Cloud-based Solution for Real-time Reporting of Cancer Data · 2019-08-13 · Cloud-based Solution for Real-time Reporting of Cancer Data Joseph D. Rogers, MS Team Lead Informatics,

Cloud-based Solution for Real-time Reporting of Cancer Data

Joseph D. Rogers, MSTeam LeadInformatics, Data Science, and Applications Team (IDSAT)Cancer Surveillance BranchDivision of Cancer Prevention and Control

2019 NAACCR/IACR Combined Annual MeetingJune 12, 2019

CDC Informatics/Data Science Strategy

3 Division for Cancer Prevention and Control Reliable. Trusted. Scientific.

“Data is moving slower than the disease…”

“The nation’s public health data systems are antiquated and in dire need of security upgrades -paper records, phone calls, spreadsheets and faxes requiring manual data entry are still are in widespread use and have significant consequences including delayed detection and response, lost time, missed opportunities and lost lives.”

Testimony of Janet Hamilton, Director of Science and Policy at CSTE, speaks at Public Witness Day, April 9, 2019 Labor, Health and Human Services, Education, and Related Agencies (116th Congress)


The New World of Public Health DataTimely, Accurate, Accessible…

CDC is developing world-class data and analytics to transform today’s realityand meet new opportunities for lifesaving prevention and response.


CDC Using Science and Innovation to Prevent, Detect and Respond

Enable strategic achievement through:State and local partnerships

Global capacityOperational excellence

Stakeholder engagement

Accelerate Priorities through:World-class data, analytics, and laboratories

Elite public health workforceStrategic communication

Outbreak response

Aspiration: We save American lives by ending epidemics, eliminating disease, ensuring domestic preparedness, and securing global health.

Strategic Priorities: Our priorities reaffirm our leadership and commitment to confront and respond to health threats wherever they occur. We will focus our scientific expertise on bringing an end to the devastation of epidemics, finally eliminating certain

diseases, and providing a new level of domestic health preparedness and global health security against current and

emerging threats.

Priority Accelerators: Protecting America’s health requires continuous improvement in our

most vital assets: our data, laboratories, and people.

Enabling Capabilities: Our strategic priorities are enabled by unique

expertise and interdependent capabilities.

We Save Lives

Eliminate DiseaseHIV/AIDS Vaccine-preventable Hepatitis C

End EpidemicsOpioids Influenza Antibiotic resistance Diabetes

Secure Global Health and America’s Preparedness

Pandemic contagionsBioterrorism threats Vector-borne


GoalSeven Imperatives for 2024

By 2024, CDC will be operating to a new normal, working across programs and agency initiatives & through emerging

priorities

To transform CDC and our partners from a culture of primarily historical data analytics to predictive data science supported by modern IT platforms and enterprise services that facilitate CDC’s public health mission

CloudCDC data will be in a cloud

Common PortalData reporting to CDC will be through a common portal

InteroperabilityCDC data will be

interoperable within and

external to CDC

Data SharingCDC data will be shared and

public, while protecting

privacy and confidentiality

Enterprise LevelAt the enterprise level, CDC data will

be catalogued, have metadata and be

labelled with appropriate access and

privacy controls

Analytical ToolsCDC scientists will have efficient access

to relevant data science tools and the

capability and expectation to perform

both historic and predictive analyses

State & Local SupportState and local health departments will

be supported to accomplish

complementary goals

Problem Statement, Need, and Solution


Problem Statement, Need, and SolutionProblem Statement• Current data collection and reporting methods are hindered by manual

processes• Result is inherently needless time lags and costly inefficiencies

Overarching need for more timely cancer incidence data for• Faster identification of cancer cases for evaluation and improvement of

cancer control strategies• Better-informed decisions about where resources need to be allocated for

cancer prevention, control, and treatment

Solution• Removal of inefficiencies to move from publishing on 24 month to real-

time data• Use of cloud-based platform to achieve real-time reporting to the central

cancer registry

Current State


HOSPITALCLINICIANPATHOLOGYLABORATORY

STATE CANCER REGISTRY

PARTIAL ABSTRACT

DATABASEFOR

PUBLICATION

TREATMENTCENTER OTHER

CONSOLIDATIONCONSOLIDATED REPORT

EHR SYSTEM

CANCERPATIENT

PATHOLOGYREPORTCurrent

State: National Program of Cancer Registries (NPCR) Information Flow


Current State: National Program of Cancer Registries (NPCR) Information Flow

Hospitals

Laboratories

Physicians

Radiation Therapy Centers & Medical Oncology Facilities

Outpatient Centers

Central Cancer Registry

•Following back•Cleaning•Editing•Linking

•Consolidating•Analyzing


Current State: National Program of Cancer Registries (NPCR) Information Flow

Pathology Laboratory

CCR (State 1)

CCR Database

CCR (State 2)

CCR Database

Hospital/Clinic/ Physician Office

Future State


Future State: Cloud-based Computing Platform (CBCP) for Real-Time Reporting

• Shorten time from case identification to completed incidence record available in CCR database

