Wisconsin Department of Health Services Wisconsin Cancer Reporting

Wisconsin Department of Health Services Wisconsin Cancer Reporting System Updates Nancy Sonnleitner, RHIT, CTR Wisconsin Cancer Reporting System Trainer Division of Public Health Analytics Section Wisconsin and Minnesota Cancer Registrars Associations Regional Fall Conference September 23, 2016 Brookfield, WI WCRA Updates Office of Health Informatics

Wisconsin Department of Health Services Agenda • • • WCRS 2016 Reporting Updates Upcoming Software Upgrades 2016 Merit Awards WCRS Accomplishments in 2016 2017 WCRS Training National Reporting Updates WCRS Data Use and Publication Highlight Pediatric and Young Adult Early Case Capture Update Coding References and Resources Final Reporting Reminders and Announcements WCRA Updates Office of Health Informatics 2

Wisconsin Department of Health Services New Data Items for 2016 Diagnoses • WCRS has seven new fields for 2016 diagnosed cases: o Tumor Size Summary o Mets at DX-Bone o Mets at DX-Brain o Mets at DX-Distant LN o Mets at DX-Liver o Mets at DX-Lung o Mets at DX-Other WCRA Updates Office of Health Informatics 3

Wisconsin Department of Health Services Data Item Reporting Status Changes • All TNM data items are now required for 2016 diagnoses for all reporting facilities. • All Collaborative Stage (CS) data items, with the exception of some site-specific factors, are no longer required for 2016 diagnosed cases. • Lymph-vascular invasion is no longer required for 2016 diagnosed cases but if available, should be abstracted. WCRA Updates Office of Health Informatics 4

Wisconsin Department of Health Services Site-Specific Factors Still Required for Staging 2016 Diagnosed Cases Site (CS Schema) Appendix GISTPeritoneum GISTEsophagus, GISTSmall. Intestine, GISTStomach GISTAppendix, GISTColon, GISTRectum Mycosis. Fungoides Placenta Prostate Testis Bile. Ducts. Distal, Bile. Ducts. Perihilar, Cystic. Duct, Esophagus. GEJunction, Lacrimal. Gland, Lacrimal. Sac, Melanoma. Ciliary. Body, Melanoma. Iris, Nasopharynx, Pharyngeal. Tonsil, Stomach WCRA Updates Site-Specific Factor Description SSF 11 Histopathologic Grading Mitotic Count; SSF 5 and 10 Location of Primary Tumor SSF 6 Mitotic Count SSF 11 Mitotic Count SSF 1 Peripheral Blood Involvement SSF 1 Prognostic Scoring Index SSF 1 PSA Lab Value Post Orchiectomy AFP, h. CG, SSF 13, 15, 16 and LDH Range 25 Schema Discriminator Office of Health Informatics 5

Wisconsin Department of Health Services Site-Specific Factors Still Required for 2016 (Not Needed for Staging) Site (CS Schema) Site-Specific Factor Brain, CNSOther, Intracranial. Gland 1 WHO Grade 1 2 8 9 11 13 14 15 16 ERA PRA HER 2: IHC Value HER 2: IHC Interpretation HER 2: FISH Interpretation HER 2: CISH Interpretation HER 2: Result of other test HER 2: Summary Result testing Combination of ERA, PRA and HER 2 Testing Breast WCRA Updates Description Office of Health Informatics 6

Wisconsin Department of Health Services Data Items with New Field Length and Position • The following data items were moved in the NAACCR layout and updated from one-character fields to twocharacter fields: o TNM Path Staged By o TNM Clin Staged By • There are now 14 values (more specificity in the physician categories) for these data items, requiring the change to a two-digit field. WCRA Updates Office of Health Informatics 7

Wisconsin Department of Health Services New Edits – V 16 A Metafile • The WCRS V 16 A Metafile contains 590 edits. • There are 52 new edits o 43 of the new edits are specific to AJCC TNM staging. o The other nine review date logic issues for treatment fields and check for proper setting of conversion flags. • These new TNM edits, while not new for CTRs working in COC facilities, are new for WCRS. • WCRS staff will be reviewing these edits in the next year and are seeking feedback on any problems you encounter. WCRA Updates Office of Health Informatics 8

