Draft User Story: Transmitting Cancer Reports from Pathology Laboratory and
Ambulatory EHR to State Public Health Departments for Public Health Cancer
Surveillance
1.2 User Story Narrative
This section will be used to identify key components and requirements of public health reporting
that may be standardized.
1.2.1 Goal
[Please describe the overall goal of the public health reporting program. Please include the
public health agency goals, as well as any goals from the healthcare perspective.]
The National Program of Cancer Registries (NPCR) is funded and managed by CDC’s Cancer
Surveillance Branch (CSB) in the Division of Cancer Prevention and Control (DCPC). NPCR
provides funds and technical assistance to 48 central cancer registries (CCRs) to improve
cancer registration and cancer surveillance throughout the United States. CDC builds state and
national capacity through support of the NPCR to monitor the burden of cancer, including
disparities among various population subgroups, and provides data for research, evaluation of
cancer control activities, and planning for future health care needs.
State-based cancer registries are data systems that collect, manage, and analyze data about
cancer cases and cancer deaths. In each state, medical facilities (including hospitals,
physicians' offices, therapeutic radiation facilities, freestanding surgical centers, and pathology
laboratories) report these data to a central cancer registry. Cancer surveillance is a complex
system that captures longitudinal data from all of these data sources using a variety of methods.
The cancer surveillance infrastructure consists of a complex network of hospitals, physician’s
offices, treatment centers, clinics, laboratories, health departments, non-governmental
organizations, and government agencies. In addition to recording the occurrence of each
reportable cancer (or tumor), the reporters provide information to CCRs on the diagnosis,
treatment and outcomes.
These data are used for surveillance and development of comprehensive cancer control
programs and health care planning and interventions. Improved accuracy of cancer surveillance
impacts all areas of public health interventions. Data also provide baseline measures and
performance measures for all cancer related interventions designed to reduce cancer incidence
or improve early detection. Identification of disparities in access to treatment or in treatment
received can inform interventions to reduce these disparities and reduce the cancer morbidity
and mortality in special populations.
1.2.2 Description of Data Reporting Events, Actors and Triggers
[Describe the setting in which data are collected, and how and when data are collected (the
triggers), and by whom. Include who generally collects the data, for what purposes (what clinical
purposes, if any, and what public health purposes). Describe, to the extent it is known, how
much of the data are currently captured in EHR systems, in practice management or other
systems, or on paper forms. Finally, describe the frequency of reports to public health, and how
the data are processed and used by public health.]
This user story covers two settings in which data are collected, Anatomic Pathology
Laboratories and Physician Offices.
Starting in the physician office, a patient is seen by a physician, who performs a procedure (e.g.,
a biopsy) based on a suspicion of cancer. The physician enters relevant information about the
patient, the encounter, the procedure, and the ordered test into the EHR system for his or her
own clinical purposes. The physician sends the tissue sample obtained during this procedure to
a pathology laboratory for analysis.
The pathologist at the pathology laboratory analyzes the tissue sample and determines that the
patient has cancer. The pathologist enters the relevant information into the Pathology
Laboratory Information System (Pathology LIS) for the laboratory’s purposes, including: patient
information; description of the tissue sample; characteristics of the identified tumor (histology,
behavior, grade, stage, etc.). The pathology laboratory sends a report of the results to the
ordering physician. The pathology laboratory also sends a report, using the North American
Association of Central Cancer Registries (NAACCR) Standards for Cancer Registries Volume V:
Pathology Laboratory Electronic Reporting (Version 2.2 or higher), to the public health cancer
registry where the patient resides. The laboratory could also send the reports through a Health
Information Exchange (HIE). The trigger for reporting cancer cases to CCRs is a list of
reportable cancers. The NPCR has developed a list of ICD-9 CM codes that laboratories can
use to identify reportable cancers for all states. There is also a NAACCR search term list that
can be used by laboratories to identify cases to be reported. A third method is that some
laboratories have their own indicator within the Pathology LIS that allows the pathologist or a
coder to identify cases as reportable cancers.
The physician receives the pathology laboratory report, incorporates the findings into the EHR,
and enters a diagnosis into the EHR system for the patient based on the pathology results. The
physician follows up with the patient and develops a treatment plan. Using the same list of ICD9-CM codes and/or a list of CPT4 procedure codes as the trigger, the EHR system reports the
new diagnosis of cancer and relevant information to the public health cancer registry (initial case
report), using the Integrating the Healthcare Enterprise (IHE) Physician Reporting to a Public
Health Repository-Cancer Registry (PRPH-Ca) Profile format. The cancer reporting to the
cancer registry can either be performed by the EHR as a completely automated function or the
EHR could pre-populate a form and give the physician an opportunity to review the report and
enter any additional information if needed. Reports could also be sent through an HIE.
