The Connection
The Official Newsletter of NCRA | Summer 2013
Summary of the
NCRA/NPCR Workload and
Time Management Study: Guidelines for
Central Cancer Registry Programs
Released!
NCRA and the CDC’s National Program of Cancer Registries (NPCR) commissioned a national survey of current practices and staffing at central cancer registries. Prepared by Susan A. Chapman, PhD, RN; Vanessa Lindler, MA; and Carolina Herrera, MA, at the University of California– San Francisco Center for the Health Professions, the survey responds to requests from experts in the field for more research on workload and staffing guidelines for central cancer registries.
The survey outlines the work of registrars in central cancer registries, highlights issues that make performing central cancer registry work challenging, and analyzes the relationship between workload and staffing within central registries. Respondents expressed a concern about adequate staffing and the need to find qualified cancer registry staff to hire. These concerns are consistent with NCRA’s 2011 hospital registry workload study,
NCRA Workload and Staffing Study: Guidelines for Hospital Cancer Registry Programs.
The study was designed to provide central cancer registries with national workload and time management data they can use to compare to their own registry. These comparisons can help inform decision making about staff size and configuration. In addition, the findings provide central cancer registry administrators with the data needed to advocate, plan, and budget for their cancer registry programs.
“This national survey is an important first step in helping central cancer registry administrators determine what levels of staffing are needed to ensure high-quality and timely data collection,” stated Linda Mulvihill, RHIT, CTR, Public Health Advisor, Cancer Surveillance Branch, Centers for Disease Control and Prevention. “The findings should be useful for registries in benchmarking their own workload and time-management data and developing staffing guidelines and staff training.”
Conducted in 2011, the survey assessed the amount of time spent on work activities performed by cancer registrars in central registries. A survey consisting of 39 multi-item questions, together with a work activities data-collection log, was sent by email to the central cancer registry manager in each of the 50 states and the District of Columbia. Twenty-four central cancer registries (47%) responded.
Sample of Key Findings:
• Over 65% of all registries reported that compensating staff well enough to retain them, finding qualified staff, and funding an additional position were a “strong” or “extreme” concern.
• About 58% of registries said that staffing another FTE registrar was a “strong” or “extreme” need.
• Few registries reported needing to improve software training, medical or coding training, or needing help to meet specific state, NPCR, or SEER requirements. However, over 54% of registries reported that education/ training for collaborative staging was a “strong” or “extreme” need for staff. • Registries in the survey reported receiving, on average, 72,211 source
records per year with a range between 4,263 to 290,974 records. • Registries reported having, on average, 34,103 unique and reportable
cases, and 2,796 unique and non-reportable cases. Registries had, on average, 1.9 source records per case.
• A common theme among the concerns and needs was the level of staffing available to perform central registry functions.
• Survey respondents reported a decline in budgeted staffing between 2008 and 2009, budgeting on average for 20.8 FTEs in 2008 and 16.4 FTEs in 2009. • The pattern of reduction in budgeted staffing is also seen in the patterns of filled and vacant positions. On average, registries reported 15.8 filled and 1 vacant FTEs in 2008 and 15.2 filled and 1.5 vacant FTEs in 2009. • Due to the number of respondents, data could not be analyzed by different
sizes of registry. The wide range of minimum and maximum hours reported are likely due to the range in size of registry caseloads. On average, the registries reported spending the most hours on abstracting at the central registry (69.3 hours per week), electronic case consolidation (59.1 hours per week), visual editing (55.4 hours per week), resolving EDIT reports (31.3 hours per week), and resolving quality issues (29.7 hours per week). On average, the least hours are spent on passive follow-up (6.4 hours per week), travel for conferences/education (6.4 hours per week), death clearance matching (4 hours per week), travel for operations (3.8 hours per week), and active follow-up (0.9 hours per week).
A complimentary copy of the NCRA/NPCR Workload and Time Management Study: Guidelines for Central Cancer Registry Programs
summary is available to members on the NCRA website at www.ncra-usa.org/workforce.
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N P c c c c SWhat’s Inside
President’s Message
3
New NCRA President encourages keeping up
with changes on a continual basis.
Registrars in Action: Cancer Registry
7
Highlights programs in the Louisiana and
New Hampshire Cancer Registries.
Commission on Cancer Update
16
Inside this Issue
LEAH KIESOW, MBA, CTR | EDITOR,
THE CONNECTION
Editor Editorial Advisory Board Managing Editors Sherry L. Giberti, CTR
Therese M. Richardson, RHIA, CTR Shirley Jordan Seay, PhD, OCN, CTR
Dear Colleagues,
Well, here we are once again, where does the time go? If only we could slow the hand of the clock and take time to “smell the roses” as they say. With that said, my wish for all of you is that you have taken the opportunity to enjoy the summer weather, spend time with family and friends, and pursue your passions outside of the daily work routine. I made a trip back to Oregon to visit loved ones in June and really appreciated the time away. My three nieces are literally growing like weeds. I guess my sister needs to stop “fertilizing” them.
Around the first of the year, the decision was made to include articles throughout the quarterly editions of the newsletter from nearly all of the committees and board of directors. I must say, many of you stepped up to the challenge and submitted some wonderful articles.
In this issue you will find The Connection filled with numerous updates ranging from the new NCRA/NPCR Workload and Time Management Study (front cover) to our new President’s message (Shirley Jordan Seay, PhD, OCN, CTR, Pg. 3) to ICD-10-CM (Pg. 4) and beyond. For those of you who were unable to attend the annual conference this year, Barbara Collins, CTR, and 2013 Program Committee Chair, provided an overview of the 39th Annual Educational Conference (Pg. 18). While you are thumbing through the pages, please meet your new ATPD Directors (Pg. 6) and learn who your newly elected NCRA leaders are (Pg. 12). The NCRA membership is a tightly woven network of unique professionals, please take the time to learn who represents you and how they serve in different capacities. By this time, some of us have probably heard about the new CP3R measures that have been in the works for a while. You will be able to discover the particulars of the measures and their adoption or expected implementation dates (pg. 16). Among other new developments, NCRA recently launched the Center for Cancer Registry Education, and Sarah Burton, CTR has provided a summary of this new tool (pg. 19).
In closing, I hope that you will take the time to read The Connection from beginning to end - it is filled with valuable updates from your board of directors, committee leaders, chairs, and liaisons. So, grab a spot in the shade on one of these warm sunny days and soak up the news!
As always, all my best to you!
Leah
EDUCATION/PROFESSIONAL
DEVELOPMENT
Status of ICD-10-CM: Casefinding Lists and Conversion Files – Page 4
Registrars in Action – Page 7: Louisiana and New Hampshire Cancer Registry Programs: Colorectal Cancer Sharing Your Story: What the CTR Credential Has Meant to Your Career – Page 8: Read testimonials of the value of the CTR credential.
Upcoming NCRA Education Opportunities – Page 9
NCRA Releases a New Salary Survey for Cancer Registrars – Page 10
Mentoring Committee Update – Page 11 NCRA Education Foundation Update – Page 14: Learn about the new recruitment CD.
Golden Opportunities for Education and Professional Growth by the Bay – Page 18: A recap of the 39th Annual Educational Conference with photos. NCRA Launches the Center for Cancer Registry Education – Page 19
Recipe to Create a Mentor – Page 20: Read the 2013 Danielle Chufar Scholarship Winning Essay.
James A. Bradley Annual Conference Scholarship – Page 21: Congratulations to the 2013 scholarship recipient.
