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Manitoba Cervical Cancer Screening Program
CancerCare Manitoba
June 2009
MCCSP Registry Infrastructure and Evaluation
Presentation Overview• Program Overview• Registry Infrastructure
– Business Process– Database Linkages– Support and Maintenance– Upgrades and Change Requests
• Information Utilization– Operations– Surveillance & Monitoring– Evaluation– Research
www.everytwoyears.ca
MCCSP Overview• Established January 2000
• Program of Manitoba Health
• Managed by CancerCare Manitoba
• Public Health Act Regulation (2009 & 2001)
• 398,770 women age 18-69 (01-06-2008)
• 7 cytology laboratory partners
• 27 Colposcopists
www.everytwoyears.ca
MCCSP Program Guidelines
• Screening starts with sexual activity
• May stop at age 70
• Pap test annually x 3 • 3 Negative 2 years
• Unsatisfactory/Low Grade = repeat 6-9 months
• Persistent Unsat/Low Grade = colposcopy
• High Grade = colposcopy
www.everytwoyears.ca
MCCSP Registry is….• A confidential centralized database of all
cervical cancer screening test results
– Includes cytology, colposcopy, associated pathology
– Demographic information on all females 18-69– Regulated by the Cervical Cancer Screening
Registry Regulation 31/2009
www.everytwoyears.ca
Registry Infrastructure• Screening Reports
– Cytology (April 2001)– Colposcopy (January 2003)
• Standardized nomenclature and dictionaries• Manitoba Health Population (18-69)• Hysterectomy tariff codes• Cancer Registry – cervical cancers• In Process
– Population expansion (10-17)– Vaccination status (MIMS, DPIN/Health Admin– All Gynecological cancers
www.everytwoyears.ca
Information Systems• Computerized and automated
– Manage dataflow and information needs• Information comes from
– Laboratory test results– Colposcopy reports– Demographic data– Health care providers– Cancer Registry– Manitoba Health databases
• Gather and consolidate data• Relies on the cooperation of the health
care community
www.everytwoyears.ca
System Infrastructure (Literally)
• Database Server– Linux – Oracle 10
• EDI Server– M/S Windows NT
• LAN network HUB (10/100 Base T Ethernet)• IP Routers
– To external laboratories • Modem to modem communication
– To Manitoba Health WAN
www.everytwoyears.ca
Business Processes• Acquire report data (electronic and manual)• Enter/edit report data • Process reports• Edit/check and validate• Link data on individuals• Determine follow up events• Perform QA• Query individual’s screening histories
www.everytwoyears.ca
Business Processes Cont’d• Generate follow up reminders• Generate standard reports• Consolidate
– Cancer data– Hysterectomy data– Population data– Duplicates
• Perform data queries• Perform system administration• Provide electronic histories to cytology
laboratories
www.everytwoyears.ca
Electronic Transmissions from Laboratories
www.everytwoyears.ca
File Upload Process
• Population Upload– Data from Manitoba Health– Modem to modem connection– Data is FTPd to Cervical Cancer
Screening Server– ISIS software
• Population upload function– Match by PHIN, surname, DOB– Update patient demographics– Population Table
www.everytwoyears.ca
File Upload Process Cont’d
• Cancer Upload Process– Data from Cancer Registry system
• Maxon Database (Sybase)• SQL script
– Extracted data is FTPd to Cervical Cancer Screening Server
– ISIS software• Cancer Upload Function
– Match by PHIN, surname, DOB/ Cancer Number/Dx Date
– Updates patient cancer information– Cancer Table
www.everytwoyears.ca
Reports• ISIS software generated reports• CCSP reporting
– PowerBuilder programs• Extracted from Oracle Database
– Population based– RHA/FSA– Health Care Provider Reports
• Ad-hoc reports extracted to EXCEL (also Comma Separated Values, ASCII text, dBase 2/3, Data Interchange Format, Lotus)
www.everytwoyears.ca
Database Linkages• Cytology Laboratories (electronic
transmission)– PHIA compliant– Results– CPSM MANQAP Quality Standards
• Manitoba Health – Population– Administrative Databases– MIMS– DPIN
• Cancer Registry • Future Pathology Laboratory Linkage
through E-Path (AIM)
www.everytwoyears.ca
Support & Maintenance• CCMB Health Information Services
– Project management/application support and development– System administration– Database management– Hardware maintenance for Cytology laboratory systems– Electronic linkage (Transmed)
• MCCSP Team– Program management – Data entry– Quality assurance – Development of Requests for Change– User acceptance testing
• Artificial Intelligence in Medicine (AIM)– Upgrades– New developments– Support for Laboratory Data Interface Improvements at
laboratories
www.everytwoyears.ca
Support & Maintenance Cont’d
• ISIS Production Database• ISIS Production Patient Inquiry• ISIS Test Database• ISIS Test Patient Inquiry• Transmed • FTP Script• Database SQL Scripts• Cancer Extract SQL Script• PowerBuilder Reporting Application
www.everytwoyears.ca
Upgrades and Change Requests
• Annual support maintenance (AIM)• Quarterly submissions• Quarterly upgrades • Testing at AIM• Remote testing by AIM• User acceptance testing at MCCSP• Production implementation by CCMB HIS
www.everytwoyears.ca
Information Utilization• Operations• Surveillance/Monitoring• Recruitment and Promotion• Evaluation• Research
www.everytwoyears.ca
Operations• Opt out (21)• Screening Results to
– Women (empowers and educates)– Cytology laboratories (MANQAP
Reporting/QA)– Health care providers (improves clinical
management and educates on screening guidelines)
• Follow Up and Monitoring– High Grade Abnormal Results (January 2003)– Low Grade Abnormal Results (April 2006)– Letters to health care providers– Letters to women
www.everytwoyears.ca
Surveillance• Screening patterns by
– Age– RHA– FSA– Time
• Abnormal Pap test management and follow up• Workload
– Cytology– Colposcopy – Provider
• Impact on participation, abnormalities, cancer incidence
www.everytwoyears.ca
Recruitment and Promotion
• Definition of eligible population• Recruitment letters• Reminder letters• Target populations and
communities• Pap Test Learning Module
www.everytwoyears.ca
Evaluation• Reaching target populations
• Statistical reports
• Pap Clinic Week
www.everytwoyears.ca
Research
• Cancer incidence and screening participation
• HPV Pilot Study (2006)• HPV Surveillance (2008)• Pap test utilization and impact of
recruitment letters (2010)
www.everytwoyears.ca
Future Questions• Manitoba Cervical Cancer Screening Program
– 788-8627– 1-866-616-8805– [email protected]
• EveryTwoYears.ca
• TellEveryWoman.ca
• Women can call for copies of their own results
www.everytwoyears.ca