Developing and Evaluating a Simple, Spreadsheet ...

Developing and Evaluating a Simple, Spreadsheet-based Pathology Report Extraction System for Cancer Registrars Ya-Fen Liang, MS1, Pei-Yi Chu, MD2, Cheng-Shyong Chang, MD3, Chen-Hsi Wang1, Polun Chang, PhD4 1 Department of Tumor Center, Changhua Christian Hospital, Changhua, Taiwan Department of Pathology and Laboratory Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan 3 Division of Hematology-Oncology Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan 4 Institute of Health Informatics and Decision Making, National Yang-Ming University, Taipei, Taiwan 2

Abstract Surgical pathology reports are essential for cancer registry. However, cancer registrars in Taiwan still code manually from the pathology reports written in unstructured free-text. The purpose of this study was to develop a cost-effective tool to automatically code the free-text reports with Microsoft® Excel VBA too. The time and accuracy performances between these two approaches were compared. Results showed that the cost-effectiveness and time-saving of the system and the potentials of using spreadsheet tools for healthcare professionals. Keywords: Spreadsheet, Cancer Registry, Pathology Report, Excel VBA Background Though the national cancer registry in Taiwan has been implemented for nearly thirty years and the coverage rate is close to 100% in all hospitals, almost all data required for cancer registry in medical chart, especially pathology report, are still coded manually in every hospital. Since it is time-consuming, expensive, and unpractical to develop the specific support system in every hospital, it is a reasonable alternative for us to use the End User Computing (EUC) strategy [1] to develop such a support system. Methodology 185 free-text pathology reports of one hundred patients, who were pathologically diagnosed as breast cancer from October 2004 to March 2005 in a medical center in central Taiwan, were retrieved from the HIS system for study. The data in other independent pathology reports, which were composed of fifteen components and required in cancer registry for National Taiwan Cancer Data Base, were analyzed to design and to code the parsing engine of the support system in Excel VBA [2], which have been widely used by our nurse cancer registrars. A well-trained cancer registrar was invited to code the 100 sets of reports manually as usual, when the system was used to do the same tasks at the same time independently. The time to complete the work was recorded and accuracy rates were assessed by the other independent well-experienced cancer registrar.

Results The time for the well-trained cancer registrar to finish the work was about 10 hours, compared to less than 1

minute by the spreadsheet-based support system. The performance for both approaches was shown in Table 1. The results showed a very comparable accuracy performance between these two approaches. From discussion with the cancer registrar, it is not assured that her performance could be improved in any way in the future since she commented the errors seemed unpreventable. However, the errors occurring in the system were believed to be able to be removed in the future by refining the parsing algorithms. Table1. The comparison of accuracy rates of two approaches in 15 coding items of cancer registry from coding 185 reports Method Cancer Registrar Spreadsheet System Coding Items (%) (%) Laterality 100.00 100.00 Histology 100.00 100.00 Behavior 100.00 100.00 Grade 99.46 100.00 Tumor Size(Pathology) 98.92 100.00 Regional Nodes Examined 100.00 100.00 Regional Nodes Positive 100.00 100.00 Margin Distance 100.00 96.22 Surgical Margin 100.00 97.30 TNM-Path T 100.00 100.00 TNM-Path N 98.38 100.00 Estrogen receptor 100.00 99.46 Progesterone receptor 97.84 99.46 Surgery Type 98.92 97.84 Regional LN Surgery 100.00 100.00

Discussion The results showed the cost-effectiveness, time-saving, and potentials of spreadsheet system, coding with the Excel VBA, in improving our performance in cancer registry. We believe the end-user computing strategy with the spreadsheet tool is a feasible and useful alternative to computerize our national cancer registry system from bottom-up. It is cost-effective and time-saving for projects without enough IT resources. We are refining the parsing engine of the system in order to better improve its performance. References 1. Brancheau JC, and Brown CV. The Management of End-User Computing: Status and Directions. ACM Computing Surveys. 1993; 25(4): 437-482. 2. Birch R. (2005, May), Microsoft Excel: 21st Century Abacus or End- User Development Tool ?. Bulletin of Applied Computing and Information Technology Vol. 3, Issue 1. ISSN 1176-4120. Retrieved March 15, 2006 from http://www.naccq.ac.nz/bacit/0301/2005Birch_Spreadsheets.htm

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