Case Studies: Oncology
A large academic medical center in the urban Northeast found itself in 2004 with critical abstracting backlogs and potential deficiencies in ACoS standards with an ACoS survey in the near future. The unavailability of skilled Certified Tumor Registrars to staff its multiple cancer programs presented an ongoing challenge to the goal of attaining compliance with ACoS CoC standards and State reporting requirements.
To meet these requirements, the institution contracted with Precyse Solutions for outsourced management of its registries and remote abstracting of cancer patient data. With the reorganization of the registries utilizing a combination of on-site and remote staff, processes were streamlined and standardized, thereby improving efficiency. Precyse remote CTR’s accessed online medical records via secure VPN connections to complete the abstraction of data. Precyse delivered records that were compliant with State abstracting guidelines and complete with all required data fields.
The results were above and beyond what the institution had hoped for. Precyse Solutions not only solved the institution’s critical backlog abstracting challenge but also provided them with added value – an efficiently managed multiple-facility cancer program that received ACoS CoC Approval with Commendation in 2006. Administration at the institution attributes the quick turnaround in backlogs to Precyse Solutions. As the only HIM consulting company to offer large scale, outsourced services and remote abstracting in the oncology arena, Precyse Solutions continues to be a leader in the industry.
| CRITICAL INDICATORS | 2004 PERFORMANCE | 2006 PERFORMANCE | BENEFIT POTENTIAL |
| Abstracting Backlog | 18-month backlog of abstracting (ideal delay in abstracting is no more than 6 months).
> 2500 cases needed to be reviewed for possible inclusion in database. |
6 month backlog and abstracting meets COC standard. | Up-to-date cancer registry data available to clinicians, administrator, and researchers for reports and analyses.
Compliance with state reporting mandate avoids reprimands and potential fines. Implemented new technologies (remote abstracting), accessed a larger labor pool, and liberated expensive office space. Relieved institution of recruiting and retention challenges. |
| Follow Up Rates | Below standard of 80% overall.
Below standard of 90% past 5 years. |
89% overall (standard= 80%)
90% past 5 years (standard=90%) |
Exceeds required standard.
Allows accurate analysis of survival data. |
| AJCC TNM Staging | Non-compliant. Ineffective process in place. Staging by managing physician inconsistent. | Prospective review implemented and compliance improved. | A catalyst for critical process review and improvement. Streamlined process enhances patient care by promoting timely, accurate staging. |
| CAP Protocol Compliance | Non-compliant. No process in place to monitor adherence to CAP Protocols. | Prospective review of ALL CAP eligible cases, not just 10%. | A catalyst for critical process review and improvement. Streamlined, automated process benefits patient care by promoting timely, accurate staging. |
| Casefinding and Suspense File Maintenance | Time-consuming process that required many hours of manual effort | Automatic download with decreased manual effort. | A catalyst for critical process review and improvement. Streamlined, automated process decreases the amount of time spent on manual casefinding. |
| Timeliness of State Reporting | Non-compliant. | Compliant. | Cash Acceleration by avoiding state fines. Failure to comply could result in the State Central Registry performing the abstracting and requesting reimbursement for all expenses incurred. |
| Filing and Retrieval Physician satisfaction |
95% | JCAHO compliance | |
| ACoS COC NCI-Designated Cancer Program (NCIP) Status | Potential for noncompliance in some standards. | Compliant in all Standards. Received Approval with four Commendations. | Prestige of accreditation with Commendation. Increased market share through visibility on COC and ACS Web sites. Ability to monitor key performance metrics useful in tracking achievements. |