Concurrent Abstracting in a Time of Change

By Laura Vondenhuevel, BS, RHIT, CTR

There are so many new things coming at the cancer registry profession in 2018. In my last blog post preparing cancer registry professionals for these changes, I talked about NAACCR’s website for 2018 Implementation Information and how it is a great resource to help us keep up with everything.

Now that we are at the beginning of the age of concurrent abstracting in the cancer registry, some of us are starting to get a little worried. Sure we’ve had the AJCC 8th edition for a year now, but as of this blog posting the new cancer registry coding manual will not be available until November or December of 2017. How long might it take our cancer registry software vendors from the time of the manual’s release to update their software to reflect those changes? The not knowing can be enough to cause angst amongst even the most flexible of cancer registrars.

I’m a big proponent of the “don’t worry about what you can’t control” approach to life. So I like to plan for what I CAN control. I’ve learned a lot since we cancer registrars were faced with our last big change in 2010 and I’ve adapted these lessons to help me stay on top of my concurrent abstracting amidst the changes coming in 2018:

Read Those Manuals | As soon as the manuals become available, read them and become acquainted with any potential data collection issues you foresee.

Check in with Your Software Vendor | After the manuals are released, check in with your software vendor for their implementation plan and timetable.

Check in with Your State Registry | Pay attention to emails or newsletters from your state’s central registry so you can be ready with 2018 cases when your registry is ready to accept them.

Text, Text, Text | If there is a data element that is not in your registry software yet, decide on a standardized location where your team will text the pertinent information as they abstract the case.

User Defined Fields are Your Friend | Create a user defined field for 2018 cases to flag them for easy retrieval later and define these for your team in a central location.

Clearly Define Your Process | Document what your concurrent abstracting process is and place it in a central location for your entire team to reference.

Example: Complete the abstract with the information available at two months from date of first contact, the state flag is set to “not ready,” and select the appropriate 2018 Case UDF option.

Detailed notes and appropriate codes are used for anticipated treatments. Text the information for new 2018 data elements in the “comments” text box.

Cases will be returned to the abstractor at six months to add any additional treatment information and marked as “ready to submit."

Cases are submitted to the state cancer registry when they are ready to receive 2018 cases.

Keep your Hospital Partners Informed | If a change will effect data requests or reports you run on a regular basis, let the administrators or clinicians you work with know in advance.

Most Importantly – Communicate | Watch for 2018 implementation updates from standard setters, software vendors and your state cancer registry. Make sure to communicate with your team regarding any changes to processes you have defined.

Change is coming. There is no doubt our concurrent abstracting processes will be effected, so it’s always best to be as prepared as possible.

What are you doing to stay on top of your concurrent abstracting amidst the changes coming in 2018? 

This article was originally featured on the CHAMPS Oncology Outlook blog on October 11, 2017 and reprinted with permission.
https://champsoncology.com/blog/concurrent-abstracting-in-a-time-of-change

Ohio House Bill 172: Modify Law Governing Access to Patient Medical Records

UPDATE: The organizations in support of HB 172 (Ohio Hospital Association, Ohio State Medical Association) decided to pull this bill in May 2018.  If they re-introduce a similar bill, they have said they will involve OHIMA in that process. 

Ohio House Bill 172, sponsored by Representative Kirk Schuring, had its second hearing in the House Health Committee on October 18^th.  OHIMA’s Executive Director, Lauren Manson, has been in contact with Representative Schuring regarding this bill.  After analysis, OHIMA does not currently support nor oppose this bill.  The bill was reviewed and HIPAA already defines the “designated record set” and in its current state, HB 172 does not appear to add anything more than what HIPAA already requires. 

HB 172 came about in response to Griffith v. Aultman Hospital where the Ohio Supreme Court decision interpreted Ohio's definition of "medical record." In this case, the daughter of a patient sued the hospital alleging that it did not provide her with all of the medical record as she had requested. Missing from the record were cardiac monitoring strips printed after the patient's discharge from the hospital and maintained by the hospital's risk management division, rather than its medical records department. 

