical review – they took terms out but didn’t say any were missing 9

Validating with the audit Found the clinical audit had ‘their own groups’ eg. Pleurodesis, Extrapleural pneumonectomy Found audit had created their own ‘groups’ eg. Just about to go out to review again. 10 Sleeve resection E54.8 B Lung resection with resection of chest wall (not identifying which lobe resection) E T01

Some lessons learnt List for Lung – still about 110 concepts Still much more than the original list and so now having to discuss user interface changes with the vendor Plan is to provide a full list and provide configuration ability to reduce list of terms for that particular user, as well as providing good search facility 11

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