Currently the overwhelming majority of pathology laboratories capture all of the information in
their Laboratory Information Systems that is needed for reporting to registries. Many report
electronically using a standard developed by the North American Association of Central Cancer
Registries (NAACCR).
The majority of physician offices are not currently reporting to public health cancer registries,
resulting in a gap in knowledge of non-hospital cancer diagnoses and treatment. Physicians’
offices that do report to cancer registries accomplish it via submission of paper reports or
through manual data entry into web-based forms. We believe that most of the information
required by cancer registries is captured in ambulatory/physician office EHRs, and that reporting
to public health cancer registries should not change the normal workflow of the physicians.
Specialty oncology EHRs probably capture all of the information required by cancer registries.
The frequency of pathology laboratory reporting to public health cancer registries varies: daily if
reporting is performed electronically, monthly or annually if reporting is performed by paper
document submission. Frequency of physician reporting to cancer registries is currently monthly
or annually. In the future, with the use of EHRs to automate physician reporting, it could be done
on a daily, weekly or monthly basis, depending on requirements of the public health cancer
registry. State cancer registries are currently able to process pathology laboratory reports in
HL7 2.3.1 and 2.5.1 formats, using the CDC-developed tool eMaRC Plus. Some states have
their own in-house systems which are also capable of processing these HL7 reports. eMaRC
Plus also has the capability to receive and process physician reports formatted according to
HL7 CDA format specified in the IHE PRPH-Ca profile (see additional information in Data
section below). In addition to mapping the various HL7 formats to the NAACCR data standard,
eMaRC Plus performs various processing functions including auto-coding of certain data
elements, vocabulary mapping, and natural language processing. After processing and any
needed manual review, registries can export a completed cancer abstract and import it into their
central cancer registry database. Registries complete various additional processing steps in
their cancer registry systems, and then are able to use the data for follow-up, analysis and
reporting de-identified patient data for all diagnosed cancer cases to the national level.
1.2.3 Data
[Please list the individual demographic, clinical, lab results, or other data that are currently
reported, and where possible, indicate if these are based on nationally accepted standards. If
possible, submit the data set, include a sample report or form.]
APPENDIX 1, TABLE 1: Pathology Laboratory Reporting to Cancer Registry provides the
required Pathology Laboratory Reporting data elements, which are based on the nationally
accepted the North American Association of Central Cancer Registries (NAACCR) Standards
for Cancer Registries Volume V: Pathology Laboratory Electronic Reporting (Version 2.2 or
higher) which have been accepted by all public health cancer registries The HL7 v2.5.1
standard has also been accepted internationally as the IHE Anatomic Pathology Reporting to
Public Health (ARPH) profile.
APPENDIX 1, TABLE 2: Physician Reporting to Cancer Registry 2 provides the data elements
that have been identified for physician reporting in the IHE Physician Reporting to a Public
Health Repository - Cancer Registry (PRPH-Ca) profile. The profile specifies the data elements,
vocabularies, and HL7 Clinical Document Architecture (CDA) for reporting, and uses HL7
Continuity of Care Document (CCD) templates. This profile has gone through IHE’s review and
comment process and is currently published for trial implementation. The data elements have
been agreed upon by a workgroup consisting of state public health cancer registries and a
number of other stakeholders. NPCR plans to combine the PRPH-Ca profile and other
documents to make up a Cancer Reporting Implementation Guide that will be vetted nationally
and may be published by NAACCR.
1.2.4 Other information
[Please provide any other pertinent information, for example: description of current health
information exchange standards that support the reporting; the prevalence/incidence of the
event of public health interest; the level of program participation in national health information
technology standards; and other information that could support selection of this user story for
the Initiative.]
Current Health Information Standards and Program Participation in National Health
Information Technology Standards
Anatomic Pathology Laboratory Reporting to state cancer registries uses the NAACCR
Standards for Cancer Registries Volume V: Pathology Laboratory Electronic Reporting (Version
2.2 or higher) that can be found at
http://www.naaccr.org/StandardsandRegistryOperations/VolumeV.aspx. Physician reporting to
state cancer registries from EHRs will use the Integrating the Healthcare Enterprise (IHE)
Physician Reporting to a Public Health Repository-Cancer Registry (PRPH-Ca) Profile
(http://www.ihe.net/Technical_Framework/upload/IHE_QRPH_Suppl_PRPH_Ca_Rev2-1_201109-02.pdf). Both of these specifications use HL7 standards and also use national and/or
internationally recognized vocabulary standards, including but not limited to: Logical
Observation Identifiers Names and Codes (LOINC) version 2.36. Code; Systematized
Nomenclature of Medicine--Clinical Terms (SNOMED CT) International Release – July 2009;
2010 Standard Occupational Classification (SOC); Public Health Data Standards Consortium
Source of Payment Typology Version 4.0; International Classification of Diseases for Oncology,
Version 3 (ICD-O-3) Morphology; AJCC Cancer Staging Manual, 7th Edition; International
Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 2011 Addenda
Diagnosis Code; American Medical Association’s Current Procedure Terminology, 4th Edition
(CPT-4) Procedure Code; RxNorm, Version 2011-5.
