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Say Goodbye to Paper: Web-Based Reporting is Here! Iris Zachary, MS, CTR, Missouri Cancer Registry Acknowledgements Missouri Cancer Registry: • Nancy Cole, CTR • Sue Vest, CTR • J. Jackson-Thompson, MSPH, PhD MCR Missouri Cancer Registry This project was supported in part by a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services (DHSS) (#U55/CCU721904) and a Surveillance contract between DHSS and the University of Missouri. MCR’s Goals • Offer a web-based reporting mechanism for physicians; • Increase the number of cancer cases reported to the central registry; and • Reduce central registry staff effort. Background • Missouri physicians required to report only if case not reported by another entity • Dermatologists began reporting on paper in 2004 – (> 160 + general surgeons, plastic surgeons, etc.) • Urologists not reporting yet – (> 160) Background • Many types of cancer being diagnosed and treated completely outside the hospital setting – Prostate – Melanoma – Breast – Leukemia Prostate Project with CDC • In 2005, MCR selected as one of 8 central cancer registries (CCRs) to participate in a pilot project. • Purpose: Pilot use of web-based (Web Plus) reporting to increase physician reporting of genitourinary system cancers. What is Web Plus? • Secure, web-based application; • Developed by CDC with input from CCRs; • Offered free of charge to CCRs; • Technical support provided by CDC; Advantages of Web Plus • Software can be modified/enhanced to meet needs of participating CCRs. • Facilities can directly enter data and submit cases on-line. Web Plus • CCR hosts servers • CCR sets up user accounts – Users log directly into CCR server – User can only access his account • Multiple security features Key elements of Web Plus • Customizable features – Create displays for specific cancer sites – Change field names to basic English (PSA value rather than CSSSF 1) – Add help messages specific to a particular cancer site – Set defaults based on cancer site • Make fields invisible – Set critical fields (text, etc.) – Move fields to any position Lessons…. • Physicians are not aware that cancer registries have national standards for codes. • Physicians and staff are overwhelmed by the number of fields Lessons…. • Training needs depend on the person who will be completing electronic forms (physician, RN, medical assistant, etc.) – Familiarity with cancer and cancer reporting terminology (e.g. histology) – Familiarity with chart – Physicians Lessons….. • Labels for items must be changed to plain English (e.g., “CSSSF1” to “PSA value”) – Field labels do not have to be NAACCR field names – Must have CS reference in case of edit errors • Can select critical fields, including text fields • Can customize boxes that offer instructions for completing fields Lessons….the use of text fields • Physician – REDUNDANT!!!! – Unnecessary – I won’t complete • Staff – Way to QA (for CCR and for them) – Makes them think about the codes they’ve chosen Lessons….. • Physicians and staff, though unfamiliar with collaborative staging, actually have enough information to stage cases for certain primary sites – CS fields (extension, lymph nodes, etc.) – CSSSF fields ( PSA values, Gleason’s score, etc.) Lessons…. • Hospital cancer registrars can be your ally – Recruiting physicians – Training staff – Serving as ongoing resource to office staff for questions Summary • Year-long project results: – Urologists were not ready to report on paper or electronically – Web Plus features make it easy to use for a variety of functions – MCR will continue to use Web Plus, with a focus on converting dermatologists from paper to web-based system, then focus on getting cases from urologists Applying what we learned to web-based melanoma reporting Project differences PROSTATE • One site • 1-2 histologies • Little diagnostic/treatment coding – Biopsy info – No surgery, radiation or chemo • CS factors • Case finding MELANOMA • Multiple sites • Multiple histologies • Confusion about codes for diagnostic procedure vs. surgical procedure – Excisional biopsy • CS factors • Case finding Decisions • What is the least amount of information we can accept? • How can we make this as easy as possible? • If it is too difficult/time-consuming, they may not report at all. How many fields? • Can we eliminate some? • Default – make invisible? • Default – leave visible (in case they do need to use it)? Use of codes • Can they do it? – All fields – Specific fields – Text • Show same slide for melanoma display • Show same slide for melanoma display Issues at MCR • • • • Training users Issuing Passwords (practice vs. individual) Managing hundreds of accounts Determining responsibilities and workflow at CCR Web Plus Future Enhancements • CCR can start the form on Web Plus (manually or via an electronic path lab file) • CCR notifies physician that form is waiting to be completed • Physician office staff can log on to Web Plus, complete and release form to CCR Disadvantages of Web-Based reporting • Lose the paper – lose the info contained on the paper • Still labor intensive, but in a different manner • Must develop good tracking systems (FB, etc.) • Managing potentially hundreds of accounts requires attention to detail Advantages of web-based reporting • Process more cases in the same amount of time • No more paper to file • Increased security • Reduce data entry/ error Future uses • Death clearance follow-back • Path lab follow-back • Utilizing e-path files for follow-back MCR Staff Shari El Shoubasi Web Plus Coordinator Toll-free: 866 240-8809 573 884-6928 Email: [email protected] MCR Staff (cont.) Nancy Cole Non-Hospital Reporting Coordinator Toll-free: 866-240-8809 Phone: 573-884-2491 Email: [email protected] Missouri -- http://mcr.umh.edu/ • https://webplus.umh.edu/webplus – Prostate • User ID: johndoe • Password: test – Melanoma • User ID: janedoe • Password: test