Wisconsin Department of Health Services WCRS Software Updates • Abstract Plus o Version 3. 6. 0 will be available by the Thanksgiving holiday o Auto-Upgrade (similar to the 3. 5. 0 upgrade) o Facilities must currently be using 3. 5. 0 before upgrading! • Web plus o It is unclear at this time when WCRS will be upgrading to V 16 for Web Plus (anticipated in late October or early November). § Facilities that convert to V 16 will need to click the non. NAACCR radio button in the current version of Web Plus when submitting files. WCRA Updates Office of Health Informatics 9

Wisconsin Department of Health Services WCRA Updates Office of Health Informatics 10

Wisconsin Department of Health Services 2016 Merit Awards WCRS thanks the American Cancer Society for hosting the third annual Merit Awards. WCRA Updates Office of Health Informatics 11

Wisconsin Department of Health Services 2016 Merit Awards • Completeness Criteria o o Submitted 25 or more cases for 2014 diagnoses Platinum Award = received 100% of 2014 estimated cases Gold Award = received 95% Silver Award = received 90% • 80 facilities received an award o 67 Platinum (up from 54 in 2015!) • There was a big increase in the number of clinics receiving awards this year. WCRA Updates Office of Health Informatics 12

Wisconsin Department of Health Services 2016 Merit Awards • Timeliness Criteria o Submitted 25 or more cases for 2014 diagnoses o Platinum Award = 95% of non-breast cases received within 6 months and breast cases within 9 months o Gold Award = 95% non-breast within 9 months and breast cases within 12 months o Silver Award = 95% of all cases received within 12 months • One facility received Platinum • 12 facilities received Gold • 12 facilities received Silver WCRA Updates Office of Health Informatics 13

Wisconsin Department of Health Services Merit Awards Summary Award Category Completeness Platinum Gold Silver Completeness Sub Total Timeliness Platinum Gold Silver Timeliness Sub Total WCRA Updates Number of Facilities 2014 2015 2016 45 14 10 69 54 16 8 78 67 9 4 80 1 0 11 12 5 9 23 37 1 12 12 25 Total Awards 81 115 105 Honorable Mention 12 14 13 Office of Health Informatics 14

Wisconsin Department of Health Services WCRS Accomplishments • • NAACCR Gold Award and CDC Registry of Excellence! Updated Manuals (Coding and Abstract Plus) WCRS Website WCRS Updates o New sleek format split into two reports o Technical Updates and Programmatic/Data Use • Weekly Scoops • Feedback Summary Reports • Updated Basic training WCRA Updates Office of Health Informatics 15

Wisconsin Department of Health Services AJCC Cancer Staging Manual 8 th Edition • Effective for all cancer cases recorded on or after January 1, 2017. • Scheduled for release at the end of October 2016. • Cost -$119. 00 • Significantly expanded, brings together all the currently available knowledge on staging of cancer at various anatomic sites. WCRA Updates Office of Health Informatics 16

Wisconsin Department of Health Services • AJCC Cancer Staging Manual th Edition 8 Features: 12 entirely new staging systems. Wide range of changed or new staging definitions. Refined emphasis on a personalized-medicine approach. Supplemented, as appropriate, by selected molecular markers. • The American Joint Committee on Cancer (AJCC) is in the process of developing an Application Programming Interface to deliver the 8 th Edition Cancer Staging System in electronic format. o Partnering with easy. DITA and Scriptorium on this project. o o WCRA Updates Office of Health Informatics 17

Wisconsin Department of Health Services Multiple Primary Histology (MP/H) • MP/H revisions: o The revised rules will be released in 2018. o NAACCR, CDC, NPCR, and Co. C requested it be delayed due to the upcoming 8 th Ed TNM. § The partnered organizations did not want to overburden registrars with multiple new coding rules. o The MP/H rules will only be available in one format: TEXT. WCRA Updates Office of Health Informatics 18

Wisconsin Department of Health Services Multiple Primary Histology (MP/H) • A Solid Tumor Database is being created to accompany the rules. It can be used independently or with the rules. • The revised site groups will include new ICD-O-3 codes, new terms and alternate names for existing codes since a new ICD-O-4 is not expected anytime soon. • New tables will be added to some site groups to assist with primary site coding (Head & Neck sites particularly). WCRA Updates Office of Health Informatics 19

Wisconsin Department of Health Services 2017 Training Opportunities • Four to Six Trainings throughout state (TBD). o Focus – AJCC staging on Lung, Breast, Colorectal, Prostate, Melanoma. o Additional sites – Head/Neck (per request!) • NAACCR 2016 -2017 Training Series. o Hosted by WCRS, Madison office o First Thursday of each month WCRA Updates Office of Health Informatics 20