Other standards/specifications used include:
1. HITSP_V2.5_2009_TP50_-_Retrieve_Form_for_Data_Capture.pdf
2. IHE_ITI_Suppl_RFD_Rev2-1_TI_2010-08-10.pdf – IT Infrastructure Supplement Guide.
3. IHE Patient Care Coordination (PCC) Technical Framework Supplement CDA Content
Modules
4. HL7 Implementation Guide: CDA Release 2 – Continuity of Care Document (CCD)
5. Associated CCD schemas and templates.
CDC NPCR staff participate in a wide variety of national health information technology
standards activities, including: HL7 workgroups, IHE committees, and S & I Framework
initiatives.
Relevant Cancer Statistics
In 2007, there were 562,875 deaths from cancer in the US, ranking it as the second highest
cause of death. The numbers of non-institutionalized adults who have ever been diagnosed with
cancer is18.6 million, and the percent of non-institutionalized adults who have ever been
diagnosed with cancer is 8.2%. Data on approximately 1.2 million new invasive cancer cases
are collected by NPCR each year.
Advances in medicine and changes in the healthcare delivery system now allow patients to
obtain their care outside the acute care hospital setting. Private oncology clinics deliver 80% of
all cancer care. Data collection systems from other sources such as these physician
offices/clinics and radiation therapy centers, however, are not as consistent or complete with
reporting. This leads to under-reporting of certain types of cancers, especially those now
diagnosed and treated outside of hospitals, such as in dermatology, urology and hematology.
Both melanomas and prostate cancers, for example, have been shown to be under-reported
when central registries rely only on hospital reporting. One study estimated that over 1,000
prostate and bladder cancer cases were not reported in single year to a single CCR, or up to
54,000 additional prostate and bladder cancer cases per year nationally.
1.3 Stakeholder Commitment
[Describe the level of stakeholder readiness and commitment to participate in this initiative. Has
a relevant professional association discussed and/or voted on this proposal? ]
Many state cancer registries already receive electronic pathology laboratory reports and there
are registries interested in receiving physician reports from EHRs, so we expect there will be
states interested in participating. Two public health cancer registries, Missouri and Kentucky,
currently receive ARRA Comparative Effectiveness Research funding through NPCR for pilot
testing implementation of physician reporting, and other states have also expressed interest in
getting involved. Any public health cancer registry that uses or is willing to use eMaRC Plus for
receiving and processing both pathology and physician reports will be ready to participate in
pilot testing.
Two vendors, 4Medica and Sunquest have successfully tested the ARPH profile at IHE
Connectathon and demonstrated at HIMSS and other Showcases. Three EMR vendors,
Greenway, eMDs and Allscripts tested the PRPH-Ca profile at the 2010 IHE Connectathon and
demonstrated implementation of the profile specifications at HIMSS and/or other Showcases.
These three vendors plan to test and demonstrate again, along with three new additional EMR
vendors and one state program that have signed up to test at Connectathon: Epic, GE,
EndoSoft and Washington State.
The North American Association of Central Cancer Registries (NAACCR) is a committed
stakeholder in supporting the development and implementation of standardized reporting from
pathology laboratories and physician offices. The NAACCR community took the lead in the
development of the pathology laboratory reporting standard and has been supporting the
maintenance of the laboratory standard through the NAACCR Pathology Data Workgroup
activities. NAACCR has identified several of their working group members to monitor and
participate in the development and testing of the IHE PRPH-Ca profile to ensure that it will meet
cancer registry data needs.
