Electronic Physician Reporting to
the Kentucky Cancer Registry
David Rust, MS
Software Developer
Sheena Batts, CTR
CER Project Manager
September 17, 2012
NAACCR Physician Reporting Workgroup
Overview
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Special Project Objectives
Strategic Approach
Making Contact with Providers
Collaborating with EHR Vendors
Transmission
Current Status
Challenges
Comparative Effectiveness Research
(CER): KY Special Project 3 (SP3)
• Objective
▫ Increase completeness of cancer treatment data
captured by the Kentucky Cancer Registry
• Goal
▫ Implement direct EHR reporting from oncology
providers in Kentucky by September 2013
Key Relationships
• Kentucky Regional Extension Center (KY-REC)
▫ Leverage MU incentives and infrastructures to achieve
direct electronic reporting
• Kentucky Health Information Exchange (KHIE)
▫ Provide secure electronic network infrastructure
• CDC
▫ Partner with CDC to develop and evaluate necessary
software tools to process the EHR clinical event
messages
Regional Extension Centers
• Funded to assist healthcare providers quickly
adopt meaningful use of EHRs
• Provide direct technical assistance to establish
EHRs
• Offer training, information and guidance
• Facilitate Meaningful Use attestation
Kentucky Regional Extension Center
• KCR contracted with KY-REC to recruit providers
• Target medical and radiation oncology providers in
Kentucky
• KY-REC obtains a signed Provider Agreement
• KY-REC critical in recruitment of providers to report
electronically to KCR
• KY-REC works closely with the KHIE implementation
specialist
Health Information Exchange
• Funded by grants through State HIE Exchange
Cooperative Agreement Program
• Funded in all states, DC, and several territories
• Provide technical infrastructure for secure
exchange of health information
Kentucky Health Information Exchange
• KCR has a signed agreement with KHIE to
utilize service
• Provide implementation specialist on-site to
oncology providers
• Information technology services may be subcontracted by the state HIE
Identifying ideal providers
• Obtained updated list of Kentucky Licensed Physicians
▫ Sorted by specialty
▫ Removed retired and hospital based physicians
• Identified group practices by address
• Start with large practices
▫ MU Certified EHR in place
• Identify legal ownership of the medical record
Contacting Practices
• Developed Participation Agreement
• Developed survey instrument
▫ Interest in meeting Meaningful Use
▫ Current medical record status
▫ Interest in electronic reporting to KCR
• Contacted practices by phone
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Identify Administrator /Manager
Any general information
Current software vendor
Sent return envelope with survey
• A KCR Participation Agreement was sent to those indicating interest
in the project
Provider Participation
• Referrals to KY-REC and KHIE are sent upon
receipt of a signed participation agreement
• Benefits of participation
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KY-REC services provided at no charge
Meets KCR physician reporting requirement
Total automation of reporting (time factor)
Reduce therapy and follow-up requests from
hospital registries
Collaborating with EHR Vendors
• Providers with MU certified EHR systems were
selected
• When the REC Provider Agreement is signed,
KCR obtains permission from the participating
provider/practice to contact their EHR vendor
• KCR establishes communication with the EHR
software vendor to discuss logistics and
development of CDA document
Pilot Vendor
• Early 2012 the first vendor was recruited to develop
the Ambulatory Healthcare Provider Reporting to
Central Cancer Registries CDA document in Team
Chart Concept(TCC) EHR
EMR because you want to, not because you have to.
At Ulrich Medical Concepts, we are proud to
have worked with the Kentucky Cancer
Registry to develop an electronic cancer registry
system.
Our software, Team Chart Concept (TCC) is an
integrated practice management, electronic
medical records system in use in the following
states:
Kentucky
Tennessee
Illinois
Missouri
Indiana
West Virginia
Virginia
Ohio
For more information, please contact Sandra Ulrich, VP Sales & Marketing.
www.ulrichmedicalconcepts.com
www.correctek.com
www.revenuesol.com
Phone 270-744-0404
Transaction Models
• KCR accepts any secure method of transaction
and any type of data format
▫ Transactions: sftp, email, web service, etc…
▫ Format: raw text, HL7 2.x, CDA, etc…
Transaction Models…
• KCR’s Ideal Model and Data Format
▫ Provider sees patient and generates a cancer diagnosis code
▫ This triggers the EHR to:
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Create the CDA document
Encodes and compresses document
Wrap in HL7 message
Encrypts and sends through KHIE web service
▫ KHIE’s BizTalk Server relays this message to the KCR’s PHIN-MS
server
▫ The message is then stored in the PHIN-MS database
▫ The CDA document is pulled from the HL7 message, decoded and
decompressed
▫ eMaRC Plus polls the database, notices a new CDA, store and
displays CDA for review and export in NAACCR file format
Healthcare Provider
EHR
Healthcare
Provider completes
documentation on
patient
The message is
encrypted and
submitted through
the KHIE Webservice
KHIE
EHR notices cancer
diagnosis trigger, CDA
document is constructed,
compressed, encoded, and
wrapped in an HL7
message
BizTalk
PHIN-MS decrypts message
and stores in PHIN-MS
database
PHIN-MS
Kentucky Cancer Registry
Files are exported
in NAACCR
format
KHIE sends
encrypted
messages to KCR
eMaRC stores and
displays CDA
documents for
review
Receive
Queue
eMaRC
Database
eMaRC polls CDA
document batches
automatically from
PHIN-MS
A program pulls,
decodes, and
decompresses the
CDA document from
the HL7 message
Message Format
• Currently, Ulrich Medical Concepts, Inc. has a CDA
document complete for transmitting
• KHIE had an established method for receiving HL7
2.5.1 messages
• The CDA document is compressed (gzipped), Base64 encoded, and inserted into OBX-5 of HL7 2.5.1
• Message is then encrypted, and submitted using the
KHIE web service
Placement of CDA in HL7 2.5.1 Message
MSH|^~\&|ACS|ACS|KCR PHINMS KCR|20110818214317||MDM^T02|00011|P|2.5.1||||||
EVN|T02|20110818214317
PID|1||KYMC|KYMC|HOODY^JONE-KY11^^^L|||||1 TEST AVE^^TEST CITY^KY^46035||||
PV1|1|N
OBX|1|ED|48769-4^Continuity of Care Panel^LN^CCD|| CDA MESSAGE ||||||F
Current Status
• Ulrich Medical Concepts, Inc. is refining the cancer section of the CDA
messages with the assistance of CDC
• KCR has received multiple HL7 wrapped CDA test messages from the
vendor through the transaction model
• KCR has received CDA messages from the provider through the transaction
model
• KCR is currently working with a large oncology specific EHR vendor
• Provider Participation
▫ 41 signed providers-Medical Oncology, Radiation Oncology and Dermatology
▫ KCR goal: Have 60 signed providers
• KCR received Pioneer Award from the Governor’s Office of Health
Information Technology
Challenges
• Ownership of medical record
▫ Quickly transitioning practices
• Software vendors have not distributed the
certified version of product to the provider
▫ Cancer Reporting is part of Stage 2 MU
• Revisions to KCR Central Registry (CPDMS)
▫ Procedures for creating partial records in progress
Questions?