Concurrent abstracting and 2018

[Karen Mason]

At Moffitt Cancer Center in Florida, our cancer registry transitioned to all-site concurrent abstracting in 2014. We will begin to abstract our January 2018 cases sometime in mid March 2018 and we are very concerned that the new datasets and data formats will not be ready for that timeframe. We take pride is offering our researchers and clinicians a more real-time dataset (up through pathological staging). Not abstracting while we wait for version 18 is not an option, both from a resource and data provision standpoint. My team and I would be happy to brainstorm and collaborate if there is anything we can do to expedite all datasets, data formats and versions being available to suit the concurrent abstracting environment. Thank you.

[Theresa Hayden]

I strongly agree with Karen Mason’s comment. Concurrent abstracting is integral not only to our cancer registry operations, but to our clinical operations as well. I believe there must be a hard line in the sand as far as time is concerned so that changes can be implemented into vendors’ software and installed for their clients PRIOR to the effective date for any change. It should no longer be acceptable to have effective dates precede implementation dates.

[Theresa Hayden]

For some further background, we presently abstract all of our hospital’s cases concurrently, with about 10% being completed within a month of date of first contact.
I realize that “concurrent” may differ from one person or organization to another. For us, that means any time we are handling a suspense case (incoming casefinding documentation or staging forms, entering treatment information from preceding month’s new start lists for systemic or radiation treatment, preparing tumor board summaries, generating survivorship forms, etc), the text and coding is updated to reflect all information currently available. Thus at completion 4-6 months out, there is little to be added and often it is more of a data quality check.

[Carol Hutchison]

I want to reiterate what Karen and Theresa have already said! Our Cancer Registry has worked very hard to get to the point of concurrent abstracting. I’m sure you’re aware that the COC requires Cancer Programs to participate in RQRS and provide Survivorship Care Plans to our patients who have completed treatment. Our Policy is to provide those Plans to the physicians so they can discuss them with patients. This usually occurs within a month after they finish treatment – in some cases, within four to six months of diagnosis. I agree that the way we did business in the past by implementing changes prior to allowing time for major updates to software and delaying availability to data items can no longer be acceptable. The days are gone for retrospective data collection and reporting. That is why Cancer Registry data is sometimes not respected by researchers and physicians. Additionally, I saw where some registrars are abstracting cases and plan on going back in to change data items after software updates are completed. This is non-productive for our Cancer Registry. We have a COC Cancer Program Accreditation Survey in January 2019 and I am very concerned about our workload and ability to complete certain standard requirements. Thank you.

[Judy Connolly]

Thank you to those who have posted their concerns on this topic. Our Cancer Registry is quite understaff and have been unable to move to a completely concurrent abstracting model however we’re making tiny strides…or at least we were. In this ever-changing landscape of healthcare the bottom line focuses on reimbursement and financials (outside of direct patient care). That being said, with the implementation of all of these changes prior to vendors being ready, will put this registry extremely behind. No matter how hard I try to explain why my department is extremely behind in abstracting, I can guarantee I will not be afforded the financial resources to dig out of this hole, because why should my organization pay for a problem that the Standard Setters created?

[Florence Mitchell]

This is the text of a letter that Karen Yatcilla and I sent to NAACCR, CoC, SEER, and NCRA:

“We are cancer registrars at a COC-accredited comprehensive community cancer center. We have completed our December 2017 casefinding and can begin abstracting 2018 cases. However, the standard setters have yet to finalize the changes to be implemented in January 2018, let alone send them to the software vendors. How, then, are we to do our work? Although standard setters seem to assume all cancer registries work on a six-month time lag – and indeed, a six-month time lag may not matter for your purposes – in our real-world clinical setting, our data are most valuable when most current. (And indeed, the CoC seems to be moving in the direction of concurrent reporting.)

We have worked hard to demonstrate the integrity of our profession and the importance of the cancer registry within our facility, but it seems that the standard setters (NAACCR, NCRA, SEER, CoC) are doing their best to undermine our progress. How can it be that you “don’t know the magnitude and scope of changes” that are to occur? While standard setters are moving at a glacial pace, private organizations are rapidly taking over real-world cancer data collection. Cancer registries may well become obsolete if our standard setters don’t adapt to 21st-century clinical needs.

The quality of cancer data depends on the people who abstract the medical record into a usable format: cancer registrars. It is abominable that the standard setters are not providing cancer registries with the tools they need to do their work.”

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