NAACCR Clinical Data Work Group: Design and Implementation Issues Jim Martin Director, Virginia Cancer Registry 2007 NAACCR Annual Meeting Detroit, Michigan

NAACCR 2007 annual meeting, Detroit, Michigan 2 1. NAACCR Clinical Data Work Group

NAACCR 2007 annual meeting, Detroit, Michigan 3 Clinical Data Work Group: Under the NAACCR IT Committee Interoperability Ad Hoc Committee Semantic Interoperability Work Group Syntactic Interoperability Work Group Pathology Data Work Group Clinical Data Work Group

NAACCR 2007 annual meeting, Detroit, Michigan 4 Clinical Data Work Group Objective Explore alternatives to the current NAACCR layout format used to transmit cancer abstracts Explore alternatives to the current NAACCR layout format used to transmit cancer abstracts Current format: fixed-width (column-delimited) flat filefixed-width (column-delimited) flat file defined in NAACCR Standards for Cancer Registries, V. 2, Data Standards and Data Dictionarydefined in NAACCR Standards for Cancer Registries, V. 2, Data Standards and Data Dictionary in use for more than 10 yearsin use for more than 10 years not a healthcare industry standardnot a healthcare industry standard

NAACCR 2007 annual meeting, Detroit, Michigan 5 Clinical Data Work Group: The NAACCR Charge Explore and describe alternatives to transmit / receive abstracts. Explore and describe alternatives to transmit / receive abstracts. Assess effect on tools (EDITS, SEER*Prep) and costs and benefits of alternatives. Assess effect on tools (EDITS, SEER*Prep) and costs and benefits of alternatives. Identify issues & develop an implementation guide for alternate method. Identify issues & develop an implementation guide for alternate method.

NAACCR 2007 annual meeting, Detroit, Michigan 6 2. The Pilot Project

NAACCR 2007 annual meeting, Detroit, Michigan 7 Pilot Project Message Format Choice Compared format characteristics, strengths, and weaknesses of: Compared format characteristics, strengths, and weaknesses of: HL7 v.2 XMLHL7 v.2 XML HL7 v.3HL7 v.3 HL7 CDAHL7 CDA CSV, comma separated valueCSV, comma separated value

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10 3. Terms, Definitions & Ideas

NAACCR 2007 annual meeting, Detroit, Michigan 11 Interoperability The ability of two or more systems or components to exchange information, and to use the information that has been exchanged. The ability of two or more systems or components to exchange information, and to use the information that has been exchanged. The ability of different types of computers, networks, operating systems, and applications to work together effectively, without prior communication, in order to exchange information in a useful and meaningful manner The ability of different types of computers, networks, operating systems, and applications to work together effectively, without prior communication, in order to exchange information in a useful and meaningful manner The ability of software and hardware on different machines from different vendors to share data htm The ability of software and hardware on different machines from different vendors to share data htm htm htm

NAACCR 2007 annual meeting, Detroit, Michigan 12 Syntactic Interoperability Achieved through standardization of message structure and the application of controlled vocabularies Syntax can be considered as the grammar or structure that conveys meaning or semantic value Ability of different systems to interpret interfaces, interchange formats, messaging standards, etc.

NAACCR 2007 annual meeting, Detroit, Michigan 13 Semantic Interoperability A common understanding of the meaning of the information exchanged. A common understanding of the meaning of the information exchanged. Organizations have internal representations of data they are required to exchange. Organizations have internal representations of data they are required to exchange. Achieved through using a defined, controlled vocabulary. Achieved through using a defined, controlled vocabulary.

NAACCR 2007 annual meeting, Detroit, Michigan 14 Two standards that are not semantically interoperable Syntactic concordance Syntactic concordance in HL7 CDA is “order placed” in CDISC is “visit sequence” in HL7 CDA is “order placed” in CDISC is “visit sequence” Semantic discordance (CDISC is Clinical Data Interchange Standards Consortium)

NAACCR 2007 annual meeting, Detroit, Michigan 15 HL7 CDA (1) CDA = Clinical Document Architecture CDA = Clinical Document Architecture A markup standardA markup standard Specifies document structure (syntax / grammar) and meaning (semantics)Specifies document structure (syntax / grammar) and meaning (semantics) Documents can be:Documents can be: Text (forms, documents) Text (forms, documents) Images (still or moving) Images (still or moving) Sounds Sounds Any multi-media file Any multi-media file

NAACCR 2007 annual meeting, Detroit, Michigan 16 HL7 CDA (2) CDA is encoded Extensible Markup Language (XML) CDA is encoded Extensible Markup Language (XML) Your browser displays XML Your browser displays XML CDA documents conform to HL7 information standards (the Reference Information Model, RIM) CDA documents conform to HL7 information standards (the Reference Information Model, RIM) HL7 CDA is an American National Standards Institute (ANSI) approved HL7 standardHL7 CDA is an American National Standards Institute (ANSI) approved HL7 standard

NAACCR 2007 annual meeting, Detroit, Michigan 17 Advantages of HL7 CDA (1) Compatible with statistical packages Compatible with statistical packages Handles repeating data items easily Handles repeating data items easily Multiple treatment valuesMultiple treatment values Capable of transmitting large text blocks Capable of transmitting large text blocks Entire pathology reportsEntire pathology reports Is a Consolidated Health Informatics (CHI) standard Is a Consolidated Health Informatics (CHI) standard Designated for use by HHS Health Information Technology Standards Panel (HITSP).Designated for use by HHS Health Information Technology Standards Panel (HITSP).

