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Background
The Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute (NCI) is an authoritative source of information on cancer incidence and survival in the United States representing 34 percent of the US population. The SEER Program funded the development of the SEER Data Management System (SEER*DMS) in 2000. Since the first deployment of the systems in Detroit in 2005, it has been utilized by the SEER Program to process and submit cancer data to the NCI. SEER*DMS also provides support for all core cancer registry functions, such as importing, editing, linking, and consolidating data and producing reports. Since 2011, the SEER Program has taken steps to invest in and implement enhancements to SEER*DMS. In 2015, external health informatics experts conducted a review of SEER*DMS and provided several recommendations in several key areas for enhancing the efficiency and utility of the system. These recommendations include:
- increase automation of tumor linkage and patient & tumor consolidation
- integrate tools into SEER*DMS like integrated case upload and report writing systems,
- use natural language processing for text abstraction,
- evaluate and improve usability,
- improve governance and communication,
- enhance system architecture, performance, security, and sustainability, and
- prepare for future trends in molecular and precision medicine and healthcare information technology.
SEER*DMS Change Control Advisory Board (CCAB)
The SEER*DMS Change Control Advisory Board (CCAB) is the SEER*DMS steering committee that provides registry input to NCI and its contractor on changes needed in SEER*DMS to enhance functionality. The CCAB suggests (or recommends) plans and proposals for significant changes and enhancements to SEER*DMS, including the development of new features and changes to algorithms, database structure, and hardware infrastructure. Participants include representatives from registries currently using SEER*DMS, in transition, or considering a transition to the system, as well as members of the SEER*DMS development team and NCI representatives. The CCAB meets on a semi-monthly basis via teleconference. These recommendations are reviewed, approved, and prioritized by the NCI.
To learn more, visit the SEER*DMS CCAB Webpage
SEER*DMS Face-to-Face Meeting (F2F)
The SEER*DMS Face-to-Face Meeting (F2F) brings together registry experts from across the country to discuss SEER*DMS initiatives that aim to support the development and enhancement of tools and processes for the cancer registry community. F2F provides a forum to discuss registry-specific insights, considerations, and barriers regarding the development initiatives. It aims to provide clarity and foster communication among all SEER*DMS stakeholders. In its first year, more than 150 attendees participated in the 2017 F2F Meeting in person and online; nineteen cancer registries were represented in person at the meeting.
SEER*DMS Initiatives
Advancements in the health informatics landscape and cancer surveillance drive the need for enhancements to SEER*DMS. Healthcare information technology, electronic data sources, clinical informatics, and informatics tools and methods have advanced considerably over time. All the while, the SEER Program is increasing its volume and variety of data with new integrations around cancer diagnostics, treatments, and outcomes. To ensure that SEER*DMS can support advancements in informatics and cancer surveillance, the SEER*DMS initiatives aim to focus on enhancing system aspects such as automation, natural language processing, acquisition and linkage of new data sources, data visualization, new informatics tools and methods, and more. Initiatives underway are detailed below.
Usability Initiative
The SEER*DMS usability initiative is a high-priority activity that aims to incorporate user-centered design practices into the SEER*DMS platform to enhance the user interface and overall user experience. As SEER*DMS evolves over time, complexities of workflow and additions of data sources into SEER*DMS require measuring and evaluating the current efficiency and overall usability workflow in the system. The SEER*DMS usability initiative will begin with a professional usability review conducted on the system to determine areas of enhancement that will to lead to improved quality, efficiency gains, and, ultimately, resource cost savings.
Review minutes from the January 2018 CCAB meeting to learn about efforts underway for the SEER*DMS usability initiative.
Auto-consolidation Initiative
Auto-consolidation is one part of efforts to increase automation in SEER*DMS to decrease the burden of manual work associated with data processing at the registries and to prepare for the future influx of new data streams. In particular, auto-consolidation is concerned with automating patient and tumor consolidation, a process that aims to create the most complete and accurate patient and tumor records. Such a patient record is typically created following manual review of all demographic information available linked to a specific patient; the tumor record, describing cancer type, stage, and treatment, is created following manual review of all reports for each specific tumor or cancer associated with a patient. These manual review processes can be resource and staff intensive, as reports and information must be visually inspected, the best value for each specific data item must be determined, and then that value must be coded into a consolidated patient and tumor record.
To make the process of patient and tumor consolidation more efficient, algorithms are being developed and incorporated into SEER*DMS to reduce the amount of visual and manual inspection required. This effort promotes focus in areas that truly need review, greater consistency across SEER*DMS registries, and minimization of the subjective nature of the manual process.
The SEER*DMS Auto-consolidation Workgroup has been established to address this initiative through: (1) Developing a process to identify tumor-related data fields that could potentially be auto-consolidated, and (2) Creating and testing auto-consolidation guidelines and rules for each tumor-related data field.
To learn more, visit the SEER*DMS Auto-consolidation Workgroup Webpage.
Claims Initiative
Claims data are made up of billing codes that healthcare providers, hospitals, and pharmacies submit to healthcare payers like private insurance companies or Medicare. Claims are a useful source of data that describe the comprehensive healthcare services provided to patients. Linking claims to SEER*DMS provides a more complete picture of the factors in a patient's life that could exacerbate or mitigate development and progression of cancers and outcomes of treatments.
As cancer researchers develop new targeted therapies for precision oncology, the volume and variety of information needed around cancer diagnostics, treatments, and outcomes will increase. Claims can provide an important adjunct to providing data on treatment as well as if someone has received a specific diagnostic test. The SEER*DMS platform is being enhanced to support the integration of this detailed data, and this effort will enrich SEER data for research. Additionally, efforts to automate the processing of claims across registries will help increase registry efficiencies.
The SEER*DMS Claims Workgroup aims to standardize processes for working with claims across registries, maximize automation, facilitate research access to source claims, and expand capture. The workgroup defined short-term, mid-term, and long-term goals.
To learn more, visit the SEER*DMS Claims Workgroup Webpage.
Meaningful Use 2
Electronic health records (EHR) are a valuable source of information. Through the Meaningful Use initiative administered by the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT, incentives are in place for healthcare providers to use certified EHR technology in a meaningful way and to ensure that this technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care. Currently, state registries are receiving requests from physician offices who would like to start electronically reporting their cancer encounters for the cancer reporting objective of the Meaningful Use Initiative. SEER*DMS is being enhanced to capture information from this valuable data stream.
The SEER*DMS Meaningful Use 2 (MU2) Workgroup aims to develop a workflow for processing these electronic reports within SEER*DMS. In SEER*DMS, registries can currently load these types of reports, match them at a patient level, and view the data. The workgroup defined a set of short-term objectives.
To learn more, visit the SEER*DMS MU2 Workgroup Webpage.