New CTRs Update – Page 23: Congratulations to the 154 new CTRs!
MEMBER/CUSTOMER SERVICE
President’s Message – Page 3: Read the transcript of NCRA’s President Dr. Shirley Jordan Seay’s Installation Address.Reward Yourself by Running for Office – Page 12: Review the positions for the 2014 slate.
2013-2014 NCRA Election Results – Page 12
2012 NCRA Award Winners – Page 21: Check out the photos!
Welcome New Members – Back Cover
ADVOCACY
Summary of the NCRA/NPCR Workload and Time Management Study:
Guidelines for Central Cancer Registry Programs Released! - Cover
Strategic Management Plan Update – Page 4
CAP (College of American Pathologists) Cancer Committee Update – Page 5 Meet Your New ATP Directors – Page 6 Informatics – Page 10: Grow your knowledge and understanding of cancer informatics.
Individual Registry Management: Reaching Out is Key to Success – Page 13: Great advice for the “solo” registrar. Commission on Cancer Update - Page 16: A summary activities from the May 2013 Committee Meeting.
Focus on Quality - Page 17: Important information about the Cancer Registry Quality Control Plan.
ADMINISTRATION & FINANCE
Professional Development Update – Page 15: Meet the Professional Development Board Director and read about recent committees activities.D W t h t w t w f
The Connection is the official newsletter of the National Cancer Registrars Association. Opinions expressed in articles in The Connection are those of the authors and are not necessarily those of the National Cancer Registrars Association, or the editor of The Connection. Reproduction in whole or part is strictly forbidden without prior consent of the editor. Copyright© 2013 The National Cancer Registrars Association. The designation CTR® is a federally registered trademark of the National Cancer Registrars Association. All rights reserved. Correspondence, inquiries, and articles must be sent to NCRA at [email protected].
Please direct address changes to: NCRA, 1340 Braddock Place, Suite 203 Alexandria, Virginia 22314 Phone: (703) 299-6640 Fax: (703) 299-6620 Email: [email protected] http://www.ncra-usa.org
Article Submission Requirements
1. Articles should pertain to newsworthy events affecting members of NCRA, including education, certification and articles of interest to the entire membership of NCRA. Also intended for inclusion are business matters of NCRA. Scientific articles are not appropriate for The Connection and should be submitted to NCRA’s Journal of Registry Management.
2. Articles should be submitted by email to NCRA. ACSII text or any desktop publishing files are allowed. 3.The document should be formatted to include any text boxes or graphic art; this will be included in the publication if possible.
4. The NCRA Editorial Advisory Board of The Connection reserves the right to refuse publication of any article that is not appropriate. The NCRA Editorial Advisory Board will review the article and the editor will notify the author of any changes before the publication.
The deadlines for article submission: September 14, 2013 (Fall issue) November 6, 2013 (Winter Issue)
The Connection
Spring | 2013
Leah Kiesow, MBA, CTR Janice Ford Peggy Meehan
President’s Message
SHIRLEY JORDAN SEAY, PHD, OCN, CTR | PRESIDENT
When you only have a short period of time to deliver a message, you have to be very focused and straight to the point. So, I would first like to humbly thank you for the privilege of serving this illustrious organization of dedicated professionals. We have come a long way, and there have been mega changes since our inception. The quality data we collect today may just change a life tomorrow.
Each president operationalizes the vision of NCRA in different ways. Susan Koering encouraged the membership to “reach to new heights,” “listen to your thoughts,” “give from your heart and share your gifts and talents.” Melanie Rogan’s challenge to you was to “find a way to make a difference.” She said: “Find a new registrar to mentor, share your knowledge and your experience.” Our Immediate Past President Sarah Burton encouraged you to “volunteer, mentor, find ways to give to the profession however you choose.” All these messages have a common theme: Share your expertise so we can continue to enhance the quality of our data and positively impact patients’ cancer experiences and outcomes.
The driving force behind my presence here is a more global picture. I see how our work directly impacts or has the potential to positively impact patient outcomes. Each time we identify a patient who hasn’t received the standard of care for treatment, whether because of a missed appointment or a lost-to-treatment scenario, we can alert the provider to get the patient back on track. I know the work we do changes lives and makes a difference. “NCRA’s primary focus of education and certification with the goal to ensure all cancer registry professionals have the required knowledge to be superior in their field,” is a statement I took to heart. It has guided my journey thus far and will continue to guide my efforts at NCRA. My focus and all the committees and activities I’ve been involved in to date have centered on education.
We don’t always realize our value and how much we can potentially impact patient outcomes. The Institute of Medicine report, To Err is Human: Building a Safer Health System, considers “avoidable delays in treatment”—i.e., when patients do not receive the standard of care in a timely manner—to be medical errors. When we as registrars perform our timely data collection, analysis, and review, we are able to alert providers so that such delays do not occur. This is just one way in which we have a tremendous impact on patient outcomes and are instrumental in preventing medical errors.
The Institute of Medicine further states that, “more commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.” One example of a quality issue arising from a faulty registry system is related to Scope of Regional Lymph Node Surgery. CDC, SEER, and CoC all found that Sentinel Lymph Node Dissection alone or in combination with Axillary Lymph Node Dissection
was underreported. After detailed review, it was determined that this underreporting occurred because of what the registrars were told to use as their primary source document for coding. Rectifying this problem was accomplished by revising the instructions for coding and educating registrars.
One thing that we know about the registry profession and oncologic management in general is that things are constantly changing. New drugs are developed for treatment every day, and there are updates and revisions to our source documents on a continual basis. My challenge to you is to keep up with the changes as they occur. I challenge you to speak up and respond when you think a standard or a change to be implemented may have an adverse impact. I encourage you to take the time to respond when a new standard is purposed and share your opinion, especially if you think it will be problematic. We are the experts, as we are constantly reviewing, analyzing, and documenting the patient’s cancer experience. We know when there is a new trend in capturing a marker or performing a test that may make a difference in how a patient’s cancer is treated. We must be proactive in collecting the data we know might be needed later without being told to do so. We must constantly take the initiative to do what is in the best interest of patients.
We are the ones ultimately in charge of our profession and we must always remember that our focus is far greater than just collecting and documenting data. We are improving outcomes for cancer patients and providing the data that will fuel the research to help find cures now and in the future.
Finally, on a different note, NCRA has been actively seeking a Standard Occupational Classification. In our most recent attempt, we were declined based on Classification Principle 1, which states that occupations are assigned to only one occupational category. It was indicated that the work that cancer registrars perform is not sufficiently distinct from the work of medical records and health information technicians. On this point, I challenge you to take every opportunity to dispel this misinformation. This can be accomplished with education. Volunteer to educate at career fairs in high schools, at community events, when you talk to your legislators, and even when you talk to your friends. NCRA will continue our pursuit of a Standard Occupational Classification; however, we need your help. If you have an elevator speech that articulates well what we do and who we are, please send it to us so we can share it. Let’s aim high and strive for a big goal: through all of our educational efforts, after this year, most people will know the term “cancer registrar,” the importance of cancer registry professionals, and the significance of the work that we do. We have made great strides as a profession and, as a unified force, we can overcome any obstacles. I am extremely proud to call myself a cancer registrar. Thank you for your support,
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Strategic Management Plan Update
SARAH BURTON, CTR | IMMEDIATE PAST PRESIDENT AND GPEC CHAIR
NCRA Vision Statement: Improving lives through quality cancer data management.
NCRA Mission Statement: To serve as the premier education, credentialing, and advocacy resource for cancer data professionals.
