Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Informatics Update Eric B. Durbin, DrPH, MS Assistant Professor, Division of Biomedical Informatics, College of Medicine Director, Cancer Research Informatics Shared Resource Facility, Markey Cancer Center Director of Cancer Informatics, Kentucky Cancer Registry University of Kentucky First Annual Kentucky-Indiana Regional Cancer Registrars’ Meeting September 8, 2016 Topics to be Covered History of the Kentucky Cancer Registry - Informatics support Towards Real Time Cancer Reporting - Electronic pathology reporting - State Health Information Exchange (HIE) Towards Improved Data Dissemination - Cancer-rates.info Kentucky Cancer Registry Established in 1990 at the University of Kentucky Markey Cancer Center Kentucky Revised Statute 214.556 - Facilities that diagnose or treat cancer patients “shall report to the Kentucky Cancer Registry, through the cancer patient data management system and in a format prescribed by the KCR, each case of cancer seen at that health facility…” KCR became CDC/NPCR registry in 1994 KCR became NCI/SEER registry in 2000 Cancer Patient Data Management System (CPDMS.net) Web-based software application used by all non-federal hospitals in Kentucky - KCR provides software and technical support free of charge Used to capture, integrate, manage and report all cancer incidence data for Kentucky Technologies - MySQL database - Java/Tomcat middle tier - PHP and Javascript (ExtJS) front end NEW: Integrating CPDMS.net with SEER*DMS over next year CPDMS.net: A Unique Integrated Statewide Reporting System Towards Real Time Reporting American College of Surgeons - RQRS Federal Agencies - CDC Early Case Capture Initiative - NCI/SEER Funding electronic data sources Cancer Research and Precision Medicine Rapid case ascertainment for clinical trials and other studies Delays in Cancer Surveillance Data A limitation of U.S. cancer surveillance programs is the length of time required to capture complete data - Hospitals - Physicians/clinics - Pathology labs - Death certificates - Other state cancer registries Cases for residents diagnosed in other states often suffer the longest reporting delays Reporting Delays in Kentucky 2004-2013 Cancer Reporting Delays In State vs. Out of State 18 16 14 Proportion (%) 12 10 In State 8 OOS 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Reporting Delay (Months) Targets for Early Case Capture Physician Electronic Health Record (EHR) reporting - Meaningful Use Stage 2 Electronic pathology (E-Path) reporting - >90% of all cancers are histologically confirmed State Health Information Exchanges (HIEs) - Emerging potential KCR E-Path History NCI/SEER sponsored implementation of electronic pathology (E-Path) reporting at SEER registries beginning in 2004 - Transmissions through Artificial Intelligence in Medicine (AIM), Inc. - Transmed CDC/NPCR sponsored implementation of national laboratory reporting to registries beginning in 2009 - Transmissions through the Public Health Information Messaging System (PHIN-MS) E-Path Reporting in Kentucky Cincinnati Children’s 54 hospital and independent labs reporting • > 95% population coverage * * * * * * * * * * * E-Path reporting site Military Installation E-Path site in progress * ** * * * * * * * * * * * * * ** ** * ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * Vanderbilt * Regenstrief Indiana HIE ** * * * * * * * * * E-Path Reporting by Source 140000 120000 100000 Reports 80000 60000 40000 20000 0 2004 2005 2006 2007 2008 2009 2010 2011 Year National Labs Hospital Labs 2012 2013 2014 2015 2016 KCR E-Path Architecture E-Path Portal for Hospital Casefinding Linking E-Path Reports to Hospital Abstracts E-Path for Rapid Case Ascertainment Population-based samples from cancer patients with short survival times Pathology Laboratories Registry Operations UK/UofL Researchers Histology External Collaborators Sex Age KCR Annotated E-Path Reports Sent in Real Time NLP Pipeline State Health Information Exchanges (HIEs) Kentucky Health Information Exchange - KCR actively engaged in physician EHR reporting for Meaningful Use HealthBridge - Limited capacity to identify and route electronic records to KCR Indiana Health Information Exchange (IHIE) - Largest/most mature in country - Collaborating with IHIE for early case capture - Regenstrief Institute developing technical infrastructures and informatics methods Kentucky IHIE Collaboration Established legal authority through Indiana State Cancer Registry - Kentucky and Indiana have a long standing data exchange agreement in place - Indiana HIE data governance board approved access by KCR Implemented standards-based reporting mechanisms - Pathology reports – HL7 2.5.x North American Association of Central Cancer Registries Volume V - Clinical data – MU2 CDA Review of CDA Reports for Known Cancer Patients, 2000-2014 (N=216) ~3000 cancer patients known to be diagnosed and/or treated in Indiana matched with IHIE patients 216 patients identified and CDA messages obtained for review 83/216 (38.4%) Showed evidence of cancer information 30/216 (13.9%) Contained sufficient information for a registry case abstract Missing information - 27/216 (12.5%) populated cancer diagnosis section (25 abstracted) - 112/216 (51.8%) failed to mention anything about a malignancy Limitations HIEs still lacking sufficient clinical information necessary for cancer surveillance and early case capture - Dependent upon hospital and provider EHRs - EHR often lacks fundamental cancer information such as diagnosis date, cancer site, histology, stage, treatment, biomarkers, and etc. EHRs and HIEs need to evolve to better represent contextual health information for each patient - Disease centric view of specific diagnoses, diagnostic tests, lab results, treatment procedures, treatment agents and disease specific outcomes However, Indiana IHE has proven to be a reliable source for e-Path reports - Regenstrief developed NLP filter Disseminating Registry Data: Cancer-rates.info An online data visualization and exploration service hosted by KCR Provides free public access to population-based cancer incidence and mortality data for central cancer registries http://cancer-rates.info/ky KCR’s cancer-rates.info Service Offered as an annual contract to participating central cancer registries Current participants include MA, NJ, GA, KY, MI, MS, AR, IA, WI, MN, TX, NM, UT, CA, WA, HI, North American Association of Central Cancer Registries (rates by State) NCI in discussions to cover ALL SEER registries Indiana State Cancer Registry - KCR’s next client? Questions/Discussion Contact Information: Eric B. Durbin, DrPH, MS Telephone: 859-218-3182 E-mail: [email protected] Web: http://www.kcr.uky.edu