APPENDIX 1
TABLE 1: Pathology Laboratory Reporting to Cancer Registry
HL7
Segment
Element Name
MSH
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
Element Name
1
Field Separator
R
R
R
R
2
Encoding Characters
R
R
R
R
3
Sending Application
O
O
O
RE
4
Sending Facility
O
O
R
R
5
Receiving Application
O
O
O
RE
6
Receiving Facility
O
O
O
RE
7
Date/Time of Message
R
R
R
R
8
Security
O
O
O
X
9
Message Type
R
R
R
R
10
Message Control ID
R
R
R
R
11
Processing ID
R
R
R
R
12
Version ID
R
R
R
R
13
Sequence Number
O
O
O
RE
14
Continuation Pointer
O
O
O
CE
15
Accept Acknowledgment Type
O
O
O
X
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
16
Application Acknowledgment Type
O
O
O
X
17
Country Code
O
O
O
RE
18
Character Set
O
O
O
X
19
Principal Language of Message
O
O
O
RE
20
Alternate Character Set Handling
Scheme
O
O
X
X
21
Message Profile Identifier
O
O
RE
RE
SFT
1
Software Vendor Organization
R
R
2
Software Certified Version or
Release Number
R
R
3
Software Product Name
R
R
4
Software Binary ID
R
R
5
Software Product Information
O
RE
6
Software Install Date
O
RE
1
Continuation Pointer
O
RE
2
Continuation Style
O
RE
DSC
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
MSA
1
Acknowledgement Code
R
R
2
Message Control ID
R
R
3
Text Message
B
CE
4
Expected Sequence Number
O
RE
5
Delayed Acknowledgement Type
W
X
6
Error Condition
B
CE
1
Error Code and Location
B
X
2
Error Location
O
RE
3
HL7 Error Code
R
R
4
Severity
R
R
5
Application Error Code
O
X
6
Application Error Parameter
O
X
7
Diagnostic Information
O
RE
8
User Message
O
RE
9
Inform Person Indicator
O
X
ERR
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
10
Override Type
O
X
11
Override Reason Code
O
X
12
Help Desk Contact Point
O
RE
PID
1
Set ID - PID
O
O
O
R
2
Patient ID
B
B
B
RE
3
Patient Identifier List
R
R
RE
R
4
Alternate Patient ID - PID
B
B
B
X
5
Patient Name
R
R
R
R
6
Mother's Maiden Name
O
O
O
X
7
Date/Time of Birth
O
O
RE
RE
8
Administrative Sex
O
O
RE
RE
9
Patient Alias
B
B
O
RE
10
Race
O
O
RE
RE
11
Patient Address*
O
O
RE
RE
12
County Code
B
B
B
X
13
Phone Number - Home
O
O
O
RE
14
Phone Number - Business
O
O
O
RE
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
15
Primary Language
O
O
O
RE
16
Marital Status
O
O
O
RE
17
Religion
O
O
O
RE
18
Patient Account Number
O
O
O
CE
19
SSN Number - Patient
B
B
B
CE
20
Driver's License Number - Patient
O
B
O
X
21
Mother's Identifier
O
O
O
X
22
Ethnic Group
O
O
RE
RE
23
Birth Place
O
O
O
RE
24
Multiple Birth Indicator
O
O
X
X
25
Birth Order
O
O
X
X
26
Citizenship
O
O
X
X
27
Veteran's Military Status
O
O
X
X
28
Nationality
B
B
O
X
29
Patient Death Date and Time
O
O
O
RE
30
Patient Death Indicator
O
O
RE
31
Identify Unknown Indicator
O
-
RE
32
Identity Reliability Code
O
-
RE
33
Last Update Date/Time
O
-
X
HL7
Segment
Element Name
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
HL7
2.3.1
34
Last Update Facility
O
-
X
35
Species Code
O
-
X
36
Breed Code
O
-
X
37
Strain
O
-
X
38
Production Class Code
O
-
X
39
Tribal Citizenship
O
RE
1
Set ID - NK1
R
R
2
Name
O
RE
3
Relationship
O
RE
4
Address
O
RE
5
Phone Number
O
RE
6
Business Phone Number
O
X
7
Contact Role
O
X
8
Start Date
O
X
9
End Date
O
X
Next of Kin/ Associated Parties Job
Title
O
X
NKI
10
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
11
Next of Kin/Associated Parties Job
Code/Class
O
X
12
Next of Kin/Associated Parties
Employee Number
O
X
13
Organization Name - NK1
O
X
14
Marital Status
O
X
15
Administrative Sex
O
X
16
Date/Time of Birth
O
X
17
Living Dependency
O
X
18
Ambulatory Status
O
X
19
Citizenship
O
X
20
Primary Language
O
X
21
