Tag Archives: data collection

EHRs (Expensive. Hideous? Required!)

By Amanda Patton, ACCC Communications

Resonating across sessions at last week’s 34th ACCC National Oncology Conference: EHR issues. One sentence takeaway: As data collection and reporting requirements multiply, the ideal oncology EHR solution remains elusive.

Here’s a snapshot of what we heard during Friday’s panel discussion on “Strategies for Optimizing Your EHR”: the good, the bad, and, yes, the getting better.

Control, or lack thereof. Sometimes a cancer program or practice has successfully tailored their EHR to meet their operational, programmatic, and reporting needs—only to have the health system or hospital opt for a completely new system.

Interoperability. While Friday’s panel discussion revealed some steps to successful EHR utilization for reporting, panelists also spoke about ongoing challenges, including having to work with several EHRs on a daily basis. “Multiple EHRs require a lot of flexibility, especially for oral medications,” said panelist Linda Frisk, PharmD, Arizona Oncology Associates, PC.

Too many portals. Oncology staff may use three different EHRs on a daily basis, plus some additional portals, for example, for specialty pharmacy. For providers, this can result in “password overload,” commented panelist Rachel Lawlor, MHA, RN, OCN, Cancer Care at Mosaic Life Care.

“Very labor intensive process.” This phrase cropped often during conference sessions–not just during Friday’s panel discussion–usually in reference to ongoing struggles to extract some types of data for reporting. In some instances, at least some data extraction is still a manual effort.

Provider compliance. Although several recent studies point to EHRs and increased “box checking” as contributing to physician burnout, panelists agreed that physician buy-in is critical to optimizing EHR utilization. “You really need to get buy-in from physicians,” said Judy Stone, CMPE, Stamford Hospital.

To get the most from your EHR, “make sure your physicians are filling in queryable fields. Make sure all the data that we can query is in there,” said Linda Frisk, PharmD. One example of leveraging EHRs to improve patient care: the ability to query ‘KRAS’ and have all the progress reports with KRAS come up.

Oncology is different. “It is simply critical to make your IT department aware of what a cancer center does and how very different we are from other divisions of the hospital and other outpatient departments,” said Judy Stone, CMPE. If your IT department doesn’t know what oncology does, invite them to observe for a day or two.

Here to stay. Data collection, analytics, and quality reporting are key requirements as healthcare moves away from fee-for-service into the value-based care environment. “Reporting quickly, efficiently, and in a way you can understand will be critical for our future,” said Linda Frisk, PharmD. EHR optimization should ultimately result in more accessible data to use both operationally and for quality reporting, and demonstrate value. “I think patients want to see value,” she said.

But wait, there’s more.  In conjunction with Friday’s panel discussion ACCC released a new resource, Optimizing Your EHR: Real-World Experiences with Electronic Health Records, which includes practical peer-to-peer tips for getting the most from EHRs to improve patient care, plus strategies to overcome common hurdles and challenges.

Visit the ACCC website here for more from the recent 34th ACCC National Oncology Conference.

What’s in a Name? Is “Tumor Registry” an Outdated Term?

By Holly J. Kulhawick, CTR

Jigsaw puzzle question mark-smThe National Cancer Registrars Association (NCRA) recently asked members on its Facebook page, “Is tumor registry an outdated term?” The responses were spirited and detailed the ways tumor registry and the Certified Tumor Registrar (CTR) credential can be confusing. For example, NCRA members noted that some of their colleagues and patients think they help patients register for treatment or that a CTR “certifies” tumors. There was a strong sense that the current terminology belittles what cancer registrars do, or gives the impression the work is less technically sophisticated than it is. In a time when registrars are struggling to defend the profession from automation and the fear that this automation will compromise data quality, the Facebook discussion suggested the time has come for the profession to revisit its terminology.

First, the term tumor is outdated on a number of fronts. Cancer registrars track more than tumors. They collect information on blood cancers and some benign and premalignant conditions. Second, the term tumor registrar is confusing. What does a “tumor registrar” do? A more descriptive term, such as Oncology Data Analyst or Oncology Data Manager, explains in three words the actual work of a registrar. Many NCRA members suggested this would help to emphasize the analytical aspects of the job and allow them to highlight to hospital administrators the role they play in supporting the cancer program and other oncology support services. Some facilities are already taking the lead, re-naming their Cancer Registry Department as the Oncology Support Services Department and updating their staff titles to Data Analysts. For some real-world examples of how CTRs can support an organization’s cancer program read “Unlock the Potential of the Cancer Registrar” (Oncology Issues, January/February 2016).

