cancer registrars: beyond the abstract - eohima.org · cancer registrars: beyond the abstract ......

Melissa Smith, RHIT, CTR Director of Client Services CHAMPS Oncology

Cancer Registrars:

Beyond the Abstract

Presented by

Eastern Ohio Health Information Management Association An affiliate of the Ohio Health Information Management Association

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Objectives

• what is a Certified Tumor Registrar (CTR) and how someone becomes a CTR through education and credentialing

Identify

• the traditional role the Cancer Registrar holds in the hospital setting Discuss

• the new, emerging roles that Cancer Registrars can pursue with the skill set of a CTR

Discuss

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History of Cancer Registration

1629

Bills of Mortality (England)

1728

General Cancer Census

(London)

1913

Cancer Campaign

Committee (ACoS,

Chicago)

1923

Bone Sarcoma Registry

(U.S.)




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History of Cancer Registries, U.S.

1926

First hospital registry at Yale-New

Haven Hospital in

New Haven, CT

1935 & 1946

First central cancer

registries (Connecticut

and California)

1956

American College of Surgeons requires a

cancer registry for approved

cancer programs.

1971

National Cancer Act

budgets monies to the

National Cancer

Institute for research,

detection and treatment of

cancer.




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History of Cancer Registries, U.S.

1973 Surveillance, Epidemiology

and End Results (SEER) Program of NCI establishes the

first national cancer registry

1992 Congress

establishes a National

Program of Cancer

Registries (Public Law

102-515)

1993

State laws make cancer a

reportable disease




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What is a Cancer Registrar?

• Provides the complete summary of a cancer, from diagnosis, treatment, and outcomes.

• Ensures that timely, accurate, and complete data is captured and recorded for each patient and primary cancer

• Works with cancer team and hospital administration to gather cancer data and disseminate cancer information as needed

Data management

experts in oncology




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What is a CTR?

First exam administered in 1983 The first certification exam for

cancer (tumor) registry professionals

Developed by the NCRA (registered trademarks of NCRA)

“Promotes standardization in the collection and use of cancer data

through examination and certification of cancer registrars

and other cancer data specialists”

Certified Tumor Registrar




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Why a CTR?

Simply put, oncology is a complex field, more so now than

ever before

Therefore oncology data is more

complex




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Where we have come:

1994 2012

Cancer Registry Coding Manuals




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Establish a standard of knowledge and

experience required

Measure each individual on these

established standards

Promote professional growth and individual study

by registrars

Formally recognize registrars who meet

the CTR requirements

Assisting employers and others in the

assessment of cancer registrars

Required to be an abstractor at a CoC-approved program

Why a CTR? (con’t)

Promotes excellence in the profession




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How does one become a CTR?

Route A: Experience & CIM Program

Complete a NCRA-Accredited

Associate Degree or Formal Education

Work practicum of 160 hours in a CTR-

staffed cancer registry

Route B: Experience &

Associate Degree

Have an Associate Degree including

2 semesters of Human A & P

Work 1 year full time (1950 hrs) in the cancer registry

field

Two main eligibility routes for the CTR exam:

http://www.ctrexam.org/eligibility/index.htm




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How does one become a CTR?

• 3 testing windows (March/June/Oct) CTR Exam

• Open Book: Data collection

• Closed book: More data collection, quality assurance, data usage, and more

• Full outline of content: http://bit.ly/CTRExamBP

CTR Exam Content

• Part 1 closed book, 180 items, max 2.5 hours

• Part 2 open book, 45 items, minimum 1.5 hours

225 questions, 4 hours total

http://www.ctrexam.org/exam




http://bit.ly/CTRExamBP

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Life of the “Traditional” Hospital Registrar

Typical work that a cancer

registrar may be responsible for in the hospital

setting




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Life of the Hospital Registrar

Casefinding Suspense System

Maintenance Case Abstracting

Follow-up Data for

Studies/Reports

Cancer Conferences and Committee

(CoC)




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Casefinding

The process of locating every patient who is diagnosed and/or treated at the hospital

• Inpatient and outpatient

• Reportable diagnoses only

Active vs. Passive casefinding methods

• Registry personnel reviewing documents

• Departments/providers reporting to the registry

Results in large list for review




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Suspense System

After casefinding, cases that are potentially reportable are placed into suspense.

Basic information entered into the registry software:

• Demographics, date of first contact or diagnosis, primary site, histology

From this list is where workload for abstracting is generated

• Is it reportable? Has it been reported?




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Case Abstracting

Bread and Butter of the Cancer Registry

• Remember “junk in, junk out”

Organizing, summarizing, & categorizing the crucial information about a patient’s cancer

• From diagnosis, treatment, recurrence, outcomes

• Tracking the cancer, not just each encounter

From ANY source

• Internal sources, physician offices, other facilities

Summary Abstract samples




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Follow-Up

Primary purpose is to monitor outcomes of cancer and its treatments

• Patients are followed until they expire

Outcome data enable researchers to assess clinical standards, quality of care and survival

"The main purpose of patient follow-up is to determine if the treatment worked."

• Dr. E. A. Codman, Founding Member of the American College of Surgeons




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Data from the Cancer Registry

Data can be pulled from the registry for many

reasons

• Institutional research

• Physician studies - quality of care

• Marketing – demographic data for targeted mailings, what patients are going elsewhere for treatment

Data sent to reporting agencies

• State population registries

• National Cancer Data Base (CoC)

• Regional registries




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*Cancer Conferences & Committee

• Multidisciplinary case presentation

• Discuss treatment options, new drugs, etc.