Living Arrangement
O
X
22
Publicity Code
O
X
23
Protection Indicator
O
X
24
Student Indicator
O
X
25
Religion
O
X
26
Mother's Maiden Name
O
X
27
Nationality
O
X
28
Ethnic Group
O
X
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
29
Contact Reason
O
X
30
Contact Person's Name
O
X
31
Contact Person's Telephone
Number
O
X
32
Contact Person's Address
O
X
33
Next of Kin/Associated Party's
Identifiers
O
X
34
Job Status
O
X
35
Race
O
X
36
Handicap
O
X
37
Contact Person Social Security
Number
O
X
38
Next of Kin Birth Place
O
X
39
VIP Indicator
O
X
1
Set ID - PV1
O
O
O
RE
2
Patient Class
R
R
R
R
3
Assigned Patient Location
O
O
X
X
4
Admission Type
O
O
O
X
PV1
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
5
Pre-admit Number
O
O
X
X
6
Prior Patient Location
O
O
X
X
7
Attending Doctor
O
O
RE
RE
8
Referring Doctor
O
O
RE
RE
9
Consulting Doctor
B
B
X
RE
10
Hospital Service
O
O
X
X
11
Temporary Location
O
O
X
X
12
Pre-admit Test Indicator
O
O
X
X
13
Re-admission Indicator
O
O
X
X
14
Admit Source
O
O
X
X
15
Ambulatory Status
O
O
X
X
16
VIP indicator
O
O
X
X
17
Admitting Doctor
O
O
X
RE
18
Patient Type
O
O
X
X
19
Visit Number
O
O
X
X
20
Financial Class
O
O
X
X
21
Charge Price Indicator
O
O
X
X
22
Courtesy Code
O
O
X
X
23
Credit Rating
O
O
X
X
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
24
Contracting Code
O
O
X
X
25
Contract Effective Date
O
O
X
X
26
Contract Amount
O
O
X
X
27
Contract Period
O
O
X
X
28
Interest Code
O
O
X
X
29
Transfer to Bad Debt Code
O
O
X
X
30
Transfer to Bad Debt Date
O
O
X
X
31
Bad Debt Agency Code
O
O
X
X
32
Bad Debt Transfer Amount
O
O
X
X
33
Bad Debt Recovery Amount
O
O
X
X
34
Delete Account Indicator
O
O
X
X
35
Delete Account Date
O
O
X
X
36
Discharge Disposition
O
O
X
X
37
Discharge to Location
O
O
X
X
38
Diet Type
O
O
X
X
39
Servicing Facility
O
O
X
X
40
Bed Status
B
B
X
X
41
Account Status
O
O
X
X
42
Pending Location
O
O
X
X
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
43
Prior Temporary Location
O
O
X
X
44
Admit Date/Time
O
O
X
X
45
Discharge Date/Time
O
O
X
X
46
Current Patient Balance
O
O
X
X
47
Total Charges
O
O
X
X
48
Total Adjustments
O
O
X
X
49
Total Payments
O
X
X
50
Alternate Visit ID
O
X
X
51
Visit Indicator
O
X
X
52
Other Healthcare Provider
B
X
X
See
Stan
dar
ds
NOT
INCLUDED
NOT
INCLUDED
PV2
See HL7 2.5.1 ELR Guide
ORC
1
Order Control
R
R
R
R
2
Placer Order Number
C
C
X
X
3
Filler Order Number
C
C
X
X
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
4
Placer Group Number
O
O
X
X
5
Order Status
O
O
X
X
6
Response Flag
O
O
X
X
7
Quantity/Timing
O
B
X
X
8
Parent
O
O
X
X
9
Date/Time of Transaction
O
O
X
X
10
Entered By
O
O
X
X
11
Verified By
O
O
X
X
12
Ordering Provider
O
O
X
X
13
Enterer's Location
O
O
X
X
14
Call Back Phone Number
O
O
X
X
15
Order Effective Date/Time
O
O
X
X
16
Order Control Code Reason
O
O
X
X
17
Entering Organization
O
O
X
X
18
Entering Device
O
O
X
X
19
Action By
O
O
X
X
20
Advanced Beneficiary Notice Code
O
O
X
X
21
Ordering Facility Name
O
R
C
22
Ordering Facility Address
O
RE
RE
HL7
Segment
Element Name
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
HL7
2.3.1
23
Ordering Facility Phone Number
O
RE
RE
24
Ordering Provider Address
O
RE
RE
25
Order Status Modifier
O
X
26
Advanced Beneficiary Notice
Override Reason
C
X
27
Fillers Expected Availability
Date/Time
O
X
28
Confidentiality Code
O
RE
29
Order Type
O
X
30
Enterer Authorization Mode
O
X
31
Parent Universal Service Identifier
O
CE
NOT
INCL
UDE
D
SPM
1
Set ID - SPM
O
RE
2
Specimen Id
O
R
3
Specimen Parent IDs
O
RE
4
Specimen Type
R
R
5
Specimen Type Modifier
O
X