The Governance, Planning, and Evaluation Committee (GPEC) monitors NCRA’s Strategic Management Plan (SMP). NCRA staff and GPEC members
have worked to create tools that can effectively evaluate the SMP and deliver results to the membership.
GPEC members recently concluded a series of articles on the six SMP strategies, and they provided an update on the SMP at the 2013 Annual Educational Conference in San Francisco. You can find the articles as well as a webinar on the SMP accomplishments for 2012 on the NCRA website at www.ncra-usa.org/SMP.
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Status of ICD-10-CM: Casefinding Lists and
Conversion Files
JENNIFER RUHL, MSHCA, RHIT, CCS, CTR | NAACCR, ICD-10-CM IMPLEMENTATION TEAM CHAIR
As many of you are aware, we are now looking at an October 1, 2014 implementation date for the ICD-10-CM. The NAACCR ICD-10-CM Implementation Team has finished our initial goals and the plan was to wait a couple of months before preparing for 2014 but that changed when a hospital registrar from a CoC program in Alaska called NCI SEER with a request.
Yes, we do listen to registrars and this one had a very good point. She wanted to know when the ICD-10-CM casefinding list would be distributed. Her IT team is currently updating all their systems to incorporate ICD-10-CM and will then do testing, which requires utilizing the 2015 casefinding list. The request is very reasonable, so we will be releasing the 2014 (ICD-9-CM) and 2015 (ICD-10-CM) casefinding lists early this year. Watch for a message from us in late August/early September about the posting of these documents on the website.
For those of you unfamiliar with the implementation dates for the annual ICD updates, they generally go into effect on October 1, 2013. So, for the last year of ICD-9-CM, the codes will be in effect October 1, 2013 - September 30, 2014. Then, ICD-10-CM will go into effect on October 1, 2014. Currently the casefinding lists for the cancer registry community run January 1 - December 31. With that in mind, for the first couple of years of ICD-10-CM, it would be beneficial for the cancer registry community to have the same effective dates for the coding updates as ICD. This means our 2014 casefinding list (ICD-9-CM) will be applicable for 10/1/2013 - 9/30/2014; then our 2015 casefinding list (ICD-10-CM) will be effective 10/1/14 - 9/30/15. Regular annual updates for ICD-10-CM will start in FY 2016 (October 1, 2015-September 30, 2106). I’ve heard little nuggets of things, such as there will probably be more hematopoietic codes coming in the future. That would be advantageous for us.
Our current plan is to have the 2014 (ICD-9-CM) and 2015 (ICD-10-CM) casefinding lists posted by September, 2013 on the SEER website (http://www.seer.cancer.gov/tools/casefinding/). By releasing the 2015 casefinding list, it will allow more time for registries to incorporate the ICD-10-CM codes into their electronic casefinding systems. Equally important, it will give time for registrars to review the codes and become familiar with them. I can almost guarantee that someone will find an error or two. If you do, please report them to Ask SEER Registrar in the “other” category. Any other questions regarding the casefinding or conversions lists may be submitted here at http://www.seer.cancer.gov/registrars/contact. html. We don’t foresee many changes to the FY 2015 ICD-10-CM, but this will give us a chance to fix any errors, restructure the list or address other questions or comments that registrars have. An updated 2015 casefinding list, with any necessary changes identified by registrar review, will be released in August/September 2014.
I would like to take this opportunity to thank the fantastic folks who volunteered to be on the NAACCR ICD-10-CM Implementation Workgroup. They were very helpful in developing and reviewing the presentations, along with the many NAACCR Narrative articles.
For those of you who need ICD-10-CM training to maintain your AHIMA credentials, AHIMA has moved the requirement date to December 31, 2014. You must have 6, 12 or 18 hours of ICD-10-CM training (based on which credential(s) you have). AHIMA credentials affected are: RHIA, RHIT, CCA, CCS, CCS-P. If you were unable to attend one of the three presentations provided by this group in 2012, you can order them from NCRA’s website (http://www.CancerRegistryEducation.org/learning-modules). AHIMA also has many educational opportunities for CEU’s on ICD-10-CM training. The following link is for a comprehensive listing of all ICD-10-CM training (http:// www.ahima.org/ContinuingEd/Campus/courseinfo/ICD10.aspx).
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CAP (College of American Pathologists)
Cancer Committee Update
CHRISTINE GIBSON, CTR, CCRP | NCRA CAP LIAISON
The CAP Cancer Committee met in Chicago on March 30, 2013 and packed a full agenda into the one-day meeting. Here are some updates:
CAP is currently working with the AJCC Revisions Committee. A CAP pathologist will be involved in site-specific revisions to ensure the CAP Cancer Protocols continue to align with the AJCC eighth edition and current diagnostic and staging procedures.
A subcommittee, the Cancer Biomarker Reporting Work Group (CBRW), was formed to evaluate the reporting of molecular markers. This group worked closely with the CDC-CER (cancer effectiveness research) panel to look at the collaborative staging and reporting of molecular markers as well as break out the molecular markers from the CAP Cancer Protocol for Breast, Lung and Colorectal templates to enhance reporting accuracy. The Council on Scientific Affairs (CSA) has approved this proposal. Dr. Alexander Lazar explained the rationale and process at the NCRA Annual Educational Conference during his presentation, Making Things Clear and Concise: CAP and the Reporting of Molecular Testing Results.
During the CAP meeting, Cancer Committee Chair Kay Washington, MD, PhD, and April Fritz, BA, RHIT, CTR, presented ICD-0-3 Morphology Codes: Answers to Questions. CAP Cancer Committee Lung Pathologist Kirk Jones, MD, FCAP, presented Collaborative Stage Coding Topics: Anatomy of the Lung—The Role it Plays in Staging.
The CAP Cancer Committee is continually working to help cancer registrars in the United States, and is also expanding its efforts on a global level. I’ll share updates throughout the year. Keep checking the NCRA website and the CAP website (www.cap.org) for news, release dates, and helpful tools for registrars and our community hospital pathologists.
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Meet Your New ATP Directors
Greetings! It was a pleasure to meet so many of you at the NCRA Annual Educational Conference in San Francisco. We’d like to introduce ourselves as your new Advocacy and Technical Practice Directors (ATPDs).
EASTERN
Pamela S. Moats, RHIT, CTR [email protected]
I’ve been in the health information management profession for 33 years, and in the cancer registry for 21 of those. I initially got into the cancer registry while on a quest for experience for a management position. What I initially thought would be a steppingstone has developed into a lifetime passion for cancer registry. I have volunteered for NCRA for 10 years and really enjoy mentoring new registrars. I ran for the ATPD position because I believe I can make a difference in promoting the profession. I currently am a cancer registry coordinator in a university hospital and I also work as a cancer program coordinator in a community hospital. I look forward to working with the state presidents to improve communications in issues relating to our profession.
MIDWESTERN
Mindy Young, CTR [email protected]I discovered cancer registry while I was taking a medical coding course. After coding for two years, the opportunity arose for me to take a cancer registry management program —and I was hooked. I have been a CTR for eight years, working in a teaching hospital for all of them. I have volunteered for my state organization and NCRA since the beginning of my career. I have grown so much professionally and personally with each new experience and have made many new friends along the way. I am very excited to have been elected ATPD–Midwest and look forward to advocating for our profession and communicating with our members over the next two years.