NAACCR 2007 annual meeting, Detroit, Michigan 18 Advantages of HL7 CDA (2) Add and revise data items easily Add and revise data items easily Data items are tagged with descriptive names Data items are tagged with descriptive names in HL7 CDA is “order placed” in HL7 CDA is “order placed” Compatible with Internet systems Compatible with Internet systems Browsers can display recordsBrowsers can display records Standard development tools can be used Standard development tools can be used Less overhead for developmentLess overhead for development

NAACCR 2007 annual meeting, Detroit, Michigan Implementation Issues

NAACCR 2007 annual meeting, Detroit, Michigan 20 A Simplified, Two-Way Messaging Scheme STORE DATA: hospital registry database records TRANSLATE DATA: hospital record translated to/from HL7 CDA message format TRANSMIT DATA: HL7 CDA message file TRANSLATE DATA: HL7 CDA message translated to/from central registry record format STORE DATA: central registry database records

NAACCR 2007 annual meeting, Detroit, Michigan 21 Notes on the Simplified Scheme Steps are the same as ones used for the current flat file scheme. Steps are the same as ones used for the current flat file scheme. Registry software vendors may need to develop database / HL7 CDA message translation utilities. Registry software vendors may need to develop database / HL7 CDA message translation utilities. Pilot project sites may use a temporary flat file-to/from-CDA translation utility. Pilot project sites may use a temporary flat file-to/from-CDA translation utility.

NAACCR 2007 annual meeting, Detroit, Michigan 22 EDITS Can be adjusted to read extensible markup language (XML) format Can be adjusted to read extensible markup language (XML) format HL7 CDA is an XML format; can be used as test case. HL7 CDA is an XML format; can be used as test case. Pilot project will not include adjusting EDITS. Pilot project will not include adjusting EDITS.

NAACCR 2007 annual meeting, Detroit, Michigan 23 SEER*Prep Converting HL7 CDA messages to SEER*Prep format can be accomplished (IMS staff in WG) Converting HL7 CDA messages to SEER*Prep format can be accomplished (IMS staff in WG) The pilot does not include developing or testing such a conversion utility The pilot does not include developing or testing such a conversion utility

NAACCR 2007 annual meeting, Detroit, Michigan 24 Costs Short, mid-, and long-term: Staff: programming, hardware, training Staff: programming, hardware, training Standards: code systems, vocabularies (adopting, maintaining) Standards: code systems, vocabularies (adopting, maintaining) Capital outlay: hardware & software Capital outlay: hardware & software Costs exist for any messaging system, including the current flat-file one. HL7 CDA takes advantage of available development tools. It has the advantages of syntactic and semantic interoperability and of being a documented standard.

NAACCR 2007 annual meeting, Detroit, Michigan 25 Resources Alschuler L, Blocker A, Brandman D HL7 interoperability survey. HL7NLMSurvey_FINAL.pdf Alschuler L, Blocker A, Brandman D HL7 interoperability survey. HL7NLMSurvey_FINAL.pdf [accessed ]. Dogac A, et. al. nd. Key issues of technical interoperability solutions in eHealth and the RIDE project. servlets/Doc?id=27836 [accessed ]. servlets/Doc?id=27836 Dolin RH, Alschuler L, et. al HL7 clinical document architecture, release 2. Am Med Inform Assoc. 2006;13:30–39. Gerlach K NAACCR Clinical Data Work Group - Pilot to Transmit the Cancer Abstract Using HL7 Clinical Document Architecture (CDA) NAACCR Conference, Detroit, MI. June 4, Garde S, et. al Towards semantic interoperability for electronic health records: Domain knowledge governance for openEHR archetypes. Methods of Information in Medicine 46(3): 332–343.

NAACCR 2007 annual meeting, Detroit, Michigan 26 Companion HL7 CDA Presentation Pilot to Transmit the Cancer Abstract Using HL7 Clinical Document Architecture (CDA) Ken Gerlach, CDC-NPCR Concurrent Session 2 3:30 – 5:00 pm Section C: Electronic Reporting Part II

NAACCR 2007 annual meeting, Detroit, Michigan 27 Contact Information Jim Martin, Ph.D. Director, Virginia Cancer Registry 109 Governor Street, 10th. Floor Richmond, VA (804)