# Presentation: 527426

## Registry Operations: The Basics

**Registry Operations: The Basics**

***Registry Operations***

***Patient Sets***

***Records***

**Reportable, Acceptable Records**

**St. Joseph’s Hospital**

**Main Street Doctor’s Group**

**Path Lab**

## What Are the Types of Records?

***There are three categories of records.  Every type of record that can be processed in Registry Operations falls under one of these three:***

_**Health Records**_ – A set of information that contains medical information, including vital status.  Types of Health Records include:

_**Supplemental Record**_ – A collection of related data with no health information, generally used to verify personal data and update follow-up information:

_**Other**_ – A collection of data with no health or person information.  Only includes:

- -- Abstract
- -- Autopsy Report
- -- Correction Record
- -- Cytology Report *
- -- Death Certificate
- -- Death Index
- -- Disease Index/Hospital Discharge File
- -- Follow-Up Record
- -- Follow-Up Abstract
- -- Hematology Report *
- -- Indian Health Services (IHS) Record
- -- Obituary
- -- Oncology Report *
- -- Path Report *
- -- Radiology Report *
- -- Radiotherapy Report
- -- Special Study Record (?)
- -- Surgery Log

- -- CMS (HCFA) File
- -- DMV Record
- -- Insurance Demographic
-         Information (HMO)
- -- IRS Record
- -- SSA Death Record
- -- State Birth Record
- -- Voters Registration

- -- Census Tract
- -- Name List for Race/Ethnicity

- * A type of lab or imaging report.

## What is in a Patient Set?

***Here is an example of what might be in a single Patient Set.  Each entity (box) represents an object about which the Registry might collect information.  This example is not exhaustive of all that might be included:***

**PATIENT**

**CTC 1**

**OTHER PROCEDURE**

**DIAGNOSIS**

**GENETIC MARKER**

**CHEMO   1**

**CTC  2**

**CHEMO   2**

**DIAGNOSIS**

**SURGERY   1**

**RADIATION   1**

- {X-Ray, Mammogram, etc.}

- CTC: Cancer/Tumor/Case

## Registry Operations: The Basics Revisited

**Registry Operations: The Basics Revisited**

***Registry Operations***

**Reportable, Acceptable Records**

**St. Joseph’s Hospital**

**Main Street Doctor’s Group**

**Path Lab**

**Abstract #123**
**From St. Joseph’s Hosp.**

-   Name: Fred Andrews
-   SSN: 123-45-5678
-   ...

***Patient Sets***

***Records***

## The Story: Step 1

**The Story: Step 1**
***The Registry Receives Path Reports***

**Path Lab**

**Path Report  #123**
**From Oak Street Path Lab**

-   Name: Jane Smith
-   SSN: 111-22-3333
-   Race: White
-   Primary Site: Breast NOS
-   Surgery: Biopsy
-   Surgery Date: 12/20/2000
-   Place of Surgery: St.
-       Joseph’s Hospital
-   Dx Text: Lobular
-       Carcinoma of Breast
-  ...

**Path Report  #432**

**Path Report  #654**

**Path Report  #789**

**Path Report  #456**

## The Story: Step 2

**The Story: Step 2**
***Path Reports Are Screened (aka “Case Finding”)***

**Path Report  #123**
**From Oak Street Path Lab**

-   Name: Paul Jones
-   SSN: 888-22-1111
-   Dx Text: Gallstones, no
-       evidence of malignancy
-  ...

- A process screens all incoming health records to determine which might be reportable to SEER, Local Agencies, or a Special Study.  In other words, “case finding” is done.
- Some records are deemed not reportable...
- while some are deemed reportable.

-   Possibly Reportable = No

-   Possibly Reportable = Yes

-   Name: Jane Smith
-   SSN: 111-22-3333
-   Race: White
-   Primary Site: Breast NOS
-   Surgery: Biopsy
-   Surgery Date: 12/20/2000
-   Place of Surgery: St.
-       Joseph’s Hospital
-   Dx Text: Lobular
-       Carcinoma of Breast
-  ...

