North American Association of Central Cancer Registries, Inc

3Recommendations

This document represents the initial feedback from the cancer registry community. The desired outcome would be to have a unified laboratory reporting standard where cancer registry reporting and non-cancer laboratory reporting are represented by proper constraints of said standard. For example, cancer registry reporting and reporting of communicable diseases should be able to be transmitted using one overall laboratory standard with constraints specific to each reporting condition, rather than contradictory specifications.

1. 
   Any fields that cancer registries require for their operations should be considered for inclusion in the laboratory specifications so as to reduce the divergence between cancer registry messaging system implementations and ELR implementations.
   
2. 
   The data types for optional fields should be included in the Draft Laboratory Standard.
   
3. 
   Thought should be put into minimizing the differences across implementation guides for public health messaging using HL7 V2 where such differences are not critically necessary for public health reporting.
   

4Appendix A. Data Types Referred to in this Document

Only a subset of the data types defined in the HL7 Version 2.5.1 Standard is used for NAACCR Cancer Registry Messaging. Those that are referred to in this Comparison Document (selected few) are listed in the table below. The table contains only data types where there is a difference between data types, as defined in the Current Registry Standard versus those defined in the Draft Laboratory Standard.

Data Types Referred to in this Document
Current Registry Standard1	Draft Laboratory Standard2
CE - Coded element	CWE_CR- Coded with exceptions – Code Required
CE - Coded element	CWE_CRE- Coded with exceptions- Code Required, but may be empty
CX - Extended composite ID with check digit	CX_GU- Extended composite ID with check digit (Globally Unique)
EI - Entity identifier	EI_GU- Entity identifier (Globally Unique)
EIP - Entity identifier pair	EIP_GU- Entity identifier pair (Globally Unique)
HD - Hierarchic designator	HD_GU- Hierarchic designator (Globally Unique)
HD - Hierarchic designator	HD_GU_PH- Hierarchic designator (Public Health)
IS - Coded value for user defined tables	CWE_CRE- Coded with exceptions- Code Required, but may be empty
TS – Time stamp	TS_1- time stamp requires that the following components must be sent: YYYY (year), MM (month), DD (day), HH (hour), MM (minutes), and SS (seconds).
TS – time stamp	TS_2 – time stamps requires that YYYY must be sent; MM, DD if available, must be sent. HH, MM, and SS are optional.
TS – time stamp	TS_3- time stamp requires that YYYY must be sent; MM, DD, HH, and MM if available, must be sent. SS is optional.
TS – time stamp	TS_4- time stamp requires that YYYY must be sent, and the condition predicate is that MM, DD must be sent if the YYYY is not ‘0000’. HH, and MM must be sent if YYYY is not ‘0000’. Sending SS is optional, if YYYY is not ‘0000’. Default value: if time is not known, use YYYY=’0000’ and leave everything else empty.
TS – time stamp	TS_5- time stamp requires that YYYY, MM and DD must be sent. HH, MM must be sent if available, and sending SS is optional.
TS – time stamp	TS_6- time stamp requires that all components: YYYY, MM, DD, HH, MM, SS must be sent.
TS – time stamp	TS_7- time stamp- If the time zone offset is included in MSH-7 (Date/time of message), which it has to be if the PH Component is being used, then it becomes the default time zone for the message and applies to all other date/time fields in that message. Except, if it is otherwise indicated in the MSH-21 (Message Profile Identifier), which permits a lab-specific override to this constraint.
XON- extended composite name and identification number for organizations	XON_GU- extended composite name and identification number for organizations globally unique

¹ For the complete definition of these data types, please see Volume V, version 4.0, Appendix B Detailed HL7 Data Type Specifications (available at http://www.naaccr.org/StandardsandRegistryOperations/VolumeV.aspx).
² For the complete definition of these data types, please see HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 2 (US Realm), Draft Standard for Trial Use (DSTU), Release 1.1 (available at http://www.hl7.org/implement/standards/product_brief.cfm?product_id=329).

5Appendix B. Acronyms and Key Words

Acronyms and Key Words
Term	Definition
AJCC	American Joint Committee on Cancer
AP	Anatomic Pathology
CAP	College of American Pathologists
Cardinality	Governance regarding which segments within an HL7 standard message are allowed to repeat and to what extent.
CKeys	Unique checklist line item identifier provided by the CAP with the eCC. These are mapped to existing SNOMED CT codes, where they exist and serve to assist in electronic CAP checklist version control.
CS	Collaborative Stage: a cancer staging data system used to collect data to derive AJCC TNM Best Stage, Extent of Disease and SEER Summary Stage
DDF	Discrete Data Fields: the data is stored and captured as discrete data elements using a standardized reporting nomenclature such as LOINC and SNOMED CT.
DSTU	Draft Standard for Trial Use, a draft standard proposed by the HL7 organization for transmission of electronic reports.
CAP eCC	College of American Pathologists electronic Cancer Checklists
Element Name	HL7 descriptive name of element in the segment.
ELR	Electronic laboratory reporting
HL7	Health Level Seven: specification used to transmit electronic reports from the source to the destination. For example, from the pathology laboratory to the to the cancer registry. May also refer to the Health Level Seven International, a standards setting organization. (For details see http://www.hl7.org)
ICD-O-3	International Classification of Diseases for Oncology; 3rd Edition
IG	Implementation Guide
ISO	International Standards Organization
LIS	Laboratory Information System
LOINC	Logical Observation Identifiers, Names and Codes
MU	Meaningful Use
NAACCR	North American Association of Central Cancer Registries, Inc.
OID	ISO Object Identifier; globally identifies some kind of object. HL7 as a health care information messaging standards setting organization uses OIDs for specific name spaces, references to code systems, value sets, and other information objects. HL7 maintains its own OID registry.
PATH	Pathology
PHI	Personal Health Information
PHIN	Public Health Information Network
SEER	Surveillance Epidemiology and End Results Program
SNOMED CT	Systematized Nomenclature of Medicine-Clinical Terms
SSN	Social Security Number
Synoptic Pathology Reporting	The electronic capture of Pathology data as per the College of American Pathologist’s cancer checklists and protocols.
TNM	Cancer Stage information - Tumor, Node, Metastasis System. Based on the extent of the primary tumor (T), extent of node involvement (N), and extent of metastases (M) as promoted by the AJCC and UICC.
Regenstrief	An internationally recognized informatics and healthcare research organization who is responsible for the development, assignment, and maintenance of LOINC codes.
UICC	International Union Against Cancer is another organization similar to the AJCC which also supports TMN staging.
Usage	Explicitly identifies whether a sending system is required to populate a particular data item if the data are available, and whether a receiving system is required to be capable of processing the data, if contained in a message.

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