| Ontario Health - Cancer Care Ontario's Data Book - 2022-2023 |
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Updated July 2020
A baseline file is used to identify all existing patient cases prior to the hospital’s start of data submission (for Clinic Visits). Once the visit activity submission commences, each visit is cross referenced back to the baseline file to determine if the patient is a new case (as of the visit date). If the patient does not match a record on the baseline file, it is counted as a new case visit and subsequently added onto the file to identify further follow up visits. A record match will count as a follow up visit. New case and follow up visits are grouped by the Visit Program Code.
See Appendix 1.39 for Clinical Practice Group and Subgroup mapping tables for ICD10CA and ICDO3.
• CPG assignment is based on ICDO3 Topography and Morphology code combinations.
• For ALR cases where the Disease records are submitted with only an ICD10CA “Diagnosis Code” within the neoplasm code range C000 – D489, a conversion ‘up’ to ICDO3 Topography and Morphology is done.
• The “ICD10CA CPG” tab contains the mapping from ICD10CA “Diagnosis Code” (ICD10CA_CD) to ICDO3 Topography (ICDO3_TOPOG_CD) and Morphology (ICDO3_MORPH_CD) codes, and the CPG and subgroup assignment.
• The “ICDO3 CPG” tab contains the mapping from ICDO3 Topography and Morphology codes to the CPG and subgroup assignment using the following steps:
1. Exact match between Topography code (ICDO3_TOPOG_CD) and full Morphology code (ICDO3_MORPH_CD), assign to CPG and subgroup.
2. If no exact match between Topography (ICDO3_TOPOG_CD) and full Morphology code (ICDO3_MORPH_CD), then match between Topography (ICDO3_TOPOG_CD) and the full Morphology code
that ends with Behaviour (BEHAVIOUR_CD) = 0, 1, 2, 3, 6, 9, assign to CPG and subgroup.
Face to face includes visits that allow both parties to see each other (ie. includes video conferencing). Telephone visits include modes such as teleconference and email.
For Psychosocial Oncology (PSO) clinic visits it is necessary to capture the HCP Number for various HCP Specialties. The HCP file must be updated for non-physician HCP numbers and their corresponding HCP Specialty. A generic HCP Number could be used to correspond to the specialties required for the programs, if unique HCP Numbers are not being used for non-physicians. The key HCP Specialties used by the PSO program are:
• 12000 Social Worker
• 06000 Nutritional Therapy (ie. dietitian)
• 03002 Physiotherapy
• 00064 Psychiatry
• 15000 Psychology
• 03003 Occupational Therapy
• 03009 Speech Language Pathology · · If unique HCP Numbers are not used for these specialties, the option to use the HCP Specialty Code as the generic HCP number is advised. For example, for ALL Social Workers, use one HCP record with HCP Number = 12000, HCP Specialty Code = 12000, CCO Program Code = PSO.
After reviewing the ALR QA reports generated after a package is submitted, the patient level details for the records that have been flagged with errors can be found on the “QA Full Report” for the corresponding Load ID of the package submitted. Once the errors have been addressed on the hospital information system (HIS), the applicable ALR (csv) files can be re-extracted and resubmitted to the Data Submission Portal (DSP). Please follow the steps for submission, as outlined in FAQ #5 (for more details).
Note: resubmission of data months outside of the “optional (quarterly) resubmissions” schedule require an ALR Special Resubmission Request Form to be submitted for approval. See the ALR – Submission Schedule for the form link.
Submission specifications for the data elements required for ALR are listed in the Specifications topic.
See Appendix 1.38 for a list of oral and other agents used in chemotherapy which should be reports.
CIHI has provided a Palliative Medicine code which was included in the Data Book 2012/13. Palliative Medicine specialty code 00121 should be used with CCO Program Code “PA” for Palliative Program in the HCP file. If a patient does not receive any chemotherapy and opts for Palliative care without treatment, the Clinic Visit should be captured with: •HCP Number associated with the Palliative Medicine (00121) HCP Specialty Code. •Palliative Care (PA) as the Visit Program Code.
