About clinical reporting of cancer
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Everyone involved in the assessment, treatment and follow-up of cancer patients must report to the Cancer Registry. Good reporting helps Norway have one of the world's most complete cancer registries. It is important for improving cancer treatment.
Reporting
The Cancer Registry of Norway receives information from several sources, including clinicians in both the specialist and primary health services, from pathology departments and from other health registries.
All reporting of clinical information from the specialist health service and pathology departments takes place electronically via the Norwegian Health Network.
Reporting - clinical information
Information from clinicians, together with pathology information, constitutes the main basis for information on cancer cases in the Cancer Registry. Clinicians should report for all cases of cancer and for certain cases of precancerous lesions and benign tumors.
Types of cancer for which there are quality registries have specific reporting forms that cover the various parts of the treatment pathway, such as assessment, surgical treatment, radiotherapy, drug therapy and follow-up. Other cancers are reported on general forms for solid and non-solid tumors.
Today, clinical information is mainly reported via the Cancer Registry's Electronic Notification Service (KREMT). This is a web-based solution that is available free of charge to everyone who is affiliated with the Norwegian Health Network.
KREMT contains functionality for reporting and caching forms. In addition, there is also an overview of missing cancer reports, receipts for submitted reports and statistics based on the health institution's own reporting.
The health institutions can also choose to use electronic reporting solutions other than KREMT. However, this requires that the Cancer Registry's notification specifications form the basis for the reporting, and that our systems recognise and can use the reports.
Reporting - pathology information
The pathology departments in Norway, both in hospitals and private pathology laboratories, send copies of pathology reports for cancer, precancerous lesions and some benign tumours to the Cancer Registry. In addition, pathology departments must submit pathology information necessary for the operation of the screening programmes.
Which remittances the pathology departments should send to the Cancer Registry of Norway is mainly specified on the basis of NORPAT codes (the pathology coding system).
A main goal for reporting pathology information is to get all pathology departments to send remittances as xml files via the Norwegian Health Network instead of paper reporting. In addition, the Cancer Registry of Norway is working to get the pathology departments to implement pathology responses where the diagnostic summary is structured (pathology templates).
Notification from paper reporting
Reporting of clinical information to the Cancer Registry of Norway has been paper-based for more than 60 years. In spring 2017, we removed the last paper forms. All reporting will now take place electronically.
Clinical information must be reported via the Cancer Registry's electronic reporting service or via other systems for electronic reporting.
Health institutions that do not have access to the Norwegian Health Network and electronic reporting do not have to report to the Cancer Registry.
The Cancer Registry of Norway no longer requests clinical information from the primary health service.
Development projects - reporting
The Cancer Registry's ambition is to find good solutions for reporting. The solutions must be user-friendly and ensure as much reuse of data as possible. Reducing the proportion of double registration is an important goal for us.
We currently collaborate with several other actors in the eHealth field to ensure good and complete clinical information in the Cancer Registry of Norway with the least possible use of resources in the health institutions. Here is a brief presentation of these projects.
Use of alternative reporting solutions
It does not matter to the Cancer Registry of Norway which reporting solution is used, as long as the reports are developed on the basis of our message specifications xml file sent to us is accepted and approved in our system. It is also important that the reports are updated when the Cancer Registry publishes new versions of the forms.
MedInsight
Oslo University Hospital primarily wishes to use MedInsight for reporting to the Cancer Registry. There are currently two types of cancer that can be reported to the Cancer Registry of Norway via MedInsight: breast cancer and lymphoma/lymphoid leukemias. In addition, DNR has created a functionality to automatically fill out forms for solid tumors based on an internal database containing this information. Aker, Ullevål and Rikshospitalet do not yet have this possibility of solid tumours. All other cancers must, until the form is available in MedInsight, be reported via KREMT.
MRS
Hemit, the South-Eastern Norway Regional Health Authority and the Cancer Registry of Norway are collaborating on a project to establish reporting to the Cancer Registry of Norway via MRS. We have applied to the National ICT Professional Forum for Medical Quality Registries for funding for this project.
Reuse of data from drug therapy systems
The Cancer Registry of Norway collaborates with Csam, Hemit and St. Olavs Hospital to try to reuse data on drug therapy stored in the Cytodose system. If this is possible, we will be able to reduce the amount of information oncologists must manually report to the Cancer Registry.
The Cancer Registry of Norway and Sykehuspartner have also initiated similar work in relation to the new system for drug treatment in the South-Eastern Norway Regional Health Authority.
Reuse and easier access to radiation data
Since 1997, the Cancer Registry of Norway has received information on doses, fractions etc. from all the country's radiation units. There is currently a discussion in the reference groups for all quality registries in the field of cancer about the information clinicians currently have to fill in manually, whether radiation therapy can be completely or partially replaced by the information we already receive directly from radiation machines. If this data can be reused, we can reduce the manual reporting from clinicians.
The Cancer Registry of Norway also cooperates with the Norwegian Patient Registry and the Norwegian Radiation Protection Authority to make it easier for the radiation units to report data on radiation therapy. Today, the radiation units must report separately to all three institutions. The goal is that in the future the radiation units will only report to the Norwegian Patient Registry, and that the Cancer Registry of Norway and the Norwegian Radiation Protection Authority will receive data from there.
Information about diagnostic imaging/radiology
The amount of information requested about diagnostic imaging/radiology varies between the various quality registries, but common to all of them is that we would have liked to have had more information about this. In addition, there is a great need for the Mammography Programme to obtain information about mammography examinations also from private clinics - not only from the public breast diagnostic centres.
Instead of asking clinicians to manually report more information about this, we want to reuse data that already exist in the Norwegian Patient Registry. A project has been established for this in continuation of the project on access to radiation data.
Integration with DIPS Classic
There is a great desire from users of DIPS Classic that it should be possible to report to the Cancer Registry of Norway directly from the EHR system. Innlandet Hospital has initiated a collaborative project that in addition to them involves Sykehuspartner, DIPS, Prokom and the Cancer Registry. We agree on the technical solution to be tested, and have started a pilot for prostate cancer reporting.
Integration in DIPS Arena
It is a stated goal of the Cancer Registry of Norway that the notification form should be an integral part of a structured EPR. To achieve this, a collaboration has been established between DIPS, the National ICT Archetype Administration, Esito, the Northern Norway Regional Health Authority and the Cancer Registry. The work to establish archetypes and templates for the Cancer Registry's notification form has already been going on for some years.