North American Association of Central Cancer Registries, Inc

1.2Differences between Volume V, Version 4.0 and ELR R2 (DSTU R1.1, U.S. Realm)

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  The Draft Laboratory Standard is intended for eligible health providers.
  
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  The Draft Laboratory Standard for Meaningful Use (MU) Stages 1 and 2 is applicable to immunizations and hospital laboratory results of reportable conditions other than cancer and therefore is not applicable to cancer registry requirements.
  
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  MU Stage 2 and 3 require specific versions of LOINC and SNOMED CT for laboratory reporting. It is known that registry reports from laboratories require other vocabularies (e.g., ICD-O-3).
  
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  The Current Registry Standard is in wide use in both the U.S. and Canada; the ELR guide is a Draft Laboratory Standard; now is a good time to minimize the differences between the Current Registry Standard and the Draft Laboratory Standard because both are based on HL7 2.5.1 and the latter is required for MU.
  
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    The Draft Laboratory Standard in its current form would not fully meet requirements for cancer registry pathology data transmission and to harmonize the two models at this time would require a considerable effort.
    
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  The Current Registry Standard is much more user friendly, and has many critical examples (use case scenarios) which the ELR Draft Laboratory Standard does not have.
  
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  The Current Registry Standard allows for a stepwise evolution from current ubiquitous narrative text in path reports towards synoptically structured path reports (e.g., is capable of receiving College of American Pathologists’ Electronic Cancer Check Lists (CAP’s eCCs). The ELR Draft Laboratory Standard seems to lack this capability.
  
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  Many vendors provide a common laboratory information system (LIS) to support pathology laboratories and other laboratories. Requiring significant differences in these otherwise similar systems may dramatically increase costs while raising a question of perceived benefits of differences.
  
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  Specifications for similar LIS functions should minimize differences that may cause problems in the community. Such differences during the DSTU period may impose significant costs to public health agencies, and laboratories implementing different interfaces. These differences may also result in potential operational issues for cancer registries.
  
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  Canadian registries, vendors, and LIS would be negatively impacted by US- specific changes to the Current Registry Standard based on the influence of the Draft Laboratory Standard.