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Meaningful Use in Iowa

Learn how James Robinson at the Iowa Cancer Registry is adapting to Meaningful Use requirements, integrating MU data, facing challenges, and sharing lessons learned in cancer data management.

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Meaningful Use in Iowa

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  1. Meaningful Usein Iowa James Robinson Application Developer Iowa Cancer Registry james-robinson@uiowa.edu October 19, 2016

  2. Iowa Cancer Registry • Founding member of NCI’s SEER Program • Most SEER registries are located within research institutions; ours is U. Iowa • State law requires cancer to be reported • ICR designated by Iowa state government as the state cancer registry

  3. Our Model • Wait approximately 9-12 months before collecting data for a given year • There are hundreds of different cancers, discovery and treatment can take months • Correct and complete data is most valuable to researchers • Match the incoming data to existing data and consolidate any new information manually • Submit data to NCI and share with IDPH

  4. Adapting to Meaningful Use • Real time data is incomplete • Most reliable information is who, what, when, and where

  5. Integrating MU Data • Questions: • Do we know about this person? • Do we know about this disease? • Do we know about this treatment? • If the answer to any of the above questions is ‘no,’ we have new information to abstract • If the answer to all of the above question is ‘yes,’ we have a new date of last contact

  6. Unexplored Territory • There are potential uses for real-time information about cancer type, extent and treatment: special studies • Getting data on diseases not seen in conventional hospitals, e.g., some melanomas, leukemias • Waiting for enough data to come in to allow us to see what we have and whether we have enough • Production CDAs range in size from 29k to 6,548k

  7. The Onboarding Process • Recruitment of EPs is supervised by IDPH • Targeting EPs specialized in dermatology, urology, and hematology • We have neither recruited nor onboarded any eligible provider that already sends us cancer abstracts

  8. Onboarding • Onboarding is a collaboration between ICR and IDPH • Testing is done between ICR and EP • At conclusion of testing, ICR contacts IDPH, who works with EP to connect to IHIN

  9. Production • Iowa’s HIE, IHIN, is an SFTP server run by a third party contractor, ICA • Participants upload CDAs to IHIN with SFTP clients • Iowa receives files within 24 hours • 5,985 CDAs received to date from 4 EPs

  10. Challenges • We have no way of dealing with SNOMED • Plan is to import CDAs directly into our data management system, which already has matching and consolidation built in • Whether CDAs are consolidated with prior CDAs for the same incidence varies from EHR installation to EHR installation • This complicates the process of determining how to handle incoming CDAs

  11. Workflow Integration • Data management system (SEER*DMS) is third party (IMS), still designing MU integration interface • Volume and difficulty of reconciling are the major issues • Planned integration is generation of new leads as a consequence of matching against our consolidated data

  12. Lessons Learned • Continuously monitor quality • Production data missing critical fields such as date of procedure • Turnkey solution for uploading CDAs is absolutely critical for supporting small EPs • 1 for 5 with EPs that have no IT support staff • The small (1-2 physician) specialty EPs are the ones whose data we want the most • When outsourcing service, maintain a clear chain of responsibility

  13. Questions? • Links: • Iowa Cancer Registry: http://www.public-health.uiowa.edu/shri/ • NCI SEER program: http://seer.cancer.gov/ • Iowa Department of Public Health: http://idph.iowa.gov/ • ICA: http://ica-carealign.com/ • Information Management Services: http://www.imsweb.com/ • SEER*DMS: http://seer.cancer.gov/seerdms/ • Your humble servant: james-robinson@uiowa.edu

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