WESTERN
Kendra Hayes, RHIA, CTR [email protected]
I’ve always had a passion for research, so when an instructor in my HIM course work told me about the cancer registry field, I became very excited. My interest in the field only grew as I learned more about it. I took a cancer registry basics class while completing my degree. The two-day class turned out to be the first step in a lifelong journey in the cancer registry profession. Professionally I have worked in health information and education as well as in the cancer registry. I have worked in different cancer registry settings, including community hospital and health management organizations. As a CTR, I have volunteered in both my state organization and with NCRA. I believe strongly in the cancer registry profession and our ability to do good in the healthcare world. Thank you for electing me to the ATPD–West position. I am excited to get started working for the NCRA members in my region!
EAST
E
ERN
MIDWESTERN
WESTERN
HERE’S HOW OUR REGIONS BREAK DOWN:
East Midwest West
Connecticut, Delaware, District of Columbia, Florida, Georgia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, West Virginia, Ontario, Quebec, Newfoundland, Prince Edward, Nova Scotia, New Brunswick, Puerto Rico, Bahamas, Africa, and Europe
Alabama, Arkansas, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Wisconsin, Manitoba, Northwest Territories, Saskatchewan, Mexico, Central America, and South America
Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming, Alberta, British Columbia, Yukon, Middle East, Asia, and Australia.
The advocacy process begins with you! To alert us to an issue, please click the Raise Your Voice buttonon the NCRA website (or go directly to www.ncra-usa.org/voice). This will take you to the Member Advocacy Questionnaire Form, the start of the advocacy process.
We categorize advocacy issues as follows:
• Legislative issues deal with state or federal initiatives or actions tied to Congress or a state legislature.
• Regulatory issues concern laws tied to regulatory enforcement by a state or federal agency.
• Internal policy relates to an NCRA policy or procedure.
• External policy relates to a policy or a procedure of a standard-setting organization or other agency (not NCRA).
We’d really enjoy hearing from state association presidents to exchange key contact information and other communications throughout the year. Please send us an email so that we can be in touch regularly. Thank you to cancer registrars everywhere for your continued professionalism and valuable contributions.
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Registrars in Action
NPCR PROGRAM: LOUISIANA TUMOR REGISTRY
Initiative
Using cancer registry data to improve quality of colorectal cancer care
Public Health Issue
The National Comprehensive Cancer Network (NCCN) recommends a minimum of 12 lymph node (LN) dissection for colon and rectal cancer surgery to ensure accurate cancer staging and appropriate utilization of adjuvant chemotherapy. Numerous studies, including clinical trials, have indicated that surgeries that remove fewer than 12 LNs are associated with worse prognosis for colorectal cancer.
How Cancer Registry Data Were Used
Since improving health outcomes is an important goal for cancer registries, researchers at the Louisiana Tumor Registry (LTR) evaluated whether Louisiana residents’ treatment complied with this established guideline using LTR data in 2011. They found that for almost half of the state’s patients, the number of nodes removed fell short of that
recommended standard. (Cancer 118(6);1675; 2012). Vivien Chen, director of the LTR, and several of the other investigators noted that compliance at a large network of hospitals was well below the recommended level. As a result, they met with a high-ranking official and his staff members, including a surgeon who supervises residents in the hospital system. The attendees were shocked by the findings and have circulated letters to their staff members and residents, reminding them of the hospital policy of complying with all evidence-based guidelines.
Implications of Cancer Registry Data Usage
It is too soon to evaluate the effect of this discussion on actual patient care, but LTR will continue to monitor treatment patterns, at this public hospital system and statewide, to look for improvements. If the compliance percentage rises, this will be one more example of the ability of cancer registries to reduce the burden of cancer.
NPCR PROGRAM: NEW HAMPSHIRE CANCER REGISTRY
Initiative
Colorectal Cancer Screening Small Media Campaign
Public Health Issue
New Hampshire Cancer Registry data show that 62% of colorectal cancers diagnosed in 2007 were in the 65 and older age group. Similarly, among 102 late stage colorectal cancers diagnosed in 2007, 63 (62%) were in this same age group. Dr. Stefan Holubar, a colorectal cancer surgeon participating in the Medical Advisory Board (MAB) for the New Hampshire Colorectal Cancer Screening Program (NHCRCSP), stated, “It can be frustrating to remove what could have been potentially preventable advanced colon cancers in older patients who have never had their colonoscopy.” While much attention has been paid to screening individuals when they turn 50, very little has been done to educate the 65+ population, and the message is not clear that people still need screening at least until their mid seventies.
How Cancer Registry Data Were Used
Based on the registry data and input from the MAB, the group decided to design a small media campaign, including posters, flyers, etc., to encourage screening in this older age group. Funding was secured from the New Hampshire Comprehensive Cancer Collaboration, and in partnership with the Community Health Institute, NHCRCSP conducted audience testing of resources to identify messages and images that might influence New Hampshire residents aged 65 and older to get colorectal cancer screenings. The focus groups were selected from counties with low-screening rates, identified by the NH Behavioral Risk Factor Surveillance Survey.
Key findings of the focus groups were:
• Participants reported a heavy reliance on their doctor to
recommend screening, and tend to assume it is not necessary if the doctor does not promote the test.
• Older patients can have many doctors and may get different recommendations for colorectal cancer screening from different specialists.
• In the messages they reviewed, participants did not like the use of the word “provider” but preferred “doctor”; they preferred pictures that emphasized relationships and familiar connectedness. • Participants believed that posters and flyers would be most
effective if they included their doctor’s name. All of the images and messages that have been designed are now freely available on the Centers for Disease Control and Prevention’s “Make It Your Own” website http://miyo.gwb.wustl.edu/ for adaptation and use by any colorectal grantee across the country.
• In New Hampshire, a blast email is planned to inform healthcare organizations and senior centers that the materials are available and can be customized with their logos. There is also some funding for assisting them with printing if they do not have that capacity.
Implications of Cancer Registry Data Usage
This project demonstrates the implementation of public health interventions based on registry data. Future efforts will assess use of the small media campaign and screening rates in older residents of NH.
The Registrars in Action column highlights the impact cancer registrars have on public health. Cancer registrars collect standardized data on a daily basis to submit to Central Cancer Registries (CCRs), and this data is then submitted to the National Program of Cancer Registries (NPCR). CDC funds 45 states, the District of Columbia, and two U.S. territories. The CDC’s Cancer Surveillance Branch is home to NPCR, which was established by the Cancer Registries Amendment Act, a law Congress enacted in 1992. As a result, cancer is the only reportable chronic disease; therefore, allowing CDC to disseminate accurate national incidence data. By understanding the burden of cancer, public health organizations, including CDC, can create programs and interventions for prevention and early detection.
CDC highlights the difference data is making through various “Success Stories.” Visit their Web site (http://www.cdc.gov/cancer/npcr/success/index.htm) to read synopses of important data-driven projects happening across the United States. If you work at a hospital registry and have a success story to share, please send to Peggy Meehan at [email protected].
Sharing Your Story: What the CTR
Credential Has Meant to Your Career
The first CTR exam was administered on March 12, 1983. Since that date 30 years ago, more than 7,000 individuals have attained the CTR credential, and more than 4,700 are currently maintaining it. Throughout 2013, NCRA is celebrating the credential’s 30th anniversary by highlighting the important role it has played in setting the standard for professional excellence in the cancer registry field.
NCRA has asked members to share their stories on what the credential has meant to their careers, and here’s what you had to say:
Carol R. Scharmett, MPA, CTR
Manager, Cancer Registry Program
Northern Westchester Hospital Mount Kisco, New York CTR since 1983
Why did you decide to earn the CTR
credential?