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
6
Specimen Additives
O
X
7
Specimen Collection Method
O
X
8
Specimen Source Site
O
X
9
Specimen Source Site Modifier
O
X
10
Specimen Collection Site
O
X
11
Specimen Role
O
X
12
Specimen Collection Amount
O
X
13
Grouped Specimen Count
C
X
14
Specimen Description
O
X
15
Specimen Handling Code
O
X
16
Specimen Risk Code
O
X
17
Specimen Collection Date/Time
O
RE
18
Specimen Received Date/Time
O
RE
19
Specimen Expiration Date/Time
O
X
20
Specimen Availability
O
X
21
Specimen Reject Reason
O
RE
22
Specimen Quality
O
X
23
Specimen Appropriateness
O
X
24
Specimen Condition
O
X
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
25
Specimen Current Quantity
O
X
26
Number of Specimen Containers
O
RE
27
Container Type
O
X
28
Container Condition
O
X
29
Specimen Child Role
O
C
Accession Id
Not
incl
ude
d
RE
Other Specimen ID
Not
incl
ude
d
RE
30
31
NOT
INCLUDED
SAC
3
Container Identifier
C
4
Primary (Parent) Container
Identifier
C
6
Specimen Source
C
10
Carrier Identifier
O
11
Position in Carrier
O
HL7
Segment
Element Name
HL7
2.3.1
2.5
13
Tray Identifier
O
14
Position in Tray
O
15
Location
O
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
OBR
1
Set ID - OBR
O
O
R
R
2
Placer Order Number
C
C
O
RE
3
Filler Order Number
C
C
R
R
4
Universal Service Identifier
R
R
R
R
5
Priority - OBR
X
X
X
X
6
Requested Date/Time
X
X
X
X
7
Observation Date/Time
C
C
R
R
8
Observation End Date/Time
O
O
X
X
9
Collection Volume
O
O
X
X
10
Collector Identifier
O
O
X
RE
11
Specimen Action Code
O
O
X
X
12
Danger Code
O
O
X
X
13
Relevant Clinical Information
O
O
X
X
14
Specimen Received Date/Time
C
B
RE
RE
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
15
Specimen Source
O
B
O
RE
16
Ordering Provider
O
O
R
C
17
Order Callback Phone Number
O
O
O
RE
18
Placer Field 1
O
O
X
X
19
Placer Field 2
O
O
X
X
20
Filler Field 1
O
O
X
X
21
Filler Field 2
O
O
RE
RE
22
Results Rpt/Status Chng Date/Time
C
C
RE
23
Charge to Practice
O
O
X
X
24
Diagnostic Serv Sect ID
O
O
X
X
25
Result Status
C
C
R
R
26
Parent Result
O
O
O
CE
27
Quantity/Timing
O
B
X
X
28
Result Copies To
O
O
O
X
29
Parent Result
O
O
O
CE
30
Transportation Mode
O
O
O
X
31
Reason for Study
O
O
O
RE
32
Principal Result Interpreter
O
O
R
RE
RE
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
33
Assistant Result Interpreter
O
O
O
X
34
Technician
O
O
O
X
35
Transcriptionist
O
O
X
X
36
Scheduled Date/Time
O
O
X
X
37
Number of Sample Containers
O
O
X
X
38
Transport Logistics of Collected
Sample
O
O
X
39
Collector's Comment
O
O
X
40
Transport Arrangement
Responsibility
O
O
X
41
Transport Arranged
O
O
X
X
42
Escort Required
O
O
X
X
43
Planned Patient Transport
Comment
O
O
X
44
Procedure Code
O
O
O
CE
45
Procedure Code Modifier
O
O
O
X
46
Placer Supplemental Service
Information
47
Filler Supplemental Service
Information
X
X
X
X
X
O
O
X
O
O
-
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
48
Medically Necessary Duplicate
Procedure Reason
C
49
Result Handling
O
RE
50
Parent Universal Service Identifier
O
CE
1
Contact Role
R
2
Contact Name
O
3
Contact Address
O
4
Contact Location
O
5
Contact Communication
Information
O
6
Preferred Method of Contact
O
7
Contact Identifiers
O
1
Set ID - OBX
O
O
R
R
2
Value Type
C
C
R
R
3
Observation Identifier
R
R
R
R
4
Observation Sub-ID
C
C
O
RE
X
CTD
OBX
HL7
Segment
Element Name
HL7
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
2.3.1
2.5
HL7 2.3.1
HL7 2.5.1
April 2011
5
Observation Value
C
C
R
R
6
Units*
O
O
RE
RE
7
Reference Range
O
O
O
RE
8
Abnormal Flags
O
O
O
RE
9
Probability
O
O
O
X
10
Nature of Abnormal Test
O
O
O
RE
