Hospital Registry Domain Diagram

A domain diagram is a skeleton class diagram that consists of—

• A group of classes and interfaces that reflect important entities in the business domain of the system being modeled.
• The relationships between the classes and interfaces.

The NPCR–AERRO Hospital Domain Diagram shows the interactions between the entities involved in hospital cancer registry functions. It shows the formation of a cancer abstract from the time individual event reports are generated at different data sources to the time the cancer abstract is stored in the hospital cancer registry and made available to institutions and national programs for research.

A text description of the diagram and legend may be found below. For information about reading diagrams, see Diagram Conventions.

• Hospital Registry
  A hospital cancer registry collects information on all cancer patients who use the services of a hospital. It may be required to report cancer cases to the central registry, to respond to inquiries from the central registry, or to allow central registry access to its records.
• General Cancer Information
  Data relating to the occurence, diagnosis, and treatment of cancer.
• National Cancer Data Base
  A joint program of the Commission on Cancer (CoC) and the American Cancer Society, the National Cancer Data Base (NCDB) is a nationwide oncology outcomes database for more than 1,400 CoC-approved cancer programs in the United States and Puerto Rico. These data are used to explore trends in cancer care, create regional and state benchmarks for participating hospitals, and form the basis for quality improvement.
• Central Registry
  A central cancer registry (CCR) collects, processes, and analyzes data on all cancer cases diagnosed. Each state in the United States has a CCR.
• Clinical Trial
  A type of research study that tests how well new methods of screening, prevention, diagnosis, or treatment work.
• Registrar
  A data management professional who validates event reports; links patients and tumors; performs consolidation, audits, quality assurance, and rapid case ascertainment; links to external data sources to improve data and for research; conducts death clearance, follow-up, and interstate data exchange; responds to calls for data; and provides data for use by others.
• Hospital
  A healthcare facility that provides inpatient and outpatient diagnostic, treatment, and palliative care services. It may serve a community or regional population or serve as a teaching and referral center. A hospital may seek approval for its cancer program from the American College of Surgeons Commission on Cancer, whose program standards require operation of a hospital cancer registry.
• Cancer Case
  A summary of all event reports submitted by reporting facilities. It contains the final best information regarding a patient and his or her cancer and includes patient demographic, medical, staging, treatment, and service information.
• Summarized Patient Data
  A record containing the most specific patient demographic information, provided by multiple data sources, to identify the patient uniquely and assist in the follow-up process.
• Summarized Tumor Data
  A record containing the most specific medical information about the cancer, provided by multiple data sources, for analysis and research.
• Summarized Treatment Data
  A record containing the most specific treatment information, provided by multiple data sources, for analysis and research.
• Summarized Follow-Up Data
  A record containing the most appropriate method and data to obtain information about the patient's vital status and cancer status.
• Patient
  A person receiving medical care for cancer.
• Encounter
  A meeting between a patient and a physician whose services are provided during one visit to a clinic, provider office, or hospital.
• Internal (Hospital) Cancer Data Source
  An area or department within a hospital that provides medical care to the patient and records the results.
• External (Non-Hospital) Cancer Data Source
  A data source that operates as a separate entity from the hospital.
• Business Office (Billing Claims)
  The department responsible for billing and collecting payment from individuals or third-party payors for healthcare services rendered by the facility. It provides information on the financial statement submitted for payment.
• Admissions
  The hospital department that processes patient admissions and generates key patient identification and demographic data, including the patient's name, address, date of birth, race, sex, Social Security number, and insurance carrier.
• Diagnostic Imaging (Radiology)
  The hospital department that creates images of structural or functional patterns of human organs or tissues for the purpose of identifying, diagnosing, or monitoring disease. Radiographs (X-rays), fluoroscopy, ultrasound, mammography, computerized tomography (CT scans), positron emission tomography (PET scans), magnetic resonance imaging (MRI scans), and nuclear medicine imaging are included. Information reported from diagnostic imaging includes the type of study, body location, description and evaluation of the image, and diagnosis.
• Hospital Disease Index
  A numerically sequenced list of diseases and conditions diagnosed in hospital patients. Diseases and conditions identified in patient medical records are coded using a standard classification system such as ICD-9-CM or CPT (Current Procedural Terminology). The disease index, compiled from these codes, is a casefinding source for the cancer registry.
• Hospital Pathology Laboratory
  The hospital department that examines organs, tissues, cells, and bodily fluids removed from patients for the investigation and diagnosis of disease, and conducts autopsies to study disease processes and to determine cause of death. Pathology reports include the type of material examined, body location from which the specimen was taken, gross and microscopic description and evaluation of tissues, components of bodily fluids, and diagnosis. A pathology laboratory may be required to report cancer cases to the central registry, to respond to inquiries from the central registry, or to allow central registry access to pathology records.
• Treatment Logs
  Daily records of treatment given or procedures performed in a hospital department such as a surgery unit or an outpatient chemotherapy clinic. They generally include patient identifiers, procedures performed, diagnosis, and practitioners, and are a source of casefinding data.
• Medical Record Department
  The hospital department that stores paper-based or computerized information recorded during the patient's encounters with the facility. Patient medical records are the primary source of patient identification, diagnosis, and treatment information.
• Pharmacy
  A hospital pharmacy maintains the hospital formulary, stocks and releases drugs for treatment as ordered by physicians, addresses complex clinical medication management issues, and provides information on available drugs, including generic and brand names, disease-specific prescriptions, and drugs administered to individual patients.
• Oncology Clinic
  An ambulatory care unit responsible for staging, medical treatment, and follow-up of cancer patients in a hospital. A clinic may focus on a particular cancer site such as breast cancer, provide a centralized setting for chemotherapy administration, or coordinate all services provided to oncology patients throughout the facility. Medical oncology documentation varies according to the services provided and may be separate from the hospital medical record.
• Radiation Oncology
  The department that provides curative, adjuvant, or palliative cancer treatment using radiation to control malignant cells. Radiation may be given as external beam radiotherapy, brachytherapy or implantation of radioactive sources, or injection or ingestion of radioactive materials. Radiation oncology documentation, which may be maintained separate from the hospital medical record, includes pre-treatment consultation summarizing the cancer diagnosis and treatment to date, treatment planning and daily dose delivery, treatment summary, and patient follow-up visits.
• Hospice/Pallative Care
  Patients with terminal disease may receive long-term care and end-of-life care care at home or in a specialty hospital unit, nursing facility, or designated hospice facility. A hospice may be required to respond to inquiries from the central registry, or to allow central registry access to its medical records, particularly for case ascertainment on patients who have died with a cancer diagnosis identified only through death certification information.
• Outpatient Services
  Ambulatory services provided to patients in hospital-based clinics and departments where the length of stay is less than 24 hours. Documentation of outpatient services, which includes the patient's medical history, physical examination, diagnostic and therapeutic procedures, consultations, observations, and discharge notes, usually is integrated with the patient's inpatient medical record to form a unified hospital medical record.
• Specialty Database
  A collection of data that describes a hospital's diagnostic and treatment experience with a specific disease. It is a tool for improving the quality of care and measuring the effectiveness of healthcare delivery for that disease. An example is the cancer registry database, which contains cancer-related information abstracted from patient medical records and patient follow-up data gathered from outside sources.
• Physician Office/Clinic
  A solo or group physician practice, usually focused on a specialty area of medical practice such as internal medicine, general surgery, or urology. Its medical records identify cancer patients and provide cancer-specific treatment data and patient follow-up information. A physician practice may be required to report cancer cases to the central registry, to respond to inquiries from the central registry, or to allow central registry access to its medical records.
• Patient (Follow-Up)
  A person receiving medical care for cancer.
• Freestanding Diagnostic Imaging Center
  An independent healthcare facility whose clients may include physician and clinic practices as well as hospitals. It creates images of body organs and structures for the purposes of diagnosing disease, evaluating disease progression, and monitoring the effects of treatment. Imaging information generally is provided to central cancer registries through reporting procedures established with physician offices and treatment facilities.
• Freestanding Surgical Center
  A surgical facility that is independent from an acute care facility.
• Freestanding Pathology Laboratory
  A pathology laboratory that operates independently from other healthcare facilities, whose clients may include physician and clinic practices as well as hospitals. It examines organs, tissues, cells, and bodily fluids removed from patients for the investigation and diagnosis of disease, and conduct autopsies to study disease processes and to determine cause of death. Pathology reports include the type of material examined, body location from which the specimen was taken, gross and microscopic description and evaluation of tissues, components of bodily fluids, and diagnosis. Pathology laboratories may be required to report cancer cases to the central registry, to respond to inquiries from the central registry, or to allow central registry access to pathology records.
• Freestanding Chemotherapy Center
  A healthcare facility established as a separate entity from traditional hospitals, though it may be affiliated with a hospital. It offers chemotherapy treatments and may provide cancer information to hospital registries for shared patients or establish its own registry database for monitoring patient care and outcomes. It may be required to report cancer cases to the central registry, to respond to inquiries from the central registry, or to allow central registry access to its medical records.
• Freestanding Radiation Oncology Center
  A healthcare facility established as a separate entity from traditional hospitals, though it may be affiliated with a hospital. It offers radiation treatment and may provide cancer information to hospital registries for shared patients or establish its own registry database for monitoring patient care and outcomes. It may be required to report cancer cases to the central registry, to respond to inquiries from the central registry, or to allow central registry access to its medical records.
• Regional Health Information Organization
  A group of stakeholders responsible for integrating health information exchange to improve healthcare safety, quality, and efficiency and improve access to health data through information technology.
• Tissue Bank
  A repository of tissue samples for use in future research projects.