As a charter CTR test taker, the credential gave “professionalism” to the work we did at the time...tickler files, mounds of paper abstracts, and all!
How do you think the CTR has helped to
advance your career?
Nowadays, the CTR credential is the first step to getting anywhere in the field, including landing a job. I stumbled into the “Tumor Registry” field by answering an ad; I didn’t know what a Tumor Registrar was when I applied (and got the job)! The CTR credential provided my entry into the hospital field when I had no hospital administration experience. The rest is history!
What advice would you give those
considering taking the CTR exam?
Just do it!Additional Thoughts
I may have stumbled into cancer registry work, but I purposely stayed because I love learning, teaching, and working with hospital staff at all levels and physicians across all specialties. The great part about registry work is that it is ever-changing, requiring me to stay vigilant and focused. I am always learning. The contribution cancer registrars make behind the scenes in the fight against cancer is critical and we should never forget that.
Joanne Harris, CTR
Chief of Cancer Surveillance
Metro Detroit Cancer Surveillance System Detroit, Michigan
CTR since 1983
Why did you decide to earn the CTR
credential?
I graduated from medical secretary school and completed my internship in the cancer registry. Metro Detroit Cancer Surveillance System, where I have worked for 50 years, was one of the first registries to become a SEER registry 40 years ago. I sat for the first CTR exam in 1983 under the encouragement of Evelyn Shambaugh, and I passed!
How do you think the CTR has helped to
advance your career?
I have gone from a clerical position to the Chief of Cancer Surveillance and have celebrated my 50th year here at the registry.
What advice would you give those
considering taking the CTR exam?
Please take the exam. It has benefits beyond your imagination, and it is getting even better.Additional Thoughts
I am glad to be a part of this important work. As the professionals coding and abstracting the data, we play a vital role in efforts to seek better cancer treatments and prevention programs. It is important work and the CTR credential sets the standard.
Jennifer McLean, CTR
Tumor Registrar
Rex Health Care Raleigh, North Carolina CTR earned in 2013
Why did you decide to earn the CTR
credential?
It was required for my current position.
How do you think the CTR has helped to
advance your career?
Once you earn the credential, you become a specialist in the field and people see that you are serious about your career. I feel that I am now on an even playing field when it comes to opportunities. Without the CTR, I was limited. I wouldn’t go see a doctor without “MD” behind their name, so I can understand why an employer would not want to hire a registrar without the “CTR” behind theirs. It is a mark of excellence.
What advice would you give those
considering taking the CTR exam?
Take the boot camps and webinars offered, buy the study guide that NCRA offers, and study hard. The CTR is obtainable; it is not an impossible dream. If you’re already working in the field, have someone audit your abstract or do self-auditing. I recommend using your manuals, instead of drop-down boxes. It will help you study as you work and help you familiarize yourself with the manuals.Additional Thoughts
The 30th anniversary of the CTR is an important milestone. The credential is the standard of excellence in cancer data collection.
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NCRA Educational Opportunities
DENISE HARRISON, BS, CTR | EDUCATION COMMITTEE CHAIR
As part of our directive to promote professional practice and standards, NCRA Education Committee members have been actively developing educational opportunities that are accessible, cost-appropriate, and forward-thinking. We’ve had a lot of interest in our strategic abstracting webinar series. If you missed any of these webinars, you can access them on the NCRA Center for Cancer Registry Education (CCRE) website, as learning modules at www.CancerRegistryEducation.org.
The fall schedule of webinars will feature both strategic abstracting and professional development sessions. The strategic abstracting webinar series is aimed at understanding and addressing complex abstracting and coding issues. This is an advanced series based on data compiled from registries’ most frequent abstracting data edit discrepancies. The professional development series focuses on various topics such as data analysis and presentation, quality in the registry, and skills for mentoring. Watch your email, the NCRA Update, and the CCRE website for the topics that will be presented each month.
NCRA offers a number of products and services to help registrars who are preparing to take the exam. Two of our most popular products are the CTR Exam Prep Workshop and CTR Exam Readiness webinar series. Just in time for the September exam period, the workshop will be held August 10-11 in
Alexandria, Virginia, right outside of Washington, D.C. The webinar series follows on August 15, 22, and 29. Registration for the workshop includes the webinar series. Additional materials for exam preparation, including our new practice test, are located on the CCRE website under the “CTR Prep” tab. If you haven’t visited the CCRE website yet, now’s the time:
NCRA has launched the Center for Cancer Registry Education (CCRE). At the new CCRE website (www.CancerRegistryEducation.org), you’ll be able to access a variety of educational products and services, including live webinars, learning modules based on archived webinars, online courses, and CTR exam study materials such as the new online practice test, and much more. The CCRE site also provides an easy way for CTRs to manage their continuing education credits.
The Education page on NCRA’s website will continue to include information and/or links to the Council on Certification, the mentoring program, NCRA- accredited formal education programs, program recognition, and workforce development.
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NEW! CTR Exam Online
Practice Test
NCRA’s has released a new online practice test to provide CTR
Exam candidates a tool to assess understanding and determine
where further study is needed. The 125-question test is organized by
the exam’s “content domains” and includes references for the correct
answers, helping candidates quickly find the information needed to
enhance their learning. To learn more, go to the
“CTR Prep” tab at the Center for Cancer Registry Education at
www.CancerRegistryEducation.org
. Interested in a group rate?
E-mail Mary Maul at
.
MICHELE WEBB, CTR | CHAIR, NCRA INFORMATICS COMMITTEE
The Informatics Committee is a work group charged with helping NCRA members understand how informatics applies to the cancer registry. Informatics extends beyond the cancer registrar’s desktop to include the origin of the information in the medical record, the data collection and reporting process, and the use of cancer data by state and national registries and for clinical, quality, and epidemiological studies. As technology advances, the cancer registrar must grow their knowledge and use of informatics. By including an “Ask Informatics” column in each edition of The Connection, we hope to help you explore this exciting topic. Please send us any questions you have on the subject!
Can you please explain what informatics is and what it means to
cancer registrars?
This is a popular question! The official definition of cancer informatics is on the NCRA website, but we know many NCRA members are still unclear about what this really means and how it applies to our work.
For starters, the science of informatics is what drives the creativity and change that is part of the cancer registrar’s work today and in the future. It helps us apply our knowledge in new ways in order to continue to perform registry tasks more efficiently, in broader scope, and in combination with advances in science and medicine.
Cancer informatics is a very broad, umbrella-like set of interdisciplinary theories, methodologies, technologies, sciences, and human perspectives that begin at the patient’s bedside and continue on through the cancer registry, state and federal agencies, research organizations, and beyond. Performance improvement, quality control, patient navigation, survivorship, and outcomes are all influenced by informatics.
The scope of informatics includes four components:
• Theory and methodology: the development, study, and application of methods and processes that are used for data collection, storage, retrieval, management, and sharing of the information and knowledge derived from its use.
• Technology: the computers, machines, equipment, software, systems, telecommunications, and information science technologies that are necessary to conduct business.
• Biological science (also called biomedicine): the application of the principles of biology, biochemistry, physiology, and other sciences to solve problems in clinical medicine. It bridges the gap between research, the cancer registry, physician practice, and healthcare delivery.