The Facebook posts also noted that the lack of clarity associated with “tumor registrar” does not help a profession that struggles to be recognized. A clear, concise title would go a long way to help elevate the work in the eyes of other health professionals. A change in terminology may also help with the Physician Quality Reporting System (PQRS), which is a quality reporting program that encourages individual eligible professionals and group practices to report information to Medicare on the quality of care. A title such as Oncology Data Analyst or Oncology Data Manager flags the cancer registrar as someone who can assist with PQRS requirements, helping to advance the role of the registrar.

A name change would also help with the general public. Some registrars noted that they have spent time explaining to patients that they are not the hospital staff to help them register for chemotherapy. A more direct or clear term would help to eliminate this confusion. The concept of registration—while reflecting accurately the work of a CTR—makes some patients nervous. When they learn they are part of a large cancer registry, they want no part of it, believing it is too much government oversight. If the terminology were changed to Oncology Data Analyst or Oncology Data Manager, it might better convey that skilled and certified professionals are collecting the data and its use is highly regulated and needed to advance cancer care and treatment.

The Facebook discussion suggested there is strong agreement on possible new terminology: Oncology Data Analyst or Oncology Data Manager. But what are the next steps? The National Cancer Registrars Association (NCRA) established a task force in 2008 to study the issue. At that time, there was insufficient member support to make a change. If members want to bring the issue to the forefront again, they can use NCRA’s formal process for members to be heard through its Advocacy and Technical Practice Directors (ATPDs). These board members serve as the liaisons between members and NCRA on matters of advocacy and technical practice. Interested members can go to the Raise Your Voice webpage to contact their ATPD to get the process started.

Guest blogger Holly J. Kulhawick, CTR, is Remote Abstractor for HCA/Methodist Healthcare San Antonio and Flatiron. 

Learn more about the pivotal role your cancer registry can play in supporting your cancer program, during a session on how to “Improve Your Data Collection—Streamline Your Accreditation & Quality Reporting Processes” at the upcoming ACCC 43rd Annual Meeting, CANCERSCAPE, March 29-31, in Washington, D.C.  Read the full agenda here


What Happened in Vegas: Highlights from the 2017 Cancer Center Business Summit

By Monique J. Marino, Senior Manager, Publications & Content, ACCC

Person in information spaceLast week in Las Vegas, the Association of Community Cancer Centers (ACCC) co-hosted the 2017 Cancer Center Business Summit, a two-day conference focused on how the business of oncology is being transformed by the dual drivers of science and technology. Featured speakers and panelists from cancer programs, technology innovators, patient advocate groups, and payers came together to explore how new technology impacts the delivery and future of cancer care. Session topics highlighted clinical pathways, advanced alternative payment models (APMs), patient-centered care, genomic science, and more. Below are highlights from three conference sessions.

A session on Clinical Pathways: With What Result? looked at how the use of pathways and guidelines have changed clinical practice in oncology and created value. Panelist Marcus Neubauer, MD, Medical Director, Oncology Services, McKesson Specialty Health and The US Oncology Network, offered four forward-looking takeaways:

  1. Quality, performance, and resource consumption will be measured for ALL Medicare providers via MIPS (the Merit-based Incentive Payment System) or APMs.
  2. The value of drugs and technology will be scrutinized carefully by ALL providers—public and private.
  3. Adherence to clinical pathways is a cornerstone for value-based care models.
  4. Practices must transform to meet value-based requirements; provide enhanced services; and be able to negotiate reimbursement contracts with payers that support these aligned efforts.

The focus on new reimbursement models continued in a session on Alternative Payment in Oncology: Today & Tomorrow.  Panelists offered perspectives on their experiences with APMs to date and their outlook for the future. Kelly Blair, MPA, Vice President Consulting, Sg2, shared results from a member survey, which found that:

  • 64% of Sg2 members are NOT participating in oncology-specific value-based or alternative payment programs.
  • Operational issues were cited as the biggest barrier to participation.
  • Of those that are participating, 80% are participating in the Oncology Care Model (OCM).

