Central Cancer Registry Business Use Case Diagram

A use case diagram—

• Presents a high-level view of how the system is used as viewed from an outsider's (actor's) perspective.
• Depicts the behavior of the system visually.
• May depict all or some of the use cases of a system.
• Can be used during analysis to capture system requirements and understand how the system should work.

The NPCR–AERRO Central Cancer Registry Business Use Case Diagram shows the business process of a central cancer registry and its interaction with business workers and business actors. A business worker acts within the system, performs the processes and interacts with other business workers and business actors. A business actor plays a role in relation to the business in the business environment, affecting it externally. In the diagram below, the actors perform different central cancer registry functions, and the results of the actions are used by the recipients.

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

Note: Functions after Perform Consolidation can be performed in any order.

• Hospital Data Source Employee
  A business actor who works for a data source inside the hospital. He or she interacts with the central cancer registry during the initial phase of the business process when event reports are prepared and transmitted.
• Non-Hospital Data Source Employee
  A business actor who works for a data source outside the hospital. He or she interacts with the central cancer registry during the initial phase of the business process when event reports are prepared and transmitted.
• Central Cancer Registry Registrar
  A business worker 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.
• Statistician/Analyst
  A business worker, internal to the organization, who performs audits and quality assurance, links to external data sources to improve data or for research, responds to calls for data, provides data for use by others, and provides rapid case ascertainment.
• Certify a Data Source for Electronic Reporting
  The Use Case describes the process for evaluating and subsequently certifying a Data Source as being qualified to perform electronic reporting that meets cancer registry standards.
• Prepare and Transmit Event Report
  The process whereby a data source submits event reports to the central cancer registry, using established criteria for record layout format, required event report types, required data items, and transmission standards.
• Receive Batch File
  To verify that a group of event reports meet the standards for record layout format, and that the batch has not been submitted previously.
• Validate Event Report
  To verify that information submitted on an event report represents a reportable case and meets logic, consistency, and data validity standards.
• Perform Patient Linkage
  To use defined criteria to determine whether source records refer to the same patient, based on the degree of agreement between demographic and other data fields. This process can be automated, manual, or a combination of both. Also called record linkage or matching.
• Perform Tumor Linkage
  To use defined criteria to determine whether source records for the same patient refer to the same tumor, based on the degree of agreement between cancer data fields. This process can be automated, manual, or a combination of both.
• Perform Consolidation
  To combine data from two or more linked source records for the same patient and tumor to produce a single ‘best’ value for each variable. This process can be automated, manual, or a combination of both.
• Perform Casefinding Audit
  An evaluation of a data source’s ability to identify and transmit eligible, reportable neoplasms to the central cancer registry. It involves a review of the most likely sources of cases, including disease indices, pathology reports (such as surgical, bone marrow, autopsy, and cytology), radiation therapy logs, and surgical logs, to identify cancer cases that should have been reported to the central cancer registry, and compare these cases to those that were reported.
• Perform Quality Assurance/Quality Improvement
  Quality control is a planned set of activities by which a cancer registrar monitors quality and takes appropriate remedial action to improve future quality, maximizing correct reporting and characterizing the reporting process in measurable terms. Quality assurance or an audit is a formal review of patient records to evaluate case completeness and data quality.
• Perform External Linkage to Improve Data
  To obtain and/or validate data items by linking central cancer registry databases with non-central cancer registry databases. For example, using death certificate data to add missing vital status and race.
• Conduct Death Clearance
  Death clearance consists of two processes: death certificate follow-back is the process of reviewing a patient’s medical history to determine if a cancer case reported first by a death certificate was diagnosed at any other source while the patient was alive; death certificate clearance is the process of linking death certificates from a state’s vital statistics office with registry records to obtain death data for previously registered cancer cases.
• Conduct Active Follow-Up
  To obtain updated information annually regarding a patient’s health status to ensure continued medical surveillance.
• Perform Interstate Data Exchange
  To report cancer cases that occur in patients who live in another state to the appropriate central cancer registry.
• Respond to Calls for Data
  To submit cancer information to organizations to meet federal and state regulations and to assist in research activities (previously called reporting).
• Provide Data for Use by Others
  To disseminate statistical analyses and data interpretations to researchers for scientific research, policymakers for planning services, hospitals for planning technology purchases and staffing, and non-governmental organizations for community cancer prevention and control.
• Conduct Linkage for Research
  To provide cancer registration data to researchers regarding their study cases.
• Perform Rapid Case Ascertainment
  A special casefinding procedure that allows early or preliminary reporting of certain types of cases to notify researchers of eligible study subjects.
• Conduct Research and Analysis
  To analyze collected cancer data and convert it into information about treatment, survival, and other factors affecting cancer patients. To perform statistical analysis on collected data to provide interpreted information on cancer for a particular population.
• Hospital Registry
  A business actor that 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.
• NAACCR
  The North American Association of Central Cancer Registries (NAACCR) is a collaborative umbrella organization for cancer registries, governmental agencies, professional organizations, and private groups in North America that are interested in enhancing the quality and use of cancer registry data. NAACCR is a business actor, external to the organization.
• SEER
  The Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute is an authoritative source of information on cancer incidence and survival in the United States. SEER collects and publishes cancer incidence and survival data from population-based cancer registries covering approximately 26% of the United States population. SEER is a business actor, external to the organization.
• Central Cancer 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. This organization refers to other CCRs and is a business actor external to the CCR business process. It interacts with the CCR when the CCR performs interstate data exchange and provides data for use by others.
• NPCR
  Established by Congress through the Cancer Registries Amendment Act in 1992 and administered by the Centers for Disease Control and Prevention (CDC), the National Program of Cancer Registries (NPCR) collects data on the occurrence of cancer; the type, extent, and location of the cancer; and the type of initial treatment. These data represent 98% of the U.S. population. NPCR is a business actor, external to the organization.
• Researchers
  Business actors who provide data for use by others and conduct linkage for research.
• Consumers (Patients, Physicians, Other Stakeholders)
  Business actors who receive the results of research and analysis.