• Human and social perspectives that recognize people (registrars and all individuals on the healthcare delivery team) as the ultimate users of cancer data. We draw on social and behavioral sciences to design, evaluate, and study solutions and policies in clinical, economic, social, educational, and organizational systems to ensure the data is optimal. We’ll review each of these components in more depth in future columns. It’s important for cancer registrars to be well-versed on each to adequately assist with the collection, coding, and classification of cancer data for use as quality outcomes. Cancer registrars must take a proactive role by investing in their education and training to broaden their skill sets and to serve as leaders in informatics and oncology data management.
To assist with individual learning needs, the NCRA Informatics Committee needs to hear from NCRA members to evaluate how we can best reach this level of expertise and performance. Please send your comments and suggestions to [email protected] for Informatics Committee review.
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NCRA Releases a New Salary Survey for
Cancer Registrars
NCRA’s Council on Certification initiated a job analysis survey of cancer registry professionals in 2012. NCRA periodically conducts a job analysis to inform the process of updating the test content outline for the CTR Exam. In addition to questions about the essential performance domains and job tasks of cancer registry professionals, the 2012 job analysis survey contained questions about the demographic characteristics of respondents, including education and income, and the characteristics of their employers. NCRA used this data to conduct further analyses of demographic and job characteristics related to income within the cancer registry workforce. To download a complimentary copy of the new Salary Considerations for Cancer Registrars, go to www.ncra-usa.org/workforce.O
SALARY CONSIDERATIONS FOR CANCER REGISTRARS
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The Mentoring Committee has been working diligently since fall 2011, and the week of the NCRA Annual Educational Conference was no different. We were as active as ever in San Francisco! Our activities began on May 31 with Linda Fine’s participation in the Cancer Registry Professional: The Paradigm Shiftpresentation and panel discussion. Other panel members included Sarah Burton, Susan Chapman, Shirley Jordan Seay, and Joyce Ritter. As the Mentoring Committee chair, Linda was the panel expert on mentoring as it applies to the future of the CTR profession.
Linda gave a mentoring presentation that included a brief history of the committee’s creation. The Mentoring Committee came out of a shared hope to give professional support to fellow registrars, fostering a culture of lifelong professional development and camaraderie. Linda Fine further elaborated on what the mentoring program is and isn’t, and the rollout of the new mentoring area on the NCRA website. In closing, Linda invited the attendees to visit NCRA’s booth in the exhibit hall, where the Mentoring Committee had set up shop for the duration of the convention. Committee members handed out information and applications, and urged seasoned CTRs to sign up to be mentors. We’re excited to say that a large number of members visited the booth and shared their own personal stories about how someone made a difference in their career and even in their life by taking the time to mentor them. It was a great and successful experience. As part of the June 1 conference festivities, the Mentoring Committee held a breakfast information session. Linda Fine offered an overview of the mentoring program and Kendra Hayes delivered an active listening presentation and exercise. To close the presentation, Christena Vallerga led a mentoring ethics review.
The active listening exercise was the first of what we hope to be many professional development exercises delivered by the Mentoring Committee. Before the exercise commenced, Kendra walked the group through a presentation titled Active Listening: Communicating on a Higher Level. She explained active listening as a method of listening that involves understanding the content of the message, the intent of the sender, and the circumstances under which the message is given. Key characteristics of active listening include the following:
• Positive attitude • Focus
• Acknowledgement of emotional state • Acknowledgement of speaker’s points • Setting aside prejudices and opinions • Noticing nonverbal cues
• Being engaged but not leading
• Encouraging the other party’s train of thought • Giving others time to respond and time to rest • Asking nonthreatening questions
• Always restating the conversation’s key points
• Allowing for secondary discussion evolution while keeping on track • Always expressing appreciation to the other individuals
A pneumonic device was given to help everyone remember the key points of active listening— S.P.E.A.R.S., which corresponds to:
• Stop distractions • Positive attitude • Engage • Actively listen • Restate • Summarize
Finally, Kendra led the group through the active listening exercise. Just for fun, you can do it too! The next time you’re talking with a registry coworker, ask them this question: How long have you been a cancer registrar? Use the active listening techniques you’ve just learned to engage the individual. During the conversation, tell them the length of time you’ve been a cancer registrar, and allow the conversation to evolve with that addition. Then evaluate the conversation and the effect of active listening by answering these questions:
Question 1: Did you or your coworker answer the question with the
number of years you’ve been working in the registry or the number
of years as a CTR?
Question 2: What was your intent in the original question? Were
you asking for the number of years in a registry, the number of
years as a CTR, or something completely different?
The original question can be answered several ways, and it’s up to us to listen actively and clarify anything that could be ambiguous, such as the number of years in a registry versus number of years as a CTR. Active listening helps us cut through the ambiguity and clarify the meaning of the information in the conversation.
In conclusion, I’d like to challenge you to do two things. The first is to intentionally use active listening and see what a difference it can make in your communication. The second is to visit the NCRA website and sign up to be a mentor. I guarantee you will be fulfilled in many ways by just doing those two things. I have been!
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Mentoring Committee Update
2013-2014 NCRA Election Results
LOUISE SCHUMAN, MA, CTR | NCRA NOMINATING COMMITTEE CHAIR
The Nominating Committee is pleased to announce the results of the 2013-2014 Board Directors, Nominating Committee, and Council on Certification elections. Congratulations to all of NCRA’s newly elected leaders!
Board Directors
President-Elect/Secretary:
Therese Richardson, RHIA, CTRTreasurer Junior:
Janet Reynolds, CTR
Educational Board Director:
Paulette Zinkann, CTRRecruitment & Retention Board
Director:
Linda Corrigan, CTR
Advocacy & Technical Practice
Board Director – East Region:
Pamela Moats, RHIT, CTRAdvocacy & Technical Practice
Board Director – Midwest
Region:
Mindy Young, CTR
Advocacy & Technical Practice
Board Director – West Region:
Kendra Hayes, RHIA, CTRCouncil on Certification
Representatives:
Sara Biese, RHIT, CTR Lisa Connor, CTR Monika Rivera, RHIT, CTR Cindy Tillman, RHIT, CTRNominating Committee
East Region:
Nadine R. Jenkins, CTR Melanie Williams Rogan, CTRMidwest Region:
Maria Teresa J. Ramirez, BS, CTR Cathy A. Reising, BBA, CTR
West Region:
Linda Jund, BS, CTR Valerie Spadt, CTR
Reward Yourself by Running for Office
LOUISE SCHUMAN, MA, CTR | NOMINATING COMMITTEE CHAIR
In the spirit of volunteering and mentoring, you will receive a call for nominations for positions on the NCRA Board of Directors and other elected positions.
The Board of Director positions open for nominations are: • President Elect/Secretary
• Treasurer Junior
• Public Relations Board Director • Professional Development Board Director
Prospective candidates for Board of Director positions will be able to view a PowerPoint presentation about what it means to serve on the Board and presentations that describe the work and time involved for each Board position. Visit the NCRA website to view the presentations at www.ncra-usa.org/BoDvolunteer.
Other open elected offices are:
• Members of the Council on Certification (four positions)
• Nominating committee members (two positions each from the East, West, and Midwest regions)
All the offices are two-year terms, with the following exceptions: • President-Elect/Secretary is a one-year term with a roll-up to
President (also a one-year term) and then Immediate Past President (another one-year term)
• Treasurer Junior is a one-year term with a roll-up to Treasurer Senior for one term.
Serving as a volunteer for NCRA is one of the most rewarding things you can do for yourself, for your profession, and for your career. You’ll help make decisions that will guide NCRA and the cancer registry profession to greater heights. At the same time, you’ll interact with and get to know your peers from across the country. These are the people who can help you in the future as colleagues, friends, and mentors. The more you network, the more you’ll grow as a registrar and a person.