If the patient undergoes systemic treatment, the Clinic Visit would capture an HCP Number associated to a Medical Oncologist, Systemic Program (SYS) as the Visit Program Code, followed by subsequent chemotherapy treatments captured in the Systemic Drug Delivery Event entity.
Family member visits should be captured separately for the patient receiving the consultation/assessment (ie. Not linked to the existing cancer patient case). Instead, a new patient case should be created. The disease registration record for the family member should have a diagnosis code Z63.7 - "Other stressful life events affecting family and household". In the Clinic Visit file, the Visit Program Code should be “PSO” (Psychosocial Oncology).
To count for a C1S or a C1R the HCP Specialty must part of the 'physician' or 'dentistry' group. For the systemic program, a patient is typically seen by a ‘medical oncologist’ but can also be seen by physicians with fellowships in medical oncology, hematology, or internal medicine.
No. Only one primary is captured for each histologically unique cancer (ie. basal cell carcinoma, squamous cell carcinoma) regardless of where it is on the body.
The single dose should be reported.(direction as of April 1, 2013)
a. All administered treatments are pulled from “Given Dose” in OPIS.
b. Un-administered ‘Oral’ treatments (and hormones) are pulled from “Dose” in OPIS, which is the dose ordered.
Intent is necessary for all anti-cancer treatment, however, we understand that non anti-cancer treatments ordered through EZ order may have an unknown intent, and that in this case only, the warning error # 483.2 can be ignored.
CCO advises that EZ order not be used (or discontinue use) for ordering anti-cancer treatments to avoid the potential assignment to ‘unknown’ intent, as this would impact funding.
Example: Bisphosphonates such as Denosumab, Zoledronic Acid and Pamidronate that are reported through EZ orders where ‘intent’ could be ‘unknown’ will have funding impact. There is funding provided through the funding model for these drugs.
Where Tylenol, Benadryl etc., have been identified as required for a regimen, the cost of these is built into the cost of the regimen (and all that is needed to trigger the funding is the regimen).
Nurse visits are currently excluded from Radiation and Systemic activity (ie. C1R, C1S, R17, S1 etc.). Currently, ALR collects data for the Psychosocial Oncology (PSO) program that is interested in ‘Nursing’ visits in addition to different disciplines (specialties) associated with the program such as, dietitian, social worker, therapists etc.. If these PSO clinic visits occur via telephone, you can flag them by using “OM” in the visit type field.
(May 14, 2014) The future of ‘Surgery Only Caselists’ and reports are uncertain at this time until a decision from senior management is made, they are unfortunately currently still on hold and therefore not required at this time for submission.
(May 14, 2014) Submission of TNM Stage Data via ALR Databook: submission of TNM stage data to CCO by RCCs is in fact still required for all primary cancer sites excluding those that are currently being staged at CCO using the Collaborative Stage Data Collection ( i.e. breast, lung, prostate, colorectal, gynecological sites, melanoma of skin and thyroid). For the scope of what TNM stage data should be submitted by the RCC (see Data Book – ALR Appendix 1.9).
Any activity that occurs on the inpatient ward should be submitted to ALR. The Visit Hospital Number can be used to identify this activity by using the appropriate ‘AT’ master number for your facility.
Examples of activity to capture includes any consultations or follow up assessments (clinic visit file), and any Systemic drug administrations for oncology (ie. Antineoplastic treatment). The Visit Date should be when the patient receives the consult or treatment and submitted according to the submission deadlines for when that time period is due (even if the patient remains as an inpatient overlapping submission deadlines).
(Updated July 2019)
The 2018 SEER Solid Tumor rules (along with 2007 Multiple Primary and Histology rules, where applicable) and Hematopoietic and Lymphoid
Database (for haematology cancer) should be followed in determining when multiple primaries should be abstracted and submitted to ALR.
There are several criteria/rules to consider by disease site, in determining if capturing multiple primaries is applicable (some include: site, histology, timing, laterality etc.)
Caveat: for synchronous multiple primaries, where SEER rules instruct to abstract a separate record for each primary, only one ALR disease record should be submitted, along with the stage for the case with the worst prognosis. See FAQ #22 for example.