Actors

Actors include hospital data source employees, non-hospital data source employees, the central cancer registry registrar, and statisticians or analysts.

Functions

Functions include certifying a data source for electronic reporting, preparing and transmitting event reports, receiving batch files, validating event reports, linking patients and tumors, performing consolidation, performing casefinding audits, performing quality assurance/quality improvement, linking to external databases to improve data, conducting death clearance and follow-up, performing interstate data exchange, responding to calls for data, providing data for use by others, conducting linkage for research, performing rapid case ascertainment, and conducting research and analysis.

• Hospital and non-hospital data source employees certify a data source for electronic reporting and prepare and transmit event reports.
• Central cancer registry registrars validate event reports, perform patient and tumor linkage, perform consolidation, perform casefinding audits, perform quality assurance and quality improvement, perform external linkage to improve data, conduct death clearance, conduct follow-up, perform interstate data exchange, respond to calls for data, provide data for use by others, conduct linkage for research, perform rapid case ascertainment, and conduct research and analysis.
• Statisticians and analysts perform casefinding audits, perform quality assurance and quality improvement, perform external linkage to improve data, respond to calls for data, provide data for use by others, conduct linkage for research, perform rapid case ascertainment, and conduct research and analysis.

Recipients

Recipients include the hospital registry, the North American Association of Central Cancer Registries (NAACCR), The Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute, the central cancer registry (CCR), CDC's National Program of Cancer Registries (NPCR), researchers, and consumers (patients, physicians, and other stakeholders).

• The hospital registry receives death clearance information.
• The central cancer registry receives data through interstate data exchange.
• NAACCR, SEER, and NPCR receive data related to a call for data and receive data for use.
• Researchers receive data for (external) use and perform rapid case ascertainment.
• Consumers receive the results of research and analysis.