I urge you to consider volunteering for these offices. If you’re unable to serve NCRA this coming year in this capacity, consider being a mentor by nominating someone (with her/his permission) for an office. Either way, you’ll have a feeling of accomplishment knowing that you’re serving NCRA—and yourself.
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Individual Registry Management:
Reaching Out is Key to Success
LISA CONNOR, CTR | CPM SIG LEADER
Are you the only CTR in your registry? Are you the only person in your registry, period? If you work at a small facility, you’re more than likely managing the registry all on your own. I speak from experience when I say that this can be challenging. Having stepped into the registry world alone, I basically taught myself about the organization and setup of my registry. If you’re like me, you’ve taken ownership of the registry and you’ve poured much time and energy into all the tasks, projects, clean-ups, and repairs. It’s important to remember, though, that you need to be around other registrars! When you meet and network with other CTRs, you’ll get lots of great ideas that will be useful in the continued success of your registry. Personally, I’ve received so many ideas from my colleagues that I’ve come to think of networking as the key to success. How many times have you
looked back at “your way” of doing something but, by talking to others, realized there actually may be a better way? “Our way” can be great, but it’s important to stay open-minded about new methods for getting a job done. I’ve gathered information from experienced CTRs about topics ranging from QA review forms to policies and procedures to templates for studies of quality. How much time did that save me? A tremendous amount!
There’s no need to reinvent the wheel. Just step out and look for help. You won’t have to look far. Continue to network through the SIG Discussion Forum. Get to know a seasoned CTR who’s willing to help in a time of registry crisis, and someone who’s an email or phone call away. You’ll find these relationships are essential to the success of your registry.
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CTR Exam Breakdown (225 items)
2014 CTR Exam Updates
2014 CTR Exam Content
and (Weighting)
Q
Data Collection (53% - 57%)
Q
Case Finding
Q
Abstracting
Q
Follow up, Survivorship and Outcomes
Q
Data Quality Assurance (10%)
Q
Analysis and Data Usage (10% - 14%)
Q
Operations and Management (8%)
Q
Cancer Committee and Conference (10%)
Q
Activities Unique to Centralized Registries (5%)
45
180
Q
Closed-book (80%)
Q
Open-book (20%)
Learn more…
Exam Blueprint
http://bit.ly/CTRExamBP
Job Analysis Video Report
http://bit.ly/YTJan2013
Council on Certification
http://www.ctrexam.org
NCRA Education Foundation Update
SUSAN M. KOERING, MED, RHIA, CTR | EDUCATION FOUNDATION BOARD CHAIR
The NCRA Education Foundation is a nonprofit organization with the mission of supporting the advancement of the cancer registry profession through education and research.
NCRA Education Foundation Leadership
The NCRA Board approved the slate of new directors for the NCRA Education Foundation on May 29, 2013. The new directors are: Betty Gentry, BS, CTR, Georgia - Term to end April 2016 Tiffany Johnson, CTR, Wisconsin - Term to end April 2016 Lori Travers, RHIT, CTR, Idaho - Term to end April 2016 Cathy Busch, BA, CTR, Illinois - Term to end May 2015 Joe Holcomb, MBA, Oklahoma - Term to end May 2014
Ex-officio member as NCRA President - Shirley Jordan Seay, PhD, OCN, CTR, Ohio
The following members will continue their service on the Board: Shannon Hart, CTR, Colorado - Term to end May 2015
Susan Koering, MEd, RHIA, CTR, Minnesota - Term to end May 2015 Eileen Abate, CTR, New York - Term to end May 2014
Sara Biese, RHIT, CTR, Wisconsin - Term to end May 2014 Lori Swain, MS, Virginia - NCRA Executive Director Welcome all!
We want to extend a thank you to Louise Schuman, MA, CTR, and Carol Hutchison, CTR, for their years of service on the Board. I also want to thank Sarah Burton, CTR for serving as the ex-officio member of the Board as NCRA President. Your shared knowledge and time are much appreciated.
Registry Recruitment Efforts
The foundation has created a CD containing 12 modules that give health information management (HIM) students a glimpse into what it’s like to be a cancer registrar—and hopefully inspire them to take college courses that could lead to a career as a cancer registrar. The CDs will be distributed at the AHIMA Assembly on Education (AOE) Symposium in July and sent to all HIM schools. Thanks to all the Board members for their work on this project!
Presentations
Susan Koering, MEd, RHIA, CTR, NCRA Education Foundation Chair, will present at the AHIMA Assembly on Education Symposium in Baltimore. Her talk, Cancer Registry – A Program Leading to a Profession, references and shares sections of the 12 recruitment modules for an audience of HIM instructors.
NCRA exhibited at AOE July 2013 and distributed the recruitment CD, which includes the 12 modules, reference materials, and an instructor’s guide.
The AOE includes instructors and administrators of colleges offering the AHIMA Health Information Management (HIM) programs, and this summer’s symposium offers an opportunity to encourage them to include Cancer Information Management (CIM) college courses as part of their curriculum. This is in keeping with the foundation’s mission of “supporting the advancement of the cancer registry profession through education and research.”
State Baskets
The foundation assisted with this year’s state basket raffle at the NCRA Annual Educational Conference in San Francisco. Thank you to all the states and many other organizations that submitted a basket. Congratulations to all the winners. The baskets bring great excitement to the exhibit hall. Watch for an update in a future The Connection issue.
Learn More About the Foundation
Visit our website, www.ncraeducationfoundation.org, to learn more about our mission and purpose, as well as the responsibilities of our committees.
Acknowledge Someone Special
There is a distinctive way to memorialize or honor someone special. Donations to the Education Foundation can be made in memory of someone you have lost or in honor of someone who is living. This can be an excellent tribute to family, co-workers, mentors, and others who have special meaning in our lives.
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NCRA Study Guide for the CTR Exam
Many CTRs tell us that the NCRA Study Guide for the CTR Exam was the most helpful resource they used as they prepared for the CTR Exam. NCRA member price is $60; non-member price is $75. Place an order at www.ncra-usa.org/CTRPrep.CTR Exam
Readiness
Webinar Series
The webinar series is designed to provide candidates with the knowledge needed to take the exam with confidence. Webinars include Computers (August 15), Statistics and Epidemiology (August 22), and CTR Exam Taking Tips (August 29). To learn more and register, go to www.ncra-usa.org/CTRPrep.
CTR Exam Online Practice Test
NCRA’s new 125-question CTR ExamOnline Practice Test is available at www.CancerRegistryEducation.org under the “CTR Prep” tab.
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Professional Development Update
DEIDRE WATSON, CTR | PROFESSIONAL DEVELOPMENT BOARD DIRECTOR
When I network and share experiences with other registrars, one thing stands out to me: Most of us didn’t “find” the registry, the registry “found” us! I didn’t grow up thinking that I would work in a cancer registry. I was going to be a teacher, doctor, or crane operator (my dad sold cranes when I was young). I didn’t know cancer registries or cancer registrars even existed. We have to change that. We have to inform young people about this profession and get them excited about being a cancer registrar. One of my goals as Professional Development Board Director (PDBD) is to improve awareness of our profession.
There are four committees that report to the Board through the PDBD— and all have been very busy! I’d like to provide an update of the activities of these committees.