(Updated May 2020)
In the scenario of synchronous multiple primaries, according to the 2018 SEER Solid Tumor rules, if it is determined that multiple primaries should be abstracted (such as bilateral breast cancer - by rule M7), the following caveat is in place to ensure that ALR activity links to a single Disease record and does not risk the potential of over funding duplicate ALR cases.
For example: synchronous bilateral breast cancer, determined by 2018 SEER Solid Tumor rule M7:
• For ST-QBP purposes, only one consult and treatment bundle will be counted for bilateral breast cancer that is diagnosed on the same date (synchronous).
Caveat for this scenario (ALR Disease record submission)
1. Only one Disease record is submitted.
For example:
a. Hospitals:
i. ICD-10-CA (diagnosis code) = C50*9
ii. Laterality = 9 (Paired site, but lateral origin unknown)
b. RCCs:
i. ICD-O-3 (topography code) = C50*
ii. ICD-O-3 (morphology code) = 80003♦
iii. Laterality = 9 (Paired site, but lateral origin unknown)
2. Treatment activity should be assigned to the single disease record for the duration of the course/cycle.
3. [RCCs] Staging should be provided for the case with the higher extent of disease (ie. worst prognosis).
In this example, if the breast cancer on each side is diagnosed on different dates (metachronous), one disease record should be submitted for each lesion (i.e.. left and right) with the Registration Date of when each cancer was diagnosed, along with staging for each case. For ST-QBP, each case will receive one consult and treatment bundle accordingly.
♦Note: RCCs are reminded that ICD-O-3 Topography and Morphology codes are required for cases with a neoplastic diagnosis (i.e. ICD-10-CA code range: C000 – D489).
The ALR drug classification report is run monthly and available in Data Book appendix 1.43.
24. Does OH-CCO count ‘benign’ disease for C1R?24. Does OH-CCO count ‘benign’ disease for C1R?
Yes, CCO pays for benign consultation as it is appropriate and good care. We are monitoring these volumes for benign and other non-cancers to make sure it is appropriate
Advanced Practice Nurse is an ‘umbrella’ term used across the country to identify that there are nurses who have a higher level of practice, by virtue of graduate education and/or title protection. APNs include Clinical Nurse Specialists and Nurse Practitioners. There is currently no specialty code specific to an APN, therefore, it is advised that the site use one of the specialty codes in Appendix 1.17 that best fits – Practical Nurse (PN) or Clinical Nurse Specialist (CNS).
Only one procedure code (CCI code) is permitted per record in the Procedure file, therefore, multiple records per case may be submitted if more than one procedure code is done on the same visit date.
CCO started collecting ALR from RCCs in 2005. Some hospitals began reporting the full ALR data set (excluding Radiation and Procedure activity) in 2014, and then started to report Procedure activity in 2015.
The list of ALR reporting facilities is available in Data Book appendix 1.34:
http://www.cancercare.on.ca/ext/databook/db1415/Appendix/Appendix_1.34_-_Reporting_Facilities.htm
The new sites have started to submit complete ALR data as of April 1, 2014. The baseline file is used for the Clinic Visit activity to be able to identify cases that are already ‘active’ prior to the submission start date. Since the baseline file is not used in the QA process on submission, the logic of error 470 is using the first visit as reported in Clinic Visit activity as the ‘first consult’, even though the case has been reported in the baseline.
There is no data quality issue on your end, since when the data moves to ALR the baseline file is accounted for, and would not affect metrics or wait times.
The false counts would be expected to taper down as time goes by, so this is a positive sign.
Visit Date on Systemic file is extracted as per the following:
For administered drugs – it’s the ‘Treat Date’ on Medication Administration (Treatment screen).
For un-administered drugs – it’s the ‘Planned Adm Date’ on Chemo Order Entry (Order Details screen).
There is high level documentation available for ALR metrics for the Radiation program (See Radiation Program) (New ALR Metrics for Radiation Planning and Treatment Activities) and Systemic Program (See Systemic program).
CCO uses a mapping file to convert Diagnosis Codes submitted in old ICD versions (ie. ICD-8, ICD-9) to ICD-10-CA. See link for CCO ICD8_9 to 10 mapping file.