• Physicians, nurses, allied health professionals

Cancer Conferences or Tumor Board

• The engine behind the cancer program

• Directs cancer resources and energies for the year

• Monitors compliance with CoC-accreditation standards

Cancer Committee

*CoC Approved




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Cancer Registry Management

Job Descriptions

Policy and Procedure

Manual

Confidentiality and Release of

Information

Retention of Documents

Quality Control of

Data

Cancer Registry Software




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Life Outside the Traditional Setting

Exploring some of the

alternative projects and

workplaces for CTRs




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Opportunities for Cancer Registrars

There are great and many opportunities for cancer registrars in the hospital and

hospital setting.

But then what – what else is there?

Let’s find out!




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Resource Planning Analyst

• Database management

• Assisting with reports

• Data clean-up

• Registry software updates

• Working with specialized researchers

• More like an epidemiologist vs. cancer registrar

• Working with specialized/site specific registries

• NCCN databases for specific sites

Just one job title for

doing “everything

else”




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Quality & Information Specialist

• Performs QA on cancer registrars

• Performs QA on hospital registry data

Concentrates on ensuring high-

quality data

• Educate those areas where QA falls short

Education & Training

• Helps develop reports for questions being asked of the data

Provides data/information

as needed




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Rapid Quality Reporting System (RQRS)

Commission on Cancer Program

• Reporting and quality improvement tool

• Promote evidenced based cancer care at the local level

Real-Time Data

• Abstracts for the primary sites (breast, colon, rectum) are completed concurrently

• Data uploaded regularly (at least quarterly)

Real Time Data & Comparisons

• Once data is uploaded, it’s updated within 24 hours to the database

• Compare data to self, to others (benchmark)




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Rapid Quality Reporting System (RQRS)

• Lung

• Stomach

• Prostate

Even though it’s only 3 primary sites

now…looking at other disease sites to

expand to

• New staff hired to complete these cases only

• Used to be just retroactive data (CP3R)

Registrars need to be proficient in these

primaries, standard treatment protocol, and how/where to

find the data needed




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Accreditation Specialists

Cancer program accreditation is complex

• ACoS Commission on Cancer (CoC)

• National Accreditation Program of Breast Centers (NAPBC)

Cancer Registrars know and live the standards – become the go-to

person for tracking and guiding standard implementation

• At the facility level




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Commission on Cancer Consultant

Trained consultant team available for CoC programs or programs in process

Provide services towards accreditation

• External assessment of standard compliance

• Survey readiness evaluation

• Complete mock surveys

• Assist with program development for new programs

• Strength and weakness evaluation

• Review of cancer registry operations

http://www.facs.org/cancer/consultant.html




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Central Cancer Registries

• Capture all the cancer incidence in a geographical area vs. by diagnosing or treating hospital.

State Central Registries

• Based on specific populations vs. geographical area

DoD and VAMC Central Registries

• One time reporting vs. treatment, follow-up etc.

Incidence only vs. multipurpose




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Vendors

Cancer registry software is very

specific

Companies use CTRs for help – think “super user”

Help registrars get the most out of the software

• Train new clients

• Help clients use reports, query systems, etc.

• Edits and abstracting questions

Sales staff

Who better to sell a cancer registry software

to a cancer registry? Why a CTR of course!




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Standard Setters

• North American Association of Central Cancer Registries (NAACCR)

• National Institutes of Health (NIH)

• Surveillance, Epidemiology, and End Results Program (SEER)

• Centers for Disease Control and Prevention (CDC)

• American Joint Committee on Cancer (AJCC)

• Collaborative Staging Task Force

The groups behind the code books,

creating data standards and education on how to code

and follow the manuals. Places

include:




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Special Data Abstraction

• Permedion, other QIO organizations

• Typically nurses

• Projects tracking compliance with standard quality of care measures

• Site specific or clinical research specific registries

Think of the clinical data abstractors

• AND being tied to reimbursement

• Finally – Cancer Registry CAN be a revenue generating department!

Now these are branching into

oncology measures




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Quality Oncology Practice Initiative (QOPI®)

Oncologist-led, practice-based QI program

• VERY different take from the hospital setting

Promote excellence in cancer care

• Promote culture of self-exam and improvement

• Measurement, feedback, improvement tools for hematology-oncology practices

Abstracting key items out of the office chart

Review documentation for completeness on:

• Distress screenings, pain, treatment summary, etc. (Items that CTRs are familiar with)




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Summary

Cancer registrars and the CTR certification

• Important for ensuring high-quality data

• High quality of employable registrars for the future

“Traditional” hospital registrars

• Gathering data at the “front lines”

• Tracking cancer from diagnosis to death

• Working towards managing the registry and the cancer program

“Non-Traditional” cancer registrars

• Analysts in the hospital setting for accreditation and quality

• Working for vendors and standard setters to create guidance for others

• Seeing the potential in new abstracting opportunities with QI and physicians




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Resources

• 2nd Ed, 2004 (there is now a 3rd Ed available)

Cancer Registry Management: Principles

& Practice

• http://www.ncra-usa.org National Cancer

Registrars Association

• http://www.ctrexam.org/ NCRA Council on

Certification

• http://training.seer.cancer.gov SEER Training Modules




http://www.ncra-usa.org/



http://www.ctrexam.org/

http://training.seer.cancer.gov/

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For More Information

Melissa Smith, RHIT, CTR Director of Client Services CHAMPS Oncology 216.255.3747 [email protected]

Join the Discussion on Our Blog CHAMPS Oncology Outlook www.oncologyoutlook.com

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