Wisconsin Department of Health Services 2017 Training - Future Plans • Standard bi-monthly Basic Training on Principles of Abstracting and Use of Abstract Plus Software. o Directed for new reporters o Held at the WCRS office, Madison • Short specific How-to-video’s on website. WCRA Updates Office of Health Informatics 21

Wisconsin Department of Health Services CAnswer Forum • The CDC has a new protocol for Education & Training Coordinators (ETCs) to assist reporters with AJCC staging questions on the CAnswer Forum. • Reporters should let their state ETC know if they: 1. Asked a question and it didn’t get answered, 2. Disagree with the answer, or 3. Notice conflicting answers. WCRA Updates Office of Health Informatics 22

Wisconsin Department of Health Services CAnswer Forum – ETC Process • ETC receives a question from a state reporter. • ETC checks if the question and answer are already posted on the CAnswer Forum for a quick resolution. • If the answer cannot be located on the CAnswer Forum, the ETC will submit a very specific and detailed question to the CDC Education staff. • CDC will contact AJCC directly and request a response. • Answer will be returned to the ETC, as well as to Co. C representatives. • WCRS monitors the status until answer is received. . WCRA Updates Office of Health Informatics 23

Wisconsin Department of Health Services WCRS Data § WCRS data are available from two online data query systems, WISH (Wisconsin Interactive Statistics on Health) and Cancer-Rates. Info. § WCRS publications include Department of Health Services reports, WCRS data bulletins, and collaborative publications. § Special data requests are fulfilled by WCRS. • Mary. Foote@dhs. wisconsin. gov WCRA Updates Office of Health Informatics 24

Wisconsin Department of Health Services Publication Highlight – Facts and Figures • The American Cancer Society and the Department of Health Services’ Wisconsin Cancer Reporting System will soon present the fifth edition of Wisconsin Cancer Facts & Figures. • Data are presented in a series of eight new briefs All Cancers Colorectal Melanoma of the Skin Childhood/Young Adult WCRA Updates Lung Breast Human Papilloma Virus Healthy Lifestyles and Reducing Risk Office of Health Informatics 25

Wisconsin Department of Health Services WCRA Updates Office of Health Informatics 26

Wisconsin Department of Health Services WCRA Updates Office of Health Informatics 27

Wisconsin Department of Health Services Pediatric Early Case Capture Update • Wisconsin is one of seven states collecting pediatric and young adult cancers (ages 0 – 19) as part of the CDC Early Case Capture grant. • WCRS requires submission of a subset of data items on these cases within 30 days from the diagnosis date. • WCRS announced the new requirement via email blasts and a specific page on our WCRS web site: https: //www. dhs. wisconsin. gov/wcrs/reporterinfo/earlycasecapture. htm WCRA Updates Office of Health Informatics 28

Wisconsin Department of Health Services Pediatric Early Case Capture Update • The WCRS website includes reporting instructions, a required data item list (no stage or treatment data required) and a snapshot of pediatric and young adult cancer incidence in Wisconsin. • Since October 2014, WCRS has worked with 24 facilities to submit cases following the specific ECC Vendor Export Web Plus submission process; these facilities are now submitting regularly. • WCRS has participated in two ECC Calls for Data to date – October 2015 and April 2016. WCRA Updates Office of Health Informatics 29

Wisconsin Department of Health Services Pediatric Early Case Capture Update Number of Cases Received by Diagnosis Month and Submission Date 25 20 October 2015 Submission n=35 Number 15 of Cases 10 April 2016 Submission n=166 5 WCRA Updates M b ar ch Ap ril M ay Ju ne Ju ly Au g Se p Oc t No v De c Fe Ja n 0 Office of Health Informatics 30

Wisconsin Department of Health Services Pediatric Early Case Capture Update • This table shows the percent of cases received, by timeliness category, for each CDC Call for Data. Timeliness Categories October 2015 April 2016 0 -30 Days 1 3 31 -60 Days 0 4 61 -120 Days 9 28 121 -180 Days 0 33 181 -270 Days 25 42 271 -365 Days n/a 35 > 365 Days n/a 19 Wisconsin diagnoses ~300 cases annually; the October 2015 completeness rate for January – June 2015 cases was 23%. The April 2016 rate was 55% complete. WCRA Updates Office of Health Informatics 31

