Cancer Registrars: Beyond the Abstract

Transcription

1 Cancer Registrars: Beyond the Abstract Presented by Melissa Smith, RHIT, CTR Director of Client Services CHAMPS Oncology

2 Objectives Identify what is a Certified Tumor Registrar (CTR) and how someone becomes a CTR through education and credentialing Discuss 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 2

3 History of Cancer Registration Bills of Mortality (England) General Cancer Census (London) Cancer Campaign Committee (ACoS, Chicago) Bone Sarcoma Registry (U.S.) 3

4 History of Cancer Registries, U.S & First hospital registry at Yale-New Haven Hospital in New Haven, CT First central cancer registries (Connecticut and California) American College of Surgeons requires a cancer registry for approved cancer programs. National Cancer Act budgets monies to the National Cancer Institute for research, detection and treatment of cancer. 4

5 History of Cancer Registries, U.S Surveillance, Epidemiology and End Results (SEER) Program of NCI establishes the first national cancer registry Congress establishes a National Program of Cancer Registries (Public Law ) State laws make cancer a reportable disease 5

6 What is a Cancer Registrar? Data management experts in oncology 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 6

7 What is a CTR? First exam administered in 1983 The first certification exam for cancer (tumor) registry professionals Certified Tumor Registrar 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 7

8 Why a CTR? Simply put, oncology is a complex field, more so now than ever before Therefore oncology data is more complex 8

9 Where we have come: Cancer Registry Coding Manuals 9

10 Why a CTR? (con t) Promotes excellence in the profession 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 CoCapproved program 10

11 How does one become a CTR? Two main eligibility routes for the CTR exam: Route A: Experience & CIM Program Route B: Experience & Associate Degree Complete a NCRA- Accredited Associate Degree or Formal Education Have an Associate Degree including 2 semesters of Human A & P Work practicum of 160 hours in a CTRstaffed cancer registry Work 1 year full time (1950 hrs) in the cancer registry field 11

12 How does one become a CTR? CTR Exam 3 testing windows (March/June/Oct) CTR Exam Content Open Book: Data collection Closed book: More data collection, quality assurance, data usage, and more Full outline of content: questions, 4 hours total Part 1 closed book, 180 items, max 2.5 hours Part 2 open book, 45 items, minimum 1.5 hours 12

13 Life of the Traditional Hospital Registrar Typical work that a cancer registrar may be responsible for in the hospital setting 13

14 Life of the Hospital Registrar Casefinding Suspense System Maintenance Case Abstracting Follow-up Data for Studies/Reports Cancer Conferences and Committee (CoC) 14

15 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 15

16 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? 16

17 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 17

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20 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 20

21 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 21

22 *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 22

23 Cancer Registry Management Job Descriptions Cancer Registry Software Policy and Procedure Manual Quality Control of Data Confidentiality and Release of Information Retention of Documents 23

24 Life Outside the Traditional Setting Exploring some of the alternative projects and workplaces for CTRs 24

25 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! 25

26 Resource Planning Analyst Just one job title for doing everything else 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 26

27 Quality & Information Specialist Concentrates on ensuring highquality data Performs QA on cancer registrars Performs QA on hospital registry data Education & Training Educate those areas where QA falls short Provides data/information as needed Helps develop reports for questions being asked of the data 27

28 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) 28

29 Rapid Quality Reporting System (RQRS) Even though it s only 3 primary sites now looking at other disease sites to expand to Lung Stomach Prostate Registrars need to be proficient in these primaries, standard treatment protocol, and how/where to find the data needed New staff hired to complete these cases only Used to be just retroactive data (CP3R) 29

30 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 30

31 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 31

32 Central Cancer Registries State Central Registries Capture all the cancer incidence in a geographical area vs. by diagnosing or treating hospital. DoD and VAMC Central Registries Based on specific populations vs. geographical area Incidence only vs. multipurpose One time reporting vs. treatment, follow-up etc. 32

33 Vendors Cancer registry software is very specific Sales staff Companies use CTRs for help think super user Who better to sell a cancer registry software to a cancer registry? Why a CTR of course! Help registrars get the most out of the software Train new clients Help clients use reports, query systems, etc. Edits and abstracting questions 33

34 Standard Setters The groups behind the code books, creating data standards and education on how to code and follow the manuals. Places include: 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 34

35 Special Data Abstraction Think of the clinical data abstractors Permedion, other QIO organizations Typically nurses Projects tracking compliance with standard quality of care measures Site specific or clinical research specific registries Now these are branching into oncology measures AND being tied to reimbursement Finally Cancer Registry CAN be a revenue generating department! 35

36 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) 36

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39 Summary Cancer registrars and the CTR certification Important for ensuring highquality 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 39

40 Resources Cancer Registry Management: Principles & Practice National Cancer Registrars Association 2 nd Ed, 2004 (there is now a 3 rd Ed available) NCRA Council on Certification SEER Training Modules 40

41 For More Information Melissa Smith, RHIT, CTR Director of Client Services CHAMPS Oncology Join the Discussion on Our Blog CHAMPS Oncology Outlook champsoncology.com 41