Domain Diagram Legend

• The patient (who is described by Patient ID, Medical Record Number, and tumor) interacts with internal (hospital) and external (non-hospital) cancer data sources.
• Internal and external cancer data sources summarize the encounter (which is described by facility and service).
• Internal and external cancer data sources contribute to summarized patient, tumor, treatment, and follow-up data. These data make up the cancer case.
• Components of the individual records (summarized patient, tumor, treatment, and follow-up data and encounter facility and service) contribute to the internal cancer data source, which is a part of the hospital.
• The registrar creates the cancer case and uses it to maintain the hospital registry, which is a part of the hospital.
• The hospital registry provides general cancer information and reports to the National Cancer Data Base, the central registry, and clinical trials.
• The hospital registry stores the cancer case.
• The registrar, who is an agent of the hospital, uses the internal and external cancer data sources.

Internal (hospital) cancer data sources include the hospital's business office (billing claims); admissions department; diagnostic imaging (radiology) department; the hospital disease index; the hospital's pathology laboratory; treatment logs for chemotherapy, gamma knife, tomotherapy machines, and surgery; medical record department; pharmacy; oncology clinic; radiation oncology department; hospice/palliative care; outpatient services; and specialty database data.

External (non-hospital) cancer data sources include physician offices or clinics, the patient, freestanding diagnostic imaging centers, freestanding surgical centers, freestanding pathology laboratories, freestanding chemotherapy centers, freestanding radiation oncology centers, regional health information organizations, and tissue banks.

Note: Definitions for individual terms can be found in the Glossary.