CPDMS.net allows health care organizations to store more than one cancer registry in a combined database. Individual patient records are stored only once in the database, regardless of how many hospitals in the organization include that patient in their registry. Each hospital in the group has at least limited access to all of the records in the database. Specific functions required to maintain the data records (i.e., create, edit, and delete) may be restricted for multi hospital users, depending on the user hospital's class relationship to the case compared with that of other associated hospitals. Reports may be generated for all patients and cases in the combined database, or they may be specified to include only one hospital's registry. Further details about using a multi hospital database are outlined in the following paragraphs.
Setup
When a multi hospital database is initially set up, the number of hospitals (or registries) using that database is entered during the setup procedure. A Group Identification number is also entered at that time, to indicate the name of the user group (i.e., Combined KY Hospitals, Inc.). There is a file related to each case record which indicates every hospital associated with that case, along with the hospital's class of case code, medical chart number, and registry accession number.
When a multi-hospital registry user logs into CPDMS.net, a screen prompts the user to choose which hospital's registry they will be representing. The user hospital is selected by choosing the hospital ID number from a drop down menu.
After a user hospital is selected, the program proceeds to the Main Menu. Users may log in to a different hospital without logging out of the system completely by using the "Change Login Hosp" function in the Maintenance menu.
Users may also login as a different facility from within the Data Entry Status screen. From the menu, click "Logout," and then "Change Login Hosp."
You may also use a new feature introduced into CPDMS where you view the affiliated hospital and change login hospital that way. This is seen below.
Data Entry
If Patient Data is selected, new patient records may be created or existing records modified. This procedure is the same for multi hospital users as it is for single hospital users, except when accessing cases that are associated with another hospital in the group. Then the functions may be restricted based on the user hospital's relationship to the patient's cases, as determined by the user hospital's class of case for each.
For example, if patient keys are entered to create a new record, but the patient has already been entered in the database by another hospital, the existing record will be displayed with the patient's social security number, name, date of birth, and sex. Select the existing record, and a message stating "Patient not currently affiliated with your Institution" appears. Now the Data Entry Status screen is displayed. At this point, some of the available functions may be performed on this record, even though the user hospital's relationship to this patient has not yet been established.
YOU MAY: | |
|---|---|
LOCATE | any case or therapy attached to this patient |
VIEW | any segment of this patient record |
CREATE | a new case for this patient and any segments attached to the new case, or user defined fields at the patient level |
KEY CHANGE | patient keys only |
EDIT | patient record, patient level user defined fields |
DELETE | user defined fields--patient level |
YOU MAY NOT: | |
CREATE | any segment attached to a case which is not associated with your hospital |
KEY CHANGE | case or therapy keys when your hospital is not associated with the case |
EDIT | any case, or segment related to a case, which is not associated with your hospital |
DELETE | the patient, the case, or any segment related to a case that is not associated with your hospital |
When a situation such as this is encountered —in which a new patient is to be entered into the registry, but the patient already exists in the database—first view the Patient Record to confirm that is in fact the same person. Compare each of the data values in the Patient Record with those that are available, and if they are all in agreement, then nothing in the record need be edited. If there are any significant discrepancies, then check with the other hospital registries in the multi user hospital group to determine the correct data values and enter any changes necessary through EDIT.
If desired, patient level user defined fields may be CREATED or EDITED. Remember, these field definitions apply to all patients in all hospitals in the database.
Now LOCATE the existing cases stored for this patient. Choose LOCATE and "Case" and a list of the cases with their sequence numbers and site groups will be displayed.
When an existing case is LOCATED and selected, a warning message will be displayed: "Case not currently associated with your institution." Choose "OK" to close this message. Now the case keys are displayed in the Data Entry Status screen. Compare the existing cases to the case to be abstracted. VIEW each case in detail to confirm if it is in fact the same primary malignancy that is to be entered. If none of the existing cases is a duplicate of the new case, then a new case record and all the segments attached to that case may be CREATED. The full range of functions (EDIT, DELETE, etc.) will be available on all segments of the record that is created.