Wisconsin Department of Health Services Pediatric Early Case Capture Update • WCRS focused on initiating seamless reporting via Electronic Health Record messaging from facilities/pathology laboratories using WISHIN Direct messaging of the Transition of Care EHR document. o This process was not successful due to problems with filtering and triggering messages from the EHR. • WCRS continues to research seamless reporting mechanisms. o Secure FTP Flat File submission being tested o In discover phase with E-Path reporting tools WCRA Updates Office of Health Informatics 32

Wisconsin Department of Health Services Pediatric Early Case Capture Update • Robin Malicki is the WCRS main contact for questions on Early Case Capture: Robin. Malicki@dhs. wisconsin. gov • The next Call for Data is due October 31, 2016 and will include all 2015 and January – June 2016 pediatric cases received at WCRS anticipates a small increase in timeliness. • Facilities that participated in last year’s pediatric survey will receive a follow up survey in late September or early October. WCRA Updates Office of Health Informatics 33

Wisconsin Department of Health Services Coding Resources - State § Wisconsin Cancer Reporting System Cancer Reporter’s Web Page. • • • Contains the WCRS Coding Manual Abstracting and editing software Links to national coding resources Address and physician reference tools And more! https: //www. dhs. wisconsin. gov/wcrs/reporterinfo/index. ht m WCRA Updates Office of Health Informatics 23

Wisconsin Department of Health Services Coding Resources - National § SEER Summary Stage 2000 Manual • http: //seer. cancer. gov/tools/ssm/SSSM 2000 -122012. pdf • Use this manual to determine the summary stage for each reportable case. If you still have a red cover SEER hard copy, it is outdated. Please download the updated reference from this web site. § AJCC Cancer Staging Manual, 7 th Edition • http: //www. springer. com/us/book/9783319406176 • This manual is required to complete TNM staging for 2015 diagnoses. WCRA Updates Office of Health Informatics 35

Wisconsin Department of Health Services Coding Resources - National § SEER Multiple Primary and Histology Coding Rules • Scroll to ‘Complete Manual’ – Download the complete manual with the latest updates. • Use this manual to determine the number of reports needed to complete each case. http: //www. seer. cancer. gov/tools/mphrules/download. html WCRA Updates Office of Health Informatics 36

Wisconsin Department of Health Services Coding Resources - National § Hematopoietic Multiple Primary & Histology Coding Rules Web Site • http: //seer. cancer. gov/seertools/hemelymph/ • Use this web site to determine the multiple primary status and correct histology and grade for all hematopoietic reportable diseases. WCRA Updates Office of Health Informatics 37

Wisconsin Department of Health Services Coding Resources - National § Site-Specific Surgery Codes • https: //www. facs. org/~/media/files/quality%20 pro grams/cancer/ncdb/fords%202016. ashx From this site, scroll down the left column and select Appendix B – site specific surgery codes. WCRA Updates Office of Health Informatics 38

Wisconsin Department of Health Services Cancer Registrars Language WCRA Updates Office of Health Informatics 39

Wisconsin Department of Health Services Registry Plus Online Help • Many of the resources shown in the previous slide are in the Registry Plus Online Help tool (included in the WCRS Abstract Plus software) and also available for download as a stand-alone product, at no cost from CDC. http: //www. cdc. gov/cancer/npcr/tools/registryplus/rpoh_tech_info. ht m WCRA Updates Office of Health Informatics 40

Wisconsin Department of Health Services Reminders… • DCOs for 2014 deaths were recently sent out to all facilities, physicians and coroners/MEs. Please review and return to WCRS by the end of September. • Call for Data Time! Please submit any outstanding 2015 and earlier diagnosed cases to WCRS immediately for inclusion in this year’s submission to CDC and NAACCR. • Check your recent Feedback Summary Report and call WCRS with any updates to the facility or contact information, or your annual estimate. WCRA Updates Office of Health Informatics 41

Wisconsin Department of Health Services Contact Information • Training and content support ØNancy Sonnleitner, RHIT, CTR ▫ Ph: (920) 448 -5226 Green Bay office ▫ Ph: (608) 261 -8388 Madison office ▫ Nancy. Sonnleitner@dhs. wisconsin. gov • Technical Support Ø Laura Stephenson, CTR ▫ Ph: (608) 266 -8926 ▫ Laura. Stephenson@dhs. wisconsin. gov WCRA Updates Office of Health Informatics 42