The trial court ruled in favor of the hospital, concluding that it had produced the medical record as defined by state law.  The appeals court agreed, noting that only records that a hospital determines need to be maintained in the process of caring for a patient and not everything having to do with the patient must be disclosed. It held that a patient's medical record consists of what is maintained by the medical records department; any information the health care provider decides not to maintain is not part of that record.

In a 5-2 decision, the Ohio Supreme Court reversed the appeals court, holding that the physical location of data is not relevant to determining whether it qualifies as a medical record. Instead, the issue is whether a health care provider decides to keep data that is generated in the process of a patient's treatment and that pertains to the patient's medical history, diagnosis, prognosis, or medical condition. The Supreme Court concluded that for purposes of the medical record definition, whether data is "maintained" by a healthcare provider (and therefore must be provided) is determined by whether the provider made a decision to keep or preserve the data.  Basically stating that “if it exists, it could be considered part of the medical record.”  Ohio HIM professionals have expressed that, logistically, this is near impossible to put into practice. 

HB 172 was developed in response to Griffith v. Aultman Hospital and is meant to limit the definition of "medical record" for purposes of the law governing access to patient medical records.  For more information on this bill and to follow its progression in the House, see The Ohio Legislature website.

Cancer Registry Professionals – Get Ready for Changes in 2018

By Laura Vondenhuevel, BS, RHIT, CTR

You know the old saying, “change is the only constant in life?” Well as cancer registry professionals, don’t we know it! Every year we see tweaks being made to our manuals, code descriptions being added and new drugs being introduced to the oncology market. So change is something to which we cancer registrars have grown accustomed. And 2018 promises to be an interesting year for us.

Flash Back to 2010
If you were part of the cancer registry community back in 2010, you remember our last big change: the move from American Joint Committee on Cancer (AJCC) Staging Manual 6th edition to the 7th edition. The effects of this change were a big adjustment and even effected other cancer data collection manuals such as the Facility Oncology Registry Data Standards (FORDS) and Collaborative Staging. Cancer registry professionals who were around for this transition will remember an added challenge was that data items were released very close to the go live date of January 1, 2010, so many software providers were not ready to go live with their updates until months later in 2010. Do you remember the widespread suggestion to use paper abstracts to fill this gap? SMH. It was not fun and we were stuck abstracting, for the most part, at six months from date of first contact.

What’s Coming in 2018
Fast forward to 2018. The age of “Concurrent Abstracting” (or at least more concurrent than six months) is upon us with many hospital cancer registry professionals abstracting cases anywhere from “in real time” to six months from the date of first contact. And, if you have been reading your emails from our standard setters, you know another big change is on the way. The North American Association of Central Cancer Registries (NAACCR) has established a website to locate 2018 implementation information in one central location – that has been a big help for those of us cancer registry professionals who are trying to keep up! If you’re trying to keep track of what is being updated, here are some details that should definitely be on your list:

• Staging: AJCC 8th Edition, Summary Stage 2018, Extent of Disease, and Site Specific Data Items (SSDI)
  
• Coding: ICD-O 3 Revisions, Solid Tumor Rules (formerly the Multiple Primary and Histology (MP/H) Rules), Hematopoietic Database and Manual, and Standards for Oncology Registry Entry (STORE) Manual (formerly FORDS)

Many of these items will not be released until November 2017 or later. So what is a concurrently abstracting cancer registry professional to do? In my next blog post, I hope to share some ideas to prep your cancer registry for these changes. It’s always better to be prepared as possible! Stay tuned…

This article was originally featured on the CHAMPS Oncology Outlook blog on October 3, 2017 and reprinted with permission.  
https://champsoncology.com/blog/cancer-registry-professionals-get-ready-for-changes-in-2018