If one of the existing case records is the same primary as the one to be entered, then first establish the user hospital's association with that case.
LOCATE and select the matching case and a warning message will be displayed that it is not currently associated with the user hospital. Press ENTER for "Ok" and then go to CREATE and Case Affiliation. A dialog box appears asking: "Add your institution's relationship to this case?" Press ENTER for "Yes" and the Class History Edit Form appears:
This screen allows the establishment of the user hospital's relationship to this case. The user hospital ID number automatically appears, based on the hospital ID selected at login. Enter the hospital chart number, registry accession number, class of case, date of first contact, institution referred from, institution referred to, palliative procedure, QA and Central review status, and abstractor initials. Select the "Save" button or press F10. At this point, the computer compares the user hospital's class code to that of the other hospital(s) related to this case. Hospitals with the highest priority class of case, or equivalent to the highest, are permitted a greater range of functions on the case record than hospitals with a lower priority class code. The priorities listed from highest to lowest are:
Class of Case Order of Precedence for Case Ownership | |
|---|---|
14 | Initial diagnosis here AND all first treatment here OR no treatment |
13 | Initial diagnosis here AND part of first treatment here |
12 | Initial diagnosis by staff physician AND all of first treatment here OR no treatment given |
11 | Initial diagnosis by staff physician AND part of first treatment here |
10 | Initial diagnosis here or by staff physician AND part or all first treatment here OR not treated/treatment unknown |
22 | Initial diagnosis elsewhere AND all of first treatment here |
21 | Initial diagnosis elsewhere AND part of first treatment here |
20 | Initial diagnosis elsewhere AND all or part of first treatment here |
00 | Initial diagnosis here AND all treatment elsewhere |
30 | Initial diagnosis and treatment elsewhere AND workup or consult done here |
38 | Initial diagnosis by autopsy here |
34 | Case not reportable to COC AND initial diagnosis and part or all of first treatment here |
36 | Case not reportable to COC AND initial diagnosis elsewhere AND part or all of first treatment here |
40 | First diagnosed and treated at one staff physician office |
41 | First diagnosed and treated at more than one staff physician office |
42 | Non-hospital cases abstracted by hospital |
43 | Pathology or lab specimens only |
99 | Non-hospital cases abstracted by KCR |
31 | Initial diagnosis and treatment elsewhere AND in transit care given here |
32 | Initial diagnosis and treatment elsewhere AND patient seen here for recurrence |
33 | Initial diagnosis and treatment elsewhere AND patient seen here with disease history |
35 | Case diagnosed before reference date AND initial diagnosis AND part of first treatment here |
37 | Case diagnosed before reference date AND initial diagnosis elsewhere AND part of first treatment here |
98 | Non-hospital treatment abstracted by KCR |
49 | Death Certificate Only |
When the Class of Case values are equal, the following rules determine case ownership in the order presented:
Class record with the most recent Date Last Update is the best
Class record with the most recent Accession Year
Class record with the highest Accession Number
Only hospitals with the highest priority are able to EDIT the case record. If the user hospital has the highest priority class code (or equal to the highest), the case data edit screen will now be displayed.
The values which were just entered in the “Associated Hospital” record will automatically appear in the fields for chart number, registry accession number, class of case, date of first contact, institution referred from and to, palliative procedure, QA review status, central review status, and abstracted by. The user hospital ID will be displayed in the class hospital ID field. Compare the available case data values to be entered with those on the screen. If there are discrepancies with any of the items entered by another hospital user, determine the correct data values and edit the screen record or the available data, if necessary. [In order to determine which other hospital(s) in the group is affiliated with this case, go to VIEW, Case, and Case Affiliations.]