The Council on Certification, led by Debbie Chambers, CTR (administrator), is a very active group. First and foremost: Happy 30th anniversary to the CTR credential! If you were one of the many who sat for that first exam, congratulations! What an accomplishment 30 years ago—and look how far we’ve come since! Here are just a few of our accomplishments over the last year:
• In January 2013, the Council published a Job Analysis Report. A free download of the executive summary is available on NCRA’s website (http://bit.ly/NCRAreport). The full report is posted in the NCRA store (http://bit.ly/VQBcow). The full report is free to members; non-members may purchase it for a nominal fee of $50. • The Job Task Analysis Task Force is now beginning the process
of assessing whether more credentials besides the CTR should be developed. Our profession is changing, and it is a great time to consider whether additional credentials (management, advanced abstracting, or other) would be beneficial or even wanted by the membership. The Council seeks your opinion, so be sure to watch for those surveys in your email—and let your voice be heard!
• The Council has also been busy evaluating testing vendors. The contract for the current vendor expires December 2013. You’ll be hearing more about this from the Council in the months to come. With a new vendor, there will be some added perks, although not immediately. For example, a couple of things that may come are additional testing times and the ability to use electronic resources in place of the bringing your own books. Very exciting!
The Formal Education Committee (FEC) is charged with helping colleges and universities develop a certificate or degree program. In the last year, the committee has focused on assisting schools that are in process of developing a program as well as reaching out to those that have expressed an interest in developing a program in the past. Many of those we’ve contacted say they’re ready to work towards building a program, which is great! Linda Shroyer, CTR is the new chair of this committee. She and
her committee will work with these programs to help them establish a Cancer Registry Management (CRM)/Cancer Information Management (CIM) program at their institution. They also work closely with the Formal Education Program Review Committee.
The Formal Education Program Review Committee (FEPRC) reviews each new program’s curriculum to ensure it meets NCRA standards as well as periodically reviews current programs to make sure their curricula continues to comply with NCRA standards and requirements. Christena Vallerga CTR, CPC, LVN is the chair for this very dynamic committee. A few of their highlights and accomplishments over the last year are:
• Reviewed documentation to ensure content is up-to-date with current standard setters
• Assisted in the creation of a one-day Central Cancer Registry agenda • Obtained affiliation agreements
• Worked with programs to develop their CRM/CIM curriculum • Assisted students who are unable to locate a clinical practicum site The Mentoring Committee, chaired by Linda Fine, CTR is one of the newer NCRA committees. The NCRA Board created this committee (initially as a task force) to formalize the mentoring process and provide support for both mentors and mentees. The mentoring committee has been very busy developing tools, resources, and processes for both the mentor and mentee. Did you know that as a mentor you could receive CE Units? It’s just one way of saying “thank you” to mentors. Please consider mentoring. You are greatly needed. A few of the other mentoring accomplishments are:
• This year, at the NCRA Annual Educational Conference in San Francisco, the Mentoring Committee held a breakfast for mentors and mentees to provide more information about the program. This was a resounding success!
• Updated the Partners in Education section of the NCRA website to become the new Mentoring page. This page provides links to information for mentors and mentees. More resources and toolkits will be added to this section of the website in coming months.
Other committee projects include:
• Developing more mentoring educational webinars to help orient potential mentees and mentors on how-to topics.
• Working towards setting up a national mentoring network! I am proud and excited to work with each of these committees. They are all doing excellent work for your association. If you’d like more information or have questions, please don’t hesitate to contact me. Also, if you’d like to volunteer with any of the committees, please let me know. We’d love to have you!
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Commission On Cancer Update
DEBORAH A. DICKERSON, RHIT, CTR | NCRA LIAISON TO THE COMMISSION ON CANCER
With the implementation of the 2012 standards and the focus on data quality we as registry professionals are in the limelight. There have been a lot of activities at the CoC that directly impacts the oncology data professional. Below is the recap of CoC’s May committee meeting activities.
HIGHLIGHTS FROM COC COMMITTEE MEETINGS MAY 16-17, 2013:
ACCREDITATION COMMITTEE:
Effective July 1, 2013, Standard 5.2 (abstracting timeliness) will be deleted. This standard was no longer relevant for enforcement by the CoC and will be replaced with a new commendation standard for Rapid Quality Reporting System (RQRS) participation. The new RQRS standard will be effective January 1, 2014.
• Abstracting timeliness will be evaluated for 2011 cases for the remainder of 2013 surveys. All CoC approved programs are required to maintain abstracting timeliness through requirements of their respective states as well as the CoC national call for data (NCDB). • Only programs enrolled in RQRS will be eligible for the Outstanding
Achievement Award (OAA). This will bring more focus on concurrent abstracting and data quality.
Effective January 1, 2014, the 2009 cancer program standards will be retired. Surveys conducted beginning in 2014 will be evaluated under the 2012 Cancer Program Standards for cancer program activity 2012-2013 (two years). As many standards were revised or are no longer applicable for 2012, it was no longer reasonable to ask programs to focus their efforts on these activities.
Effective immediately eliminate surveyor review of one of the CP3R measures during on-site visit. System changes with implementation of the new SAR did not support this process. However, the evaluation may be reinstated as required in the future.
QUALITY INTEGRATON COMMITTEE
Ten new CP3R measures for Breast, GI, Lung and Esophageal cancers have been approved. The rectal measure is a revision and will replace the current measure. These are highlighted in the table below:
BREAST MEASURES ADOPTED BY COC/QIC – EXPECTED IMPLEMENTATION DATE AUGUST 2013
Radiation therapy is considered or administered within 1 year (365 days) of diagnosis for women undergoing mastectomy for breast cancer with >=4 positive regional lymph nodes.
Needle biopsy is performed prior to surgical treatment of breast cancer. Breast conservation rate for women with AJCC stage 0, I, or II breast cancer (surveillance).
ESOPHAGEAL MEASURE ADOPTED BY COC/QIC MAY 2013
Neo-adjuvant chemotherapy, radiation and surgery within 120 days of first radiation – esophagus and GE junction.
GASTRIC MEASURES ADOPTED BY COC/QIC MAY 2013
Neo-adjuvant or adjuvant chemotherapy is administered or considered for stage IB-IIIC (M0) gastric cancer for patients 18-79 years of age. Removal of 15 or more lymph nodes are pathologically examined for resected gastric cancer (excludes stage 4).
NON-SMALL CELL LUNG CANCER (NSCLC) ADOPTED BY COC/QIC MAY 2013
Systemic chemotherapy is considered or administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively or surgically resected cases with pathologic, lymph node positive (pN1) and (pN2) NSCLC.
A total of at least 10 lymph nodes are removed and pathologically examined for resected NSCLC (pathologic stage IA, IB, IIA, IIB) surveillance measure.
Surgery is not the first course of treatment for cN2, M0 cases.
Compare NSCLC resection rate to all NCDB – Path T by type of resection surveillance measure.
RECTAL MEASURE (REVISION) ADOPTED BY COC/QIC MAY 2013
Radiation and chemotherapy administered or considered for AJCC stage II or III resected rectal cancer patients under 80 years of age.
1) Surgical resection within 120 days of start of either radiation administered or chemo considered (whichever starts first).
2) Chemotherapy considered or administered within 90 days of surgery.
• Breast will be the first implemented with 2013 abstracting. The remaining measures are anticipated by January 2014.
• Additional sites and histology’s are under discussion. These include GYN, melanoma and prostate cancers.
The Cancer Quality Improvement Project (CQIP) is a cancer report of quality measures that will be provided to all approved cancer programs annually. The first roll ou
