An Outline of Automated Cancer Registration

Chris Carrigan

National Coordinator for Cancer Registration in England

For the Automated Cancer Registration Workshop

Wednesday 4th December 2002

What is Automation?

• Application of Procedures

• Suited to Repetitive Tasks

• Eliminates Variability

• Standardisation

• Speed, Efficiency, Consistency

• Based on Rules

• Mechanism to Apply the Rules

Why Automate?

• Consistency / Standardisation• Better use of Resource (People/Machines)• Increasing Electronic Sources

– Cancer Waiting Times– National Clinical Audit Support Programme– NHS Messaging Programme– Death Certification– Cross-Registry Transfers

Why Automate….?

• Capacity

• Respond to Change

• Improve Speed

• Shift the Balance:

From Process

To Service Delivery

Cancer Registry

NSTSDemographics

Waiting Times

CMDS

ONSDeaths

Pathology

Procedures

Stagin

g

Death

Cer

t

New

lyD

iagnosed

Screening Programmes S

cree

n H

isto

ry

Radiotherapy

Prescription

Chem

o/H

ormone

Radiotherapy

Opportunities

• Cancer Information Hub

• Data Quality Assurance

• Local Intelligence

• National Intelligence

• Value-Added Service Delivery

Understanding Automation

Methods of Representation..

National Specification Project

• Delivery Services Model

• Process Model

• Rules Model

• Data Model

Initial data cleanse validate and format

Patient matching

Create provisionalpatient record

Tumour matching

Update/addtumour record

Update/addtreatment record

(if data provided)

Update/adddeath details

(if data provided)

Overall Cancer Registration Process

Receive & log data

Reformat record

Discard record

Record already received in

batch?

Are mandatorypatient items

there?

Does data needformatting?

Yes

No

YesNo

No

Match against database

Yes

Is translation needed?

Translate specific data items

Yes

Initial data cleanse & format(Pre-registration processing)

Add derived data items e.g.

basis

No

Are specificdata items

valid?

Data review& correction

No

Yes

Match against NSTS

No

Data review &correction

No

Yes

Yes

Yes

Discard record

NoPatient

Matching

Are itemsnow there?

Complex !

• Loading / Translation

• Validation

Stages of Automation - Simplified

• Linkage

• Survivorship

?

?

PATIENTSEARCH

SOURCERECORD

PATIENTWEIGHTING

CANCERREGISTRYDATABASE

DECIDEMANUALLY

CREATE NEWPAT/TUMOUR

TUMOURSEARCH

TUMOURWEIGHTING

END

DECIDEMANUALLY

CREATE NEWTUMOUR

UPDATETUMOUR

END END

PatientLinkage

TumourLinkage

Linkage and Survivorship

SurvivorshipSurvivorshipTumourLinkage

Development LifecycleDefine Rules

Establish Test Data

Define Test ResultsPerform Tests

Improve Rules

Review Errors

Develop Software

Clinical

I.T.

Clinical

ClinicalI.T.

Clinical

and I.T.

Clinical

and I.T.

Example

An automated process..

Tumour LinkageInputs

Source IdentifierSite, Morphology and Side

Event Date

OutputsDefinite Match, New Tumour, No Decision

Example Inputs and Outputs

InputsHospital Admission, Nasal Cavity (C30.0) on 25th May 1999

Pathology Result, T2X120, M82703 on 5th June 1999

OutputDefinite Match

Summary of Comparative Tumour Matching Performance

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Manual 2 3 4 5 6 7

Supplier Identification Code

No Decision Made

Wrong

Decision Made Against Advice

Correct

Key Messages

• React to Increasing Volume• Change the Balance of Process• Change the Emphasis of Purpose• Focus on Service Delivery• Recognise Specialist Capabilities• Need for Collaboration• Standardisation• Benefits Realisation

National Requirements

PROVIDE A NATIONAL

CANCER REGISTRATION SERVICEINFORMATION

UKACR Web Site

• Links to – Today's Presentations– ENCR Automated Registration Website

An Outline of Automated Cancer Registration

Chris Carrigan

National Coordinator for Cancer Registration in England

For the Automated Cancer Registration Workshop

Wednesday 4th December 2002