Hospitals with a lower priority may edit any record segments attached to the case, but not the case record itself. When a lower priority hospital attempts to edit a case, the screen which appears is the “Associated Hospital” screen. This hospital user may edit only those fields specific to the hospital: chart number, registry accession number, class of case, QA status, and central review status.
Hospitals of any priority may LOCATE, VIEW, or CREATE any segment of a patient record. They may EDIT any segment, except lower priority hospitals may not edit the case segment. Once the user hospital’s association to a case has been established, additional therapies or text may be added. The follow-up record should be updated if the user hospital has more current information.
Only hospitals with the highest priority may make key changes to the case. Other associated hospitals may make key changes to the patient and therapy records, but not the case record.
No hospital may delete an existing patient record when that patient is associated with more than one hospital. No hospital may delete a case record when that case is associated with more than one hospital. If an individual hospital within a multi-user group wishes to delete a patient from its registry, that hospital accomplishes this by deleting its association with the case record. To do this, select DELETE and then Case. The following message appears on the screen: “Delete Your Institution’s Affiliation with This Case?”
Choose the reason for the deletion from the drop-down menu and type a comment, if desired. Select “Yes” and the user hospital’s association record for this case will be deleted. When only one hospital in a multi hospital group is associated with an existing patient record, then that hospital may delete the patient, case, or any other segment just like a single hospital user of CPDMS.net. Any hospital associated with a case, regardless of priority, may delete any of the case’s therapy records.
The following table summarizes the data entry functions available to each type of user in a multi hospital group:
USER HOSPITAL NOT ASSOCIATED WITH CURRENT PATIENT RECORD | |
|---|---|
| MAY: | |
LOCATE | Any patient, case or therapy segment |
VIEW | Any segment of any record |
CREATE | New patients and all attached segments, new cases and all attached segments |
KEY CHANGE | Patient keys only |
EDIT | Patient data and patient level user defined fields |
MAY NOT : | |
CREATE | Any segment attached to an existing case |
KEY CHANGE | Case or therapy keys |
EDIT | The case, or segments related at or below the case level |
DELETE | Any part of the record |
USER HOSPITALS ASSOCIATED WITH THE CURRENT PATIENT'S CASE RECORD BY A LOWER CLASS PRIORITY | |
|---|---|
MAY: | |
LOCATE | Any patient, case or therapy segment |
VIEW | Any segment of any record |
CREATE | Any segment for new or existing records |
KEY CHANGE | Patient and therapy keys |
EDIT | Any segment except case or another hospital's association to a case record |
MAY NOT : | |
EDIT | Case records |
DELETE | Case or patient records |
USER HOSPITALS ASSOCIATED WITH THE CURRENT PATIENT’S CASE RECORD BY THE HIGHEST CLASS PRIORITY | |
|---|---|
MAY: | |
LOCATE, VIEW, CREATE, KEY CHANGE, and EDIT any segment of the record | |
DELETE | That hospital's association with the case record; or any segment attached to the case record |
MAY NOT : | |
DELETE | Any case or patient when other hospitals are associated with that record |
Reports
Multi-hospital groups have the ability to generate reports from the entire database or to select one or more specific registries. The registry data to be included on a report is specified on the report criteria screen. See below for an example using Patient Accession Log.
At "Select hospital(s) to report," choose which facility's records are to be included in the report. Hold down the control key while making selections in order to highlight multiple facilities. Use the "Select All" button to highlight every facility in the database, and "Unselect All" to clear selections.
Cases will never be counted more than once. Each case will carry the data values for Class of Case, Chart Number, Registry Accession Number, QA Status, and Central Review Status from the associated hospital record with the highest class priority. If multiple hospitals have the highest class priority, each case will carry the data values from the record of the hospital that most recently updated the case.
The maintenance procedures for multi hospital users are the same as for single hospital users of CPDMS.net. The support files are stored only once and apply to all hospitals using the database, as are the User defined labels.