11
Observation Result Status
R
R
RE
R
12
Date Last Observation Normal
Value
O
O
O
13
User Defined Access Checks
O
O
O
X
14
Date/Time of the Observation
O
O
O
RE
15
Producer's ID
O
O
O
CE
16
Responsible Observer
O
O
O
RE
17
Observation Method
O
O
O
RE
18
Equipment Instance Identifier
O
O
-
X
19
Date/Time of the Analysis
O
O
-
CE
20
Reserved for harmonization with
V2.6
X
Not
spec
ified
X
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
X
Reserved for harmonization with
V2.6
Not
spec
ified
X
22
Reserved for harmonization with
V2.6
Not
spec
ified
23
Performing Organization Name
O
RE
24
Performing Organization Address
O
CE
25
Performing Organization Medical
Director
21
X
O
NTE
1
Set ID - NTE
O
O
O
RE
2
Source of Comment
O
O
O
RE
3
Comment
O
O
O
RE
4
Comment Type
O
O
O
RE
FHS
R
1
File field separator
R
R
2
File encoding characters
O
R
3
File Sending Application
O
RE
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
4
File Sending Facility
O
R
5
File Receiving Application
O
RE
6
File Receiving Facility
O
RE
7
File Creation Date/Time
O
R
8
File Security
O
RE
9
File name/ID/Type
O
RE
10
File Comment
O
RE
11
File Control ID
O
RE
12
Reference File Control ID
O
RE
1
File Batch Count
O
R
2
File Trailer Comment
O
RE
1
Batch field separator
R
R
2
Batch encoding characters
R
R
3
Batch sending application
O
RE
4
Batch sending facility
O
R
FTS
BHS
HL7
Segment
Element Name
HL7
2.3.1
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
5
Batch receiving application
O
RE
6
Batch receiving facility
O
RE
7
Batch creation date/time
O
R
8
Batch security
O
RE
9
Batch name/ID/type
O
RE
10
Batch comment
O
RE
11
Batch control ID
O
RE
12
Reference batch control ID
O
RE
1
Batch message count
O
R
2
Batch comment
O
RE
3
Batch totals
O
RE
BTS
Legend
Required
HL7
Segment
Element Name
HL7
2.3.1
R
Required but may be empty
The element may be missing from
the message, but must be sent by
the sending application if there is
relevant data. If the confirming
sending applications knows the
required values for the element,
then it must send that element. If
the conforming sending application
does not know the required values,
then that element will be omitted.
RE
Conditional
C
Optional
O
Backwards Compatible
B
Not used for this trigger event
X
Recommended to be submitted
(Ireland)
Rec
Specific to message type
Used only in a shared messagestructure specification i.e. a
specification that is shared by
multiple message types.
2.5
NAACCR
USA/CAN
Vers 2.2
NAACCR
USA/CAN
Vers 4.0
usage
HL7 2.3.1
HL7 2.5.1
April 2011
TABLE 2: Physician Reporting to Cancer Registry
Data Element
Mapping Constraints (Code
Systems and/or Value Sets)
Optionality
(M=Mandatory
, R=Required
but can be
null)
Date Case Report Exported
M
Patient Name
(First, Middle, Last)
M
Patient Address
(Street Address, City, State, Zip Code,
Country)
R
Address History
R
Patient Telephone
R
Patient Sex/Gender
H&P DSTU OID for
Administrative Gender
2.16.840.1.113883.5.1
R
PHINVADS link for HL7 V3
Administrative Gender
2.16.840.1.113883.1.11.1
Patient Date of Birth
R
Patient Medical Record Number
M
Patient Social Security Number
R
Patient Race
H&P DSTU OID for Race
2.16.840.1.113883.5.104
R
PHINVADS link for HL7 V3 Race
2.16.840.1.113883.1.11.14914
Patient Ethnicity
H&P DSTU OID for Ethnicity
2.16.840.1.113883.5.50
PHINVADS link for HL7
V3Ethnicity
2.16.840.1.114222.4.11.837
Patient Birth Place
R
R
Data Element
Patient Marital Status
Mapping Constraints (Code
Systems and/or Value Sets)
Optionality
(M=Mandatory
, R=Required
but can be
null)
H&P DSTU OID for Marital Status
2.16.840.1.113883.5.2
