by Holly J. Kulhawick, CTR
Concurrent abstracting is the process of completing the cancer registry abstract in stages after each treatment occurs, rather than all at one time, four to six months after diagnosis. Some registries have always abstracted concurrently, but others are finding—or at least feeling as if—they are being forced into concurrent abstracting by the new Commission on Cancer (CoC) requirement to submit to the Rapid Quality Reporting System (RQRS). RQRS is a reporting and quality improvement tool that provides real-time clinical assessment of hospital-level adherence to quality of cancer care measures. On January 1, 2017, participation in RQRS will become mandatory for all CoC-accredited cancer programs.
Facing Down the Fear
Recent discussions on the National Cancer Registrars Association’s Facebook page indicate a high level of anxiety among those converting to concurrent abstracting. As with all fears, this one is best dealt with by facing it down and examining it under a bright light. Is concurrent abstracting really that difficult? No. Does it take more time? Sometimes. Cancer programs implementing concurrent abstracting for RQRS, can use resources on the RQRS website to help with updates and data quality assurance. CoC-accredited facilities can log on to CoC DataLinks to access their RQRS data. The password-protected site provides monthly alerts on the patients submitted to RQRS as well as updates on the treatment administered, offered, or recommended.
As CTRs embark on concurrent abstracting, they need to release the mantra that it has no advantages. Instead, recognize that this is the best way to provide quality, up-to-date cancer data, and accept the challenge. A major concern when converting to concurrent abstracting is who completes the updates. Certified Tumor Registrars (CTRs) are fiercely territorial regarding their work. This is not a helpful position to take when conducting concurrent abstracting. It is important to allow different members of the team to take turns updating the cases. In doing so, registrars may find that two sets of eyes are better than one at spotting errors or capturing all the nuances of a case. This can also prove to be an advantage in improving data quality and fostering teamwork.
Another concern is the need to return repeatedly to cases to provide treatment updates. To many CTRs, this seems like a doubling of the work. It does increase the time in certain abstracts, but the improvement in quality can be an offsetting factor. Think about it. How many times is an abstract seen only once? Not many, since in many large cancer registries the tasks are assigned to different staff members. One person may load the case and another may add surgeries and biopsies. Some registries use an automated system to load radiation or chemotherapy data with a staff person conducting follow-up months later. This same type of work plan can be used for concurrent abstracting. Allowing several staff to construct and review the abstract can also assist with quality assurance (QA). If only one person is assigned to conduct QA, they may be less attentive. If they know others will be reviewing the abstract, they may be more conscientious.
Data Clinicians Want and Need
Physicians have long complained about the latency of cancer registry data. Concurrent abstracting and RQRS help to address their concerns. Cancer registrars must respond. The cancer registry data does take too long to collect and to be put to use. Today, everyone wants instant results and oncology is no different. Any patient’s case can spiral out of control over a matter of days. Clinicians want to be able to monitor and respond as close to real time as possible. If it takes cancer registrars four to six months to even start a case, they are not providing clinicians with the data that they want and need—data that helps ensure high-quality cancer treatment and care.
The cancer registry department also benefits from concurrent abstracting. In addition to physicians valuing real-time data, your facility’s Finance and Administrative departments will too. They can analyze the data to help improve operations and services. As a result, these departments see the cancer registry fulfilling a vital need for the organization. This can often lead to more timely responses to requests for budget items, IT support, and additional staff. The cancer registry database can also be used to prepare tumor conference presentation forms. In many facilities, the completion of these forms is very involved, requiring registry staff to create the equivalent of an abbreviated abstract. This is a drain on staff time, since most tumor conferences occur monthly. With concurrent abstracting, the timely data can be merged to populate the forms, reducing the time to just minutes per form. Clinical staff appreciate the results and the doctors no longer need to haul office medical records to tumor conferences.
A near-to-real-time cancer registry database can also help in preparing Survivorship Care Plans (CoC Standard 3.3). To assist with these plans, cancer registry departments may want to consider educating nurse navigators on the database and providing them access so that they can update chemotherapy and/or offsite treatments. Sharing the database will not only help with these important plans, but will also foster a sense that the registry belongs to the team, not just CTRs.
Moving to concurrent abstracting may seem daunting—and, yes, even scary—but it’s an important step that can support and advance the work of the entire cancer care team.
Guest blogger Holly J. Kulhawick, CTR, is Supervisor, Cancer Registry, at ACCC Cancer Program Member Renown Health in Reno, Nevada.