## The Story: Step 3

***Path Reports May be Visually Edited***

**Path Report  #123**
**From Oak Street Path Lab**

- Based on registry policy, any incoming health record may undergo visual editing.  Any changes can be flagged as updated to be returned to the data source (here, the Oak Street Path Lab).
- Returned updates can be used to determine where additional training may be needed and to keep the information in the central registry and in hospital registries synchronized.
- We will assume in this registry that only Abstracts are visually edited.

-   Possibly Reportable = Yes

-   Name: Jane Smith
-   SSN: 111-22-3333
-   Race: White
-   Primary Site: Breast NOS
-   Surgery: Biopsy
-   Surgery Date: 12/20/2000
-   Place of Surgery: St.
-       Joseph’s Hospital
-   Dx Text: Lobular
-       Carcinoma of Breast
-  ...

## The Story: Step 4

**The Story: Step 4**
***The Reportable Path Report is Matched***

- A process then attempts to match the possibly reportable record to existing Patient Sets.
- In this story, we will assume there is no match.

## The Story: Step 5

**The Story: Step 5**
***A New Patient Set is Created From That Path Report***

- Because there was no match to an existing Patient Set, a new one is added.  This represents the best information known by the registry about Jane Smith.  The patient set is flagged as not finalized, meaning it won’t be used for reporting until the Registry deems it ready (hopefully, when the Registry receives and consolidates an Abstract).

## The Story: Step 6

**The Story: Step 6**
***The Registry Creates or Receives Abstracts***

**Abstract  #9876**
**From St. Joseph’s Hosp.**

-   Name: Jane B. Smith
-   SSN: 111-22-3333
-   DOB: 3/12/1938
-   Primary Site: Breast,
-      Upper Left Quadrant
-   Histology: Lobular Carcinoma
-   Treatment: Breast
-      Conserving Surgery
- -  Date of Surgery: 2/15/01
-   Treatment: Radiation (Beam)
-   ...

**Abstract  #8675**

**Abstract  #4545**

**Abstract  #2020**

**Abstract  #1311**

- This Hospital does its own abstracting.  After some time passes, St. Joseph’s sends  Abstract Records to the Registry to be processed as all Health Records are.

## The Story: Step 7

***The Abstract is Screened*** ***and*** ***Visually Edited***

- The new Abstract is screened and found to be possibly reportable.
- Again, in this registry, Abstracts are visually edited.
- An audit log is created to track all changes.  Any change may be flagged as one which needs to be reported back to the data source (St. Joseph’s Hospital).
- Here, there is one change and the facility is to be notified about the change.

**Audit Log**
- 1. ICD-10 site code
-        from	            C503 to C502
-        on	            8/26/01
-        by	            Reg Smith
-        why	            Code did not match text
-        Fac notification?   Yes

## The Story: Step 8

**The Story: Step 8**
***The Abstract is Matched***

- The new Abstract is matched, and a match is found on Patient and CTC.

**Audit Log**
- 1. ICD-10 site code

## The Story: Step 9

**The Story: Step 9**
***The Patient Set is Consolidated***

- The information from the edited St. Joseph’s Hospital Abstract is consolidated into the Patient Set.  This provides the complete, best information the Registry knows about Jane B. Smith’s breast tumor.
- An audit log is created to track the changes made in the patient set.  Global reason (St. Joseph’s abstract received) may be assigned to a set of changes.  Specific reason may be assigned to each change.

**Audit Log**
- 1. Name
-        from	            Jane Smith to Jane B. Smith
-        on	            8/26/01
-        by	            Reg Smith
-        why	            St. Joseph’s Abstract received
- 2. DOB
- 3. Primary Site
- ...

**Audit Log**
- 1. ICD-10 site code

## The Story: Step 10

**The Story: Step 10**
***The Surgery Log is Sent by the Hospital and Screened at the Registry***

**Surgery Log Record  #78**
**From St. Joseph’s Hosp.**

-   Name: Jane Bell Smith
-   SSN: 111-22-3333
-   Surgery: Modified Radical
-    Mastectomy
-   Date of Surgery: 4/26/02
-   ...