• Shift CCR staff work to spend less time on file processing, running multiple separate applications, and tracking down missing data, to more productive tasks

Advantages

• Labs send electronic pathology reports in real time to cloud-based service

• Service automatically processes these reports by extracting and coding salient data elements

Vision



CBCP initiates abstracting process by automatically notifying the ordering facility to request that they complete partial abstract created by CBCP

Facility completes abstract via the cloud service(s)

Dashboard interface to monitor abstracting and automatically send completed abstract to CCR, where it enters the usual reporting stream.• For these reports, minimal to no CCR staff time is needed




CBCP

Future State: Cloud-based Computing Platform (CBCP) for Follow-Back by the Central Cancer Registry (CCR)

Pathology Reporting Service

Partial Abstracts

Pathology Laboratory

Hospital / Clinic / Physician Office

Complete Abstracts

CCR

CCR Database

Management System

CBCP Dashboard (rule/Role-

Based)


Future State: Dashboard Example

CBCP for Real-time Reporting Advantages


CBCP for Real-time Reporting Advantages

Coordinated funding No siloed projects Shared governance

Vetting of innovative concepts

Unified interface and single portal for

pathology laboratories and

EHR vendors

Reduced costs: cost sharing and lower

direct costs

Native advanced security Language neutral

Service can be used by other disease

domains

Shared Services


Cancer Surveillance ModernizationA cloud-based Platform of shared services allows different organizations to develop and support a service. These services can work in concert as a fully functional system.


Laboratory Information System Interface Service


Data Transport Service

Pathology Laboratories

Hospitals

Physician Offices/Ambulatory Providers

State Central Cancer Registries

CBCP

Radiation Therapy Centers & Medical Oncology Facilities


Patient Matching, Record Linkage, and Deduplication Service


Web-based Abstracting Service


ePath Report Processing/Analysis Service


EHR Report Processing/Analysis Service

Parsed CDA Document

Auto-generated Abstract

Mapped Values (direct)

Translated Value

DefaultedValue

Mapped Values (complex rules)


NLP/Machine Learning Service

Shared NLP Web Services and Pipelines NLP Applications, Tools and Components

Clinical Language Engineering Workbench (CLEW)

*eMaRC Plus, *ETHER, etc.

Engineers

Non‐EngineersEncoding

Summarization

Temporal & Clinical Information Extraction

Safety Data Service Consumer and Service Provider

Pathology Service Consumer and Service Provider

Other Shared Services

Training Datasets

Machine Learning Models

Hybrid Models

Rule‐based Models

*eMaRC Plus: electronic Mapping, Reporting, and CodingETHER: Event‐based Text‐mining of Health Electronic Records System


Interface with Vendor-based Hospital Registry Service

Hospital A Cancer Registry

State A Central Cancer

Registry

• Abstracting• Follow-back• Structured Data Capture

Hospital B Cancer Registry

State B Central Cancer

Registry

SERVICES

Value of the Cloud and Real-time Data


Value of the Cloud and Real-time Data• Much faster identification of cancer cases to evaluate and improve

cancer control strategies and program planning• Find out what interventions work or don’t and adjust quickly• Better-informed decisions about where resources need to be

allocated• Timelier identification of cancer patients cases for clinical trials• Quickly identify where research needs are• A model for real-time reporting of other chronic and infectious

disease data


Central Cancer Registry (CCR) Question and Answers • Q: Where is the data stored in the cloud and for how long?

• A: When a request for proposal (RFP) is issued, the standards for server use and location can be stipulated. The CCR can determine how long that data is stored in the cloud (rule-based levels).


Central Cancer Registry (CCR) Question and Answers (continued)• Q: Where is the data stored in the cloud and for how long?Best Consolidate reports from multiple facilities and route

to CCR database management systemBetter Parse report, create a partial abstract, prompt a single

facility to complete the abstract, route to CCR database management system

Good Parse report and route to CCR database management system


Central Cancer Registry (CCR) Question and Answers (continued)• Q: How will the cloud be governed and how will data access be

controlled?

• A: A governance team will be made up of CCR representatives and other stakeholders. The CCR will have full control of their data via roles set up for each CCR administrator.


Central Cancer Registry (CCR) Question and Answers (continued)• Q: What role will the CCR and CCR database management

system have once the cloud is fully implemented?

• A: The CCR and its database management system will continue in its current role; however, the focus will be on case-finding, linking, consolidation, and quality control efforts. The cloud will focus on automating upstream processes and creating real-time data access.

39 Division of Cancer Prevention and Control Reliable. Trusted. Scientific.

Project Leadership:• Wendy Blumenthal, MPH, Health Scientist• Sandy Jones, Public Health Advisor



“The best way to predict your future is to create it”

― Abraham Lincoln

Go to the official federal source of cancer prevention information: www.cdc.gov/cancer

Division of Cancer Prevention and ControlReliable. Trusted. Scientific.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you!

Documents

Cloud-based Solution for Real-time Reporting of Cancer Data · 2019-08-13 · Cloud-based Solution for Real-time Reporting of Cancer Data Joseph D. Rogers, MS Team Lead Informatics,