PHINVADS link for HL7 V3
Marital Status
2.16.840.1.113883.1.11.12212
R
Physician Name
M
Physician Address
M
Provider Organization
M
Provider Referred From
R
Coded Social History Section
R
Social History Narrative
Occupation
Industry
History of Tobacco Use
R
2.16.840.1.113883.6.243
2.16.840.1.114222.4.11.887
PHIN VADS Link for occupation
(SOC)
DYNAMIC
R
2.16.840.1.113883.6.85
2.16.840.1.114222.4.11.1100
PHIN VADS link for Industry NAICS 2007
DYNAMIC
R
2.16.840.1.113883.3.520.3.16
Payers Section
Primary Payer at Diagnosis
R
R
X12 Data Element 1336
(2.16.840.1.113883.6.255.1336)
OR
R
Source of Payer Typology
(2.16.840.1.113883.221.5)
Cancer Diagnosis Section
M
Cancer Diagnosis Entry
R
Data Element
Mapping Constraints (Code
Systems and/or Value Sets)
Diagnosis Date
Optionality
(M=Mandatory
, R=Required
but can be
null)
R
Histology
2.16.840.1.113883.6.43.1
(ICD-O-3)
R
Behavior
2.16.840.1.113883.3.520.4.14
PHINVADS link to Behavior
R
Best Method of Confirmation (Diagnostic
confirmation)
2.16.840.1.113883.3.520.4.3
PHINVADS link to Best Method
of Confirmation
R
Primary Site
2.16.840.1.113883.6.43.1
(ICD-O-3)
R
Laterality
2.16.840.1.113883.3.520.4.1
PHINVADS link to Laterality
R
2.16.840.1.113883.15.6
(TNM Classification of Malignant
Tumours, 7th Edition)
R
Stage Group Narrative
TNM Clinical Stage Group
TNM Clinical Stage Descriptor
PHINVADS link for TNM Stage
Descriptor
R
TNM Edition
2.16.840.1.113883.3.520.4.5
PHINVADS link for TNM Edition
R
TNM Clinical Staged By
2.16.840.1.113883.3.520.4.4
PHINVADS link to TNM Staged
By
R
2.16.840.1.113883.15.6
(TNM Classification of Malignant
Tumours, 7th Edition)
R
2.16.840.1.113883.15.6
(TNM Classification of Malignant
Tumours, 7th Edition)
R
2.16.840.1.113883.15.6
(TNM Classification of Malignant
Tumours, 7th Edition)
R
TNM Clinical T
TNM Clinical N
TNM Clinical M
Active Problems Section
R
Data Element
Active Problems (includes Comorbidities)
Mapping Constraints (Code
Systems and/or Value Sets)
2.16.840.1.113883.6.103
(ICD-9 CM)
PHINVADS link for Comorbidities
Progress Note Section
Optionality
(M=Mandatory
, R=Required
but can be
null)
R
R
Progress Notes Narrative
Coded Results Section
Procedure
R
2.16.840.1.113883.6.12
(CPT-4)
R
Procedure Date
Coded Result
Result Text
Result Date
Diagnosing Laboratory
Procedures Section
R
Procedure (e.g., Surgery of primary site)
2.16.840.1.113883.6.12
(CPT-4)
R
Site of procedure
Date of Surgery
Procedures– Narrative Radiation Therapy
Section
Radiation Therapy Narrative
R
Medications Section
R
Medications
(Chemotherapy, Hormone Therapy,
Immunotherapy)
2.16.840.1.113883.6.88
(RxNorm)
OR
R
2.16.840.1.113883.6.285
(HCPCS Level II Alphanumeric
Codes)
Start Date
R
Stop Date
R
Data Element
Mapping Constraints (Code
Systems and/or Value Sets)
Optionality
(M=Mandatory
, R=Required
but can be
null)
Frequency
R
Route
R
Dose
R
Site
R
Rate
R
Product
R
Strength
R
Code
R
Medications Administered Section
(medications that are administered during
the encounter)
Chemotherapy, Hormone Therapy,
Immunotherapy
R
Medications
(Chemotherapy, Hormone Therapy,
Immunotherapy)
2.16.840.1.113883.6.88
(RxNorm)
OR
R
2.16.840.1.113883.6.285
(HCPCS Level II Alphanumeric
Codes)
Start Date
R
Stop Date
R
Frequency
R
Route
R
Dose
R
Site
R
Rate
R
Product
R
Strength
R
Code
R
Care Plan Section
R
Observation Requests
R
Data Element
Medication
Procedure
Patient Referred To
Mapping Constraints (Code
Systems and/or Value Sets)
2.16.840.1.113883.6.88
(RxNorm)
OR
2.16.840.1.113883.6.285
(HCPCS Level II Alphanumeric
Codes)
2.16.840.1.113883.6.12
(CPT-4)
Optionality
(M=Mandatory
, R=Required
but can be
null)
R
R
R