Panelist Dave Terry, Chief Executive Officer, Archway Health, offered lessons learned implementing bundled payment models:

  • Develop accountable incentives in your bundled payment contracts.
  • Leverage data analytics.
  • Ensure specialist engagement.
  • Embrace innovation.

And panelist Cynthia Terrano, Vice President Payer Strategies, Moffitt Cancer Center, noted the importance of getting payers involved in the conversation. “The train has left the station on APMs,” she told meeting attendees. “Cancer programs need to reach out to their payers now to develop partnerships and experiment with different alternative payment models.”

With data collection a pivotal piece of value-based payment, what help might lie ahead for community oncology? In a discussion on Big Data Platforms to Support Community Oncology, panelist Robert S. Miller, MD, Vice President and Medical Director, CancerLinQ, shared his perspective of what the future may hold, including:

  1. Widespread data sharing.
  2. Meaningful penetration of actionable oncology-specific technology.
  3. Real insights gleaned from unsupervised machine learning applied to next generation sequencing (NGS) output.
  4. Big data platforms supporting external compliance reporting.
  5. Real-world evidence used in regulatory decisions.
  6. Greater structured data capture in EHRs embedded in clinician workflows—a culture change aided by technology solutions.

At the end of a busy two days of sessions, one message came across loud and clear—it will truly take a village to deliver cancer care in the 21st century. Beyond the multidisciplinary cancer care team, this village will include technology innovators that are designing the IT infrastructure necessary to move from fee-based to value-based care; third-party laboratories that process and interpret the genetic and genomic tests required to deliver personalized or precision medicine; and specialty pharmacies that are critical to patients accessing life-saving medications and the financial assistance services they need to afford them.

March 29–31, 2017, in Washington, D.C., the ACCC 43rd Annual Meeting CANCERSCAPE will bring together policy experts and key stakeholders from leading national organizations to share insights on the status of the Affordable Care Act and how value-based care, drug pricing reform, and changes to Medicare will affect cancer programs and practices. Learn more. Early Bird registration rates end Friday, February 17.

OPEN Pre-Conference Highlights

By Amanda Patton, ACCC Communications

New ACCC "Hub" in the Exhibit Hall, one-stop for resources, informatiion, and membership information

ACCC “Hub” in the Exhibit Hall welcomes conference attendees with a central source for resources and information on everything ACCC.

We’re in St. Louis for the ACCC 33rd National Oncology Conference this week. Events got underway on Wednesday, October 19, with dynamic pre-conference sessions focused on some of the most challenging and rapidly evolving areas in cancer care delivery. Read on for highlights from the Oncology Pharmacy Education Network (OPEN) pre-conference.

A morning panel discussion during the OPEN Pre-Conference focused on strategic planning for the oncology pharmacy. Zaven Norigian, PharmD, BCOP, Beth Israel Deaconess Medical Center, moderated a discussion with Steve D’Amato, BSPharm, New England Cancer Specialists, and Ali McBride, PharmD, MS, BCPS, BCOP, University of Arizona Cancer Center, that touched on some of the toughest challenges for oncology pharmacy today. Among these:

Cost of drugs. Pharmacy budgets continue to increase, the value of inventories in clinics is escalating, and if programs are not paid in a timely manner, cash flow problems will result. With the increase in immunotherapies and new oral agents, programs are wrestling with how to afford of these therapies and provide access to these for all of their patients. “The bank is going to break eventually,” said D’Amato.

Implementing genomic testing. Operationalizing this in the community setting is creating big challenges for the oncology pharmacy, panelists agreed. It requires a multidisciplinary approach providing integration and education for clinical pharmacists and nurses. There must be buy-in from everyone.

EHR and data issues. Programs need to be able to mine their data, understand their data, and reduce the staff time needed to collect and report data. Pharmacy is looking to technology to solve some of these important issues—without being “nickel and dimed to death” by their EHR vendors, panelists said.

USP 800. This is top-of-mind if you work in pharmacy, panelists agreed. Among the pressing challenges: How do you explain issues related to USP 800 compliance to the C-suite? Attendees were urged to act now—if they haven’t already—and at a minimum bring in a consultant to determine what it will cost to be compliant by 2018. “We know it’s going to be costly…it’s not something you can flip the switch one day and start it,” said Norigian.

