California’s effort to improve cancer registry signals shift to preventative care


California’s Department of Public Health is partnering with a major hospital chain to improve the way patient information is reported to the California Cancer Registry in hopes of making the data more consistent and useful to researchers and policymakers.

The cancer registry, which tracks patient data, including treatments, outcomes, medical histories and geographical information, can serve as an important tool for not only pathologists but environmental policymakers.

For decades, information flowed in the form of narrative reports filled out by doctors, often interpreted by clerical staff and then submitted to the state’s cancer database. While the College of American Pathologists has offered a widely adopted checklist to guide the process, concerns about accuracy have persisted.

In response, over the last year, the Department of Public Health has teamed up with St. Joseph Health System to launch a pilot project that some are calling historic. The idea is simple. Doctors use a fill-in-the-blank computer program to record patient information, which is then submitted to the registry.

“It keeps you from missing things,” said Dr. Michael Marino, chief medical information officers for St. Joseph Health. “This hits 80 different types of cancer. Without it, you’re bound to miss something.”

After adopting the program, it’s hard to imagine going back, said Michelle Woodley, vice president of clinical informatics at St. Joseph Health.

“With this automated system, you can’t have people fat-fingering or miscoding something for the wrong kind of cancer, which could make your research not potentially valid,” she said.

Ten of St. Joseph Health’s California hospitals have now adopted the new technology, which the state hopes will encourage more health facilities to come on board. While most hospitals report information within six-months, this new program produces searchable data sets that can potentially be used in real-time.

“The project is scalable so it can be expanded to include other participants,” said Kurt Snipes, with the Cancer Surveillance and Research Branch of the Department of Public Health. “The work with St. Joseph’s was the first of its kind in California.”

While the idea may seem like common sense to an outsider, the challenge could be getting doctors and hospitals to embrace the practice. Making the pilot program appealing to St. Joseph Health, the national Catholic health system was in the midst of overhauling its computer systems when the state’s proposal caught its attention. But, for other hospitals and health professionals, the idea could be jarring or even daunting.

“You’re asking me instead of doing this narrative pathology report that I may have done for years, you want me to be very structured,” Marino said,” and in order to do this, you can’t be in a paper system or a dictation system. This is actual coding into a computer program.”

However, a wide desire for the advantages of such a system could, in the long run, out pace any resistance. If more hospitals participate, the accuracy and availability of the cancer-registry data could dramatically improve, giving health professionals unprecedented access to information, not only to treat patients but to offer preventative care, as well.

“There’s a whole big push for predictive analytics,” Woodley said. “How do you start to use this data to predict who’s at risk and intervene early?”

That means that not only can doctors quickly research what types of treatments have been successful for specific diseases, but state and local officials can also more accurately track environmental factors that lead to certain types of cancer.

“I think everybody in healthcare in the United States is making this mind-shift,” Marino said. “It’s no longer about me taking care of just you and doing what I learned 50 years ago. It’s how do I learn from how I’m treating you, and how do I prevent it from happening to someone else.”

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