The Cancer Registrar Shortage and the Impact of CoC's CTR Standard 5.1

Effective January 1, 2015, all abstraction of medical records for cancer cases at Commission on Cancer (CoC) accredited facilities must be performed by cancer registrars who have achieved the Certified Tumor Registrar (CTR) credential.

The role of the cancer registrar is essential in the effort to gather vital information for treatment planning, research studies and in the conduct of clinical trials. Further, as quality of data is more closely looked at in this era of monitoring patient outcomes with a financial eye, already overburdened cancer programs and state registries are doing their best to cope with an ever increasing volume of work. The new CTR standard seeks to ensure the quality of this data collected by cancer registrars is optimized.

Eligibility for the CTR credential requires one of the following:

• An AS degree in either Cancer Registry Management or Cancer Information Management from an NCRA-certified program plus a 160 hour practicum in a CTR-staffed cancer registry;
• An AS degree in any subject plus a certificate in CRM or CIM (additional 60 college credits) and a 160 hour practicum;
• Or an AS degree in any subject plus 1,950 hours (one year) experience working in the cancer registry field.

The CTR exam itself is a 225 question, two-part test over 4.5 hours.
According to the National Cancer Registrar’s Association’s (NCRA) Council on Certification, an average of 347 exam candidates over the past five years have taken the exam. In 2012, 373 took the CTR exam with 70% passing. The largest age group of testers was 40-49 years old (24%). It should be noted that only 13% of the test candidates were under 30 years old. And the average age of NCRA’s membership is 52.

While some may argue that there is no current shortage, the numbers stand for themselves. The Bureau of Labor Statistics reflects a projected growth of 22-24% for health information management professionals, which includes cancer registrars. According to Laurie Hebert, RHIA, CCS, CCS-P, CTR and Vice President of Cancer Registry Services at Care Communications in Chicago, “As organizations increasingly acknowledge reporting backlogs and related problems in the cancer registry, administrators are finding it’s not as easy to commit to fixing these problems and train qualified professionals as it used to be”.

Whether the reason for this is attrition (either due to many registrars reaching retirement age or those that don’t want to go through the effort to become certified), a shortage of schools offering an accredited program to interested candidates or the mere increase in the number of cancer programs being established, the problem exists. And with the new standard now in force, it’s likely that this issue is going to worsen.

So how can this be addressed?
Outsourcing is typically an obvious alternative, but vendors offering this service have the same issue with regard to hiring certified personnel.

The emergence of EHRs across the healthcare landscape may make some case finding efforts easier for CTRs, but for many organizations there’s still a hybrid of electronic medical records and paper in the HIM. And in many hospitals today, largely due to mergers and acquisitions, cancer registrars may be required to review information in multiple systems, including pathology and laboratory systems from disparate vendors. And again, still a plethora of paper exists.

If the current certified workforce of cancer registrars can’t quickly attend to backlogs and the volume continues to grow, perhaps circumstance requires a different approach to how data abstraction is done. Many other industries have relied on computer-assisted tools to significantly improve manual processes for years.

These tools can better define the workflow, automate the abstraction of data to simply be verified and not manually entered, and automate the entry of that data into a database or other management system. This not only helps promote the efficiency of current employees, but as new employees come into the organization, their learning curve is significantly decreased with the definition and automation of the workflows in place.

Perhaps it’s time for Computer-Aided Abstraction. What do you think?