Cancer Registry Enrichment via Linkage with Hospital-Based Electronic Medical Records: A Pilot Investigation.

Background: Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. Objectives: To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. Methods: A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. Results: A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5% of registry records with updated surgery information, 1% of records with updated radiation information, and 7% of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. Conclusion: Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.

Enhancing central cancer registry treatment data using physician medical claims: a Florida pilot project.

BACKGROUND: To capture the complete first course of therapy and cancer incidence, given the shift in cancer care from the hospital to the private physician practice, central cancer registries (CCRs) in the United States are actively pursuing cancer reporting from ambulatory providers. The 837 medical health claim is a national standard which CCRs can use to capture and translate data into standardized cancer reporting for surveillance. METHODS: The Florida Cancer Data System conducted a pilot project with a large medical oncology practice to transmit electronic claims from 2011 to 2013. Using the logic and platform developed under a previous National Cancer Institute (NCI) contract, claims were consolidated and translated into standardized cancer registry codes. Consolidated physician claims were compared against gold standard data from the practice electronic health record (EHR) and evaluated for enhancement to registry data. RESULTS: A total of 623 patient tumor cases were collected from the practice EHR and matched to the physician claims data, and to the original cancer registry record. The claims captured 256 cases (41 percent) with chemotherapy, compared to 28 percent in the registry data set, and 45 percent in the gold standard EHR data set. Combining physician claims with registry data produced 280 cases (45 percent) with chemotherapy. The physician claims plus the registry cancer chemotherapy treatment data produced 92 percent agreement, 92 percent sensitivity, and 91 percent positive predictive value. Claims added 103 cases, or 16.5 percent, to the total chemotherapy received. CONCLUSIONS: Physician medical claims data capture chemotherapy information not otherwise reported by hospitals, and is a standardized and efficient mechanism for cancer reporting.

Cancer registry enrichment via linkage with hospital-based electronic medical records: a pilot investigation.

BACKGROUND: Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. OBJECTIVES: To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. METHODS: A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. RESULTS: A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5 percent of registry records with updated surgery information, 1 percent of records with updated radiation information, and 7 percent of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. CONCLUSION: Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.