**Surgery Log Record #99**

**Surgery Log Record #63**

**Surgery Log Record #88**

**Surgery Log Record #51**

- St. Joseph’s sends its Surgery Log to the Registry for Quality Control purposes.  Each Record within the log is screened as all Health Records are.

-   Possibly Reportable = Yes

## The Story: Step 11

**The Story: Step 11**
***The Surgery Log Matches a Patient and CTC Within a Patient Set***

- The Surgery Log Record matches to this patient set at the Patient and CTC level.  The registry can also verify that an abstract for this Patient and CTC has been received from St Joseph’s already.

## The Story: Step 12

**The Story: Step 12**
***The Surgery Log is Consolidated into the Patient Set***

- The Surgery Log Record is consolidated into the Patient Set, giving the Registry the best information that it has of Jane Bell Smith’s breast tumor.  Again, an audit log is created to track changes.

**Audit Log**
- 1. Name
- ...
- 15. Name
-       from	            Jane B Smith to Jane Bell Smith
-        on	            10/15/01
-        by	            Jess White
-        why	            St. Joseph’s surg log received
- ...

## The Story: Step 13

***The Patient Set is Finalized***

- The Patient Set has been consolidated, but not “polished up”.  At this point, to finalize the Patient Set, the census tract is assigned, ethnicity is assigned, age recode is generated, survival time is calculated, etc.
- The status is changed to finalized, meaning this information can now be provided to SEER, etc.  Finalized is _not_ meant to imply that the patient set will never change again.

***Patient Set***

-   Status = Finalized

-   Surgery: Biopsy
-   Surgery Date:
-    12/20/2000
-   Place of Surgery:
-    St.Joseph’s Hosp

-   Primary Site: Breast NOS
-   Dx Text: Lobular Carcinoma
-       of Breast
-   Hist: Lobular Carcinoma
-   Age of Dx Recode: 13

-   Name: Jane Bell Smith
-   SSN: 111-22-3333
-   Race: White
-   DOB: 3/12/1938

-   Surgery: Breast
-    Conserving Surg.
-   Surgery Date:
-    2/15/2001

-   Beam

-   Surgery:
-      Modified Radical
-      Mastectomy
-   Surgery Date:
-      4/26/2001

## The Story: Step 14

***Provide Data to SEER and Others***

- The information in the Patient Set is now ready to be submitted to SEER, etc.  Only Patient Sets where Status = Finalized are used for reporting.

***Patient Set***

-   Status = Finalized

-   Surgery: Biopsy
-   Surgery Date:
-    12/20/2000
-   Place of Surgery:
-    St.Joseph’s Hosp

-   Name: Jane Bell Smith
-   SSN: 111-22-3333
-   Race: White
-   DOB: 3/12/1938

-   Surgery: Breast
-    Conserving Surg.
-   Surgery Date:
-    2/15/2001

-   Beam

-   Surgery:
-      Modified Radical
-      Mastectomy
-   Surgery Date:
-      4/26/2001

-   Primary Site: Breast NOS
-   Dx Text: Lobular Carcinoma
-       of Breast
-   Hist: Lobular Carcinoma
-   Age of Dx Recode: 13

## Registry Operations

***Registry Operations***

**Reportable, Acceptable Records**

**St. Joseph’s Hospital**

**Abstract #123**
**From St. Joseph’s Hosp.**

-   Name: Fred Andrews
-   SSN: 123-45-5678
-   ...

***Patient Sets***

***Records***

**The Story: Step 15**
***Provide Data to Data Sources***

- Data may be returned to the Data Sources in many ways.
- Reports may be generated on the Patient Sets, returning information for all Patient/CTCs with which the source has interacted.
- Communications may be created based on Health record updates which are marked ‘Facility Notification=Yes’
- Reports may be generated on the raw Health Records, providing a summary for each patient of the information reported by the facility.
- Follow-back queries may be generated to notify the data source that different records have conflicting information.