Initially, Cathy Gray, BA, CTR, Cancer Registry Manager, at the UMass Memorial Medical Center, was invited to participate in discussions about quality metrics as a courtesy to the cancer registry staff. At that time, the UMass Memorial Cancer Center of Excellence medical and administrative staff, and even Cathy herself, did not realize that the cancer registry would have a central role in the quality metrics program they were about to implement.
Timely Collection Required
During that meeting, when team members were discussing the metrics to be captured for seven selected primary sites, Cathy remembers ticking data items off in her head: “We’ve got that. We’ve got that too. Yes, we collect that…” as the various metrics were added to the lists. However, for quality metrics to really matter in the care and treatment of cancer patients, much of the information collected by the cancer registry was too late. The solution to utilize data already being collected and making it relevant for timely positive interventions lay in concurrent abstracting of cancer cases. With a visionary leader in Cancer Center director, Dr. Giles Whalen, a supportive Cancer Center administrative staff, an excellent abstractor, and flexible, well-supported, cancer registry software, Cathy and her registry team were up to the task of making concurrent abstracting possible.
Implementing the Solution
Cathy’s biggest challenge was the initiation of a new process to manage concurrent abstracting of cancer cases. She developed a plan where a calendar quarter was selected to focus on abstracting only the seven primary sites of interest shortly after a case was identified. She was committed to implementing both case finding and abstracting processes that assured the case would be handled a maximum of two times by the abstractor. Cathy’s plan also included placing her most experienced registry staff member in the role of concurrent abstractor and hiring one additional abstractor to help manage the residual caseload. The Cancer Center administrative staff granted her that FTE.
After developing the overall implementation plan, it was time to add new user-defined fields to the cancer registry software to collect non-standard data fields for the metrics and pull reports for compliance reviews. “That’s when I discovered how truly flexible our CNExT software is,” says Cathy, “I was able to add non-traditional data items comprised of codes and labels and dates for retrieval rather than relying on text entry, and we even utilized some of the old Patient Care Evaluation fields still retained in CNExT for some of the metrics.” In addition, a user-defined field indicating the calendar quarter the patient was first admitted to the UMass Memorial system was added to the CNExT software to facilitate the retrieval of reports on a quarterly basis.
Learning Process
Learning about the interpretation of data fields has been a two-way street. Meetings were scheduled monthly with the medical care team and the cancer registry. On the registry side, the staff needed to understand how to collect the new non-standard data fields. On the medical team side, the staff needed to know how to interpret the codes used for fields already collected by the cancer registry. Once the medical team realized that additional fields could be added to the cancer registry data set, there were more requests for collection of data items. For example, one of the palliative care physicians asked to have advanced directives and palliative care consultation fields added to the registry data set to meet the palliative care standards set by the Commission on Cancer. Cathy points out, “One of the beautiful things about the cancer registry system, that can’t be done with other medical systems in place, is that data can be stratified by stage, by site, by histology and other criteria which make the data more meaningful.”
Asked to reflect upon her feelings going into the project and after implementation, Cathy has this to say, “I love a challenge and I love for the cancer registry data to be used. This project was another opportunity to move the cancer registry to the forefront in patient care.” For Cathy, it feels great to be able to say to the UMass Memorial medical care team, “We can give you that!”