Succeeding with Oral Oncolytics

An OPEN Pre-conference session tackling a critical current day challenge highlighted ACCC’s education initiative, Steps to Success: Implementing Oral Oncolytics. (The session was broadcast live, and will be available on the ACCC website on-demand soon.)

“One of the biggest challenges with oral oncolytics is that we put so much responsibility on the patient,” said presenter Niesha Griffith, RPh, MS, FASHP, West Virginia University Health System. Pharmacists need to be “on the frontlines” of taking care of oncology patients, she said.

Calling attention to the Steps to Success white paper developed as part of this ACCC initiative, Griffith focused on the project’s key programmatic recommendations for successful integration of oral oncolytics:

  • Take a multidisciplinary approach
  • Assign responsibilities; clearly identify who is responsible for what
  • Work collaboratively with specialty pharmacy (as needed)
  • Provide financial advocacy services
  • Develop a robust patient education program
  • Put in place effective processes for monitoring for adherence and toxicity
  • Maximize the use of technology

Griffith stressed the importance of developing robust case management platforms so that all providers can document information from patient visits. Where possible, develop methods to streamline processes. For example, devising a streamlined process for prior authorizations can help avoid pulling staff away from frontline care for this time-consuming task. Access more resources from ACCC on successful integration of oral oncolytics here.

Stay tuned for more from the ACCC 33rd National Oncology Conference from ACCCBuzz. Follow the conference highlights on Twitter #ACCCNOC.

Cancer Registars: Is Concurrent Abstracting that Scary?

by Holly J. Kulhawick, CTR

ThinkstockPhotos-180686516Concurrent abstracting is the process of completing the cancer registry abstract in stages after each treatment occurs, rather than all at one time, four to six months after diagnosis. Some registries have always abstracted concurrently, but others are finding—or at least feeling as if—they are being forced into concurrent abstracting by the new Commission on Cancer (CoC) requirement to submit to the Rapid Quality Reporting System (RQRS). RQRS is a reporting and quality improvement tool that provides real-time clinical assessment of hospital-level adherence to quality of cancer care measures. On January 1, 2017, participation in RQRS will become mandatory for all CoC-accredited cancer programs.

Facing Down the Fear

Recent discussions on the National Cancer Registrars Association’s Facebook page indicate a high level of anxiety among those converting to concurrent abstracting. As with all fears, this one is best dealt with by facing it down and examining it under a bright light. Is concurrent abstracting really that difficult? No. Does it take more time? Sometimes. Cancer programs implementing concurrent abstracting for RQRS, can use resources on the RQRS website to help with updates and data quality assurance. CoC-accredited facilities can log on to CoC DataLinks to access their RQRS data. The password-protected site provides monthly alerts on the patients submitted to RQRS as well as updates on the treatment administered, offered, or recommended.

As CTRs embark on concurrent abstracting, they need to release the mantra that it has no advantages. Instead, recognize that this is the best way to provide quality, up-to-date cancer data, and accept the challenge. A major concern when converting to concurrent abstracting is who completes the updates. Certified Tumor Registrars (CTRs) are fiercely territorial regarding their work. This is not a helpful position to take when conducting concurrent abstracting. It is important to allow different members of the team to take turns updating the cases. In doing so, registrars may find that two sets of eyes are better than one at spotting errors or capturing all the nuances of a case. This can also prove to be an advantage in improving data quality and fostering teamwork.

Another concern is the need to return repeatedly to cases to provide treatment updates. To many CTRs, this seems like a doubling of the work. It does increase the time in certain abstracts, but the improvement in quality can be an offsetting factor. Think about it. How many times is an abstract seen only once? Not many, since in many large cancer registries the tasks are assigned to different staff members. One person may load the case and another may add surgeries and biopsies. Some registries use an automated system to load radiation or chemotherapy data with a staff person conducting follow-up months later. This same type of work plan can be used for concurrent abstracting. Allowing several staff to construct and review the abstract can also assist with quality assurance (QA). If only one person is assigned to conduct QA, they may be less attentive. If they know others will be reviewing the abstract, they may be more conscientious.

