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NAACCR Clinical Data Work Group: Design and Implementation Issues

NAACCR Clinical Data Work Group: Design and Implementation Issues. Jim Martin Director, Virginia Cancer Registry 2007 NAACCR Annual Meeting Detroit, Michigan. 1. NAACCR Clinical Data Work Group. Clinical Data Work Group: Under the NAACCR IT Committee. Clinical Data Work Group Objective.

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NAACCR Clinical Data Work Group: Design and Implementation Issues

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  1. NAACCR Clinical Data Work Group: Design and Implementation Issues Jim Martin Director, Virginia Cancer Registry 2007 NAACCR 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 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 Current format: • fixed-width (column-delimited) flat file • defined in NAACCR Standards for Cancer Registries, V. 2, Data Standards and Data Dictionary • in use for more than 10 years • not 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. • Assess effect on tools (EDITS, SEER*Prep) and costs and benefits of alternatives. • 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: • HL7 v.2 XML • HL7 v.3 • HL7 CDA • CSV, comma separated value NAACCR 2007 annual meeting, Detroit, Michigan

  8. NAACCR 2007 annual meeting, Detroit, Michigan

  9. NAACCR 2007 annual meeting, Detroit, Michigan

  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.www.globalvoice.com/index.asp • 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 mannerwww.inproteomics.com/nwgloshi.html • The ability of software and hardware on different machines from different vendors to share datawww.ntia.doc.gov/ntiahome/ntiageneral/ipv6/draft/draftglossary.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. • Organizations have internal representations of data they are required to exchange. • Achieved through using a defined, controlled vocabulary. NAACCR 2007 annual meeting, Detroit, Michigan

  14. Two standards that are not semantically interoperable Syntactic concordance <orderNum> in HL7 CDAis “order placed”<orderNum> in CDISCis “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 • A markup standard • Specifies document structure (syntax / grammar) and meaning (semantics) • Documents can be: • Text (forms, documents) • Images (still or moving) • Sounds • Any multi-media file NAACCR 2007 annual meeting, Detroit, Michigan

  16. HL7 CDA (2) • CDA is encoded Extensible Markup Language (XML) • Your browser displays XML • CDA documents conform to HL7 information standards (the Reference Information Model, RIM) • HL7 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 • Handles repeating data items easily • Multiple treatment values • Capable of transmitting large text blocks • Entire pathology reports • Is a Consolidated Health Informatics (CHI) standard • 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 • Data items are tagged with descriptive names • <orderNum> in HL7 CDA is “order placed” • Compatible with Internet systems • Browsers can display records • Standard development tools can be used • Less overhead for development NAACCR 2007 annual meeting, Detroit, Michigan

  19. 4. Implementation Issues NAACCR 2007 annual meeting, Detroit, Michigan

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

  22. EDITS • Can be adjusted to read extensible markup language (XML) format • HL7 CDA is an XML format; can be used as test case. • 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) • 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 • Standards: code systems, vocabularies (adopting, maintaining) • 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. 2005. HL7 interoperability survey. www.alschulerassociates.com/library/documents/ HL7NLMSurvey_FINAL.pdf [accessed 20070531]. Dogac A, et. al. nd. Key issues of technical interoperability solutions in eHealth and the RIDE project. http://ec.europa.eu/idabc/servlets/Doc?id=27836 [accessed 20070531]. Dolin RH, Alschuler L, et. al. 2006. HL7 clinical document architecture, release 2. Am Med Inform Assoc. 2006;13:30–39. Gerlach K. 2007. NAACCR Clinical Data Work Group - Pilot to Transmit the Cancer Abstract Using HL7 Clinical Document Architecture (CDA). 2007 NAACCR Conference, Detroit, MI. June 4, 2007. Garde S, et. al. 2007. 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 23219 (804) 864-7865 jim.martin@vdh.virginia.gov NAACCR 2007 annual meeting, Detroit, Michigan

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