Data Clinicians Want and Need

Physicians have long complained about the latency of cancer registry data. Concurrent abstracting and RQRS help to address their concerns. Cancer registrars must respond. The cancer registry data does take too long to collect and to be put to use. Today, everyone wants instant results and oncology is no different. Any patient’s case can spiral out of control over a matter of days. Clinicians want to be able to monitor and respond as close to real time as possible. If it takes cancer registrars four to six months to even start a case, they are not providing clinicians with the data that they want and need—data that helps ensure high-quality cancer treatment and care.

Programmatic Benefits

The cancer registry department also benefits from concurrent abstracting. In addition to physicians valuing real-time data, your facility’s Finance and Administrative departments will too. They can analyze the data to help improve operations and services. As a result, these departments see the cancer registry fulfilling a vital need for the organization. This can often lead to more timely responses to requests for budget items, IT support, and additional staff. The cancer registry database can also be used to prepare tumor conference presentation forms. In many facilities, the completion of these forms is very involved, requiring registry staff to create the equivalent of an abbreviated abstract. This is a drain on staff time, since most tumor conferences occur monthly. With concurrent abstracting, the timely data can be merged to populate the forms, reducing the time to just minutes per form. Clinical staff appreciate the results and the doctors no longer need to haul office medical records to tumor conferences.

A near-to-real-time cancer registry database can also help in preparing Survivorship Care Plans (CoC Standard 3.3). To assist with these plans, cancer registry departments may want to consider educating nurse navigators on the database and providing them access so that they can update chemotherapy and/or offsite treatments. Sharing the database will not only help with these important plans, but will also foster a sense that the registry belongs to the team, not just CTRs.

Moving to concurrent abstracting may seem daunting—and, yes, even scary—but it’s an important step that can support and advance the work of the entire cancer care team.

Guest blogger Holly J. Kulhawick, CTR, is Supervisor, Cancer Registry, at ACCC Cancer Program Member Renown Health in Reno, Nevada.

Tap Into the Expertise of Your Cancer Registrar

By Linda Corrigan, MHE, RHIT, CTR

ThinkstockPhotos-507273299Hospitals understand their cancer registry data are sent to state and federal agencies to document incidence rates and to identify cancer clusters. But many may not be realizing the full potential of their cancer registry database, a goldmine full of information that can help your facility. Hospital-specific data provide a wealth of information that can assist with financial and strategic planning, assessing timeliness of treatment, understanding survival rates, conducting community needs assessments, and implementing targeted marketing initiatives.

As the custodians of your data, cancer registrars know it better than anyone and can see trends as they happen. Make sure to include your cancer registrar in meetings and ask for updates. Tap into your cancer registrar’s expertise and put your data to work. Your cancer registrar can:

  • Help your program justify additional staff. For example, by monitoring case volume by site, year, and insurance coverage, your cancer registrar can supply data to make the case for adding physicians to your cancer program.
  • Run reports to identify patterns (or specifics) about who is seen in your cancer program by identifying referring physicians or hospitals. These data can help track trends in patient retention as well as outmigration.
  • Assist with quality improvement/process improvement initiatives. For instance, time to treatment is a frequent target for cancer program improvement efforts. Your cancer registrar can do a deep data dive into your patient population and uncover the exact profile of those patients experiencing the greatest delays.
  • Collect specific data to generate custom reports through user-defined fields in the database. What data do you want to collect? Many registrars have already started reviewing patients seen in the beginning of 2016, so now is the time to talk with your cancer registrar about any additional data you may need for future reports.
  • Compare your data (demographics and disease-site specific data) to that housed in several other national databases.
  • Support your Cancer Committee with data that identifies your patient population and specific health disparities in your service area as the triennial Community Needs Assessment is being completed.

These are just some of the many ways the expertise of your cancer registrar can support your cancer program. An upcoming ACCCBuzz blog post will explore the evolving role of cancer registrars and how your oncology program can support registrars as an integral member of the cancer care team.

ACCC Member Linda Corrigan, MHE, RHIT, CTR, is currently serving as President of the National Cancer Registrars Association.  Learn about the NCRA Annual Education Conference, April 5-7, 2017, here.  Explore NCRA’s Center for Cancer Registry Education here.  The January/February 2016 Oncology Issues features, “Unlock the Potential of the Cancer Registrar,” an article co-authored by Ms. Corrigan that describes how cancer registrars can support lung screening programs within community cancer centers.