By Kristie Lilje. marketing
communications manager for IMPAC Medical Systems, Inc. Originally
published in the November 2003 issue of Advance for Health
Information Professionals.
In 1983, the National Tumor Registrars Association (NTRA)—now
the National Cancer Registrars Association (NCRA)—initiated its
certification exam to qualify tumor registrars as certified tumor
registrars (CTRs). “The intent of the exam was to promote
professional recognition of tumor registrars, standardization and
quality data for analyses,” explained Jean Cicero, RHIT, CTR,
NTRA’s Certification Committee chair from 1978-81. Twenty years
later, the exam has been administered to more than 4,400 people,
and CTRs are now a required component for all cancer programs
seeking voluntary accreditation from the American College of
Surgeons (ACoS).
The first 543 candidates who passed the exam in 1983 certainly
didn’t need “certification” to make more of a difference to their
communities, but the CTR credential was the first step in a long
line of standards changes and improvements that have impacted all
cancer registries throughout the country. This article spotlights
four of the first CTRs—their experience over the past 20 years and
their stories of how they are making a difference. All four
registrars have retained their credential since 1983, maintaining
20 hours of continuing education every two years.
Martha Oliva, BS, CTR
Jackson Memorial Hospital
Martha Oliva, BS, CTR, came to the United States in 1971 from
Cuba, and entered the hospital setting by “winning” the competency
exam in 1974. Oliva became a tumor registrar in 1976, and quickly
immersed herself in the field as a consultant for ACoS from
1981-2000, reviewing cancer programs prior to the accreditation
survey. She also served as the editor for the 6th edition of the
TNM staging manual (Spanish version).
According to Oliva, the best part of being a cancer registrar is
how much she is able to learn from her colleagues. “I don’t have
one mentor; I have several,” explained Oliva. “Over the years,
I’ve had the opportunity to learn from so many people, and I
appreciate all the ways I am able to pass the knowledge onto
others,” she added.
Oliva began teaching in the 1980s with the Florida Cancer
Registrars Association (FCRA) and with the Union Internationale
Contre le Cancer (UICC) in 1996. She has given lectures and
training classes to registrars throughout Central and South
America on data collection procedures and standards
implementation. In addition
to consulting for UICC, Oliva is the editor for the Spanish
version
of the CDC software, AbstractPlus. She is also past-president of
the FCRA and NCRA. Currently, she is a member of the NCRA Advisory
Board, as well as a member of the International CTR
Exam Committee.
More than 20 years after becoming a registrar, Oliva still works
at UM/Jackson Memorial Teaching Hospital in Miami, FL, managing a
team that includes three CTRs, an oncology program secretary and
two clerks who handle patient follow-up. When she’s not busy
preparing reports, abstracting or doing follow-up, she oversees
the registry and cancer programs for the League Against Cancer, a
non-profit organization that maintains a clinic helping
underprivileged cancer patients in need of treatment for cancer.
“The bottom line is the patient,” she explained. “The more
knowledge you gain, the better we do our work and the better the
research that can be accomplished. The end result of everything we
do is about helping the patient.”
Beverly Hodge, CTR
Virginia Hospital Cancer Center
Beverly Hodge, CTR, has worked at Virginia Hospital Cancer Center
in Arlington, VA, as the coordinator of the cancer registry since
1976. Like many CTRs, Hodge fell into the profession when a
friend offered her a position doing abstracting at a local
hospital. More than 27 years later, Hodge also views her most
significant contribution as the value she is able to make in
patients’ lives.
“The best part about being a CTR is the opportunity I have to
contact patients for follow-up,” Hodge explained. There are
currently more than 4,000 patients in follow-up, and the staff
makes approximately 25 to 35 calls per month. “They are so happy
that we’re not asking for money and that we’re interested in
them,”
she added.
Hodge has also been involved in a variety of organizations over
the years and is the past-president of the DC Metro Tumor
Registrars Association and the Virginia State Registrars
Association. She has also served on NCRA’s nominating committee
for several years recruiting fellow CTRs for office. In addition
to sitting for the 1983 exam, she also took each practice exam
from 1977-1982 to field test questions.
According to Hodge, the increasing use of computers in the
registry has helped to streamline many processes within the cancer
program. There have been several changes in staging systems from
ICD-O-3 to new editions of TNM staging and now to FORDS, she
explained. “The staging systems are now incorporated into the
electronic management systems, which saves considerable time and
effort,” she said.
Virginia Hospital Cancer Center implemented an electronic system
in 1987, adopting CancerNet—a system that was developed by ACoS
and later acquired by ELM Services and then IMPAC Medical Systems.
“Our facility is now completely paperless,” Hodge explained.
“Being paperless has not only reduced the amount of space we need
for storage, but it has considerably improved the turn around time
for reports, which now takes only minutes.”
Annette Hurlbut, RHIT, CTR
Quality Engineer, Clinical Systems
IMPAC Medical Systems
Annette Hurlbut, RHIT, CTR, knows first hand the impact of
software on the field of cancer registry. Hurlbut obtained her
degree in medical record technology and began working at a local
Washington, DC, facility more than 25 years ago, receiving her CTR
credential in 1983. After working in the registry for more than 10
years, she took an offer with ELM Services in 1987, a company
specializing in registry software. She has been in the software
industry since then in a variety of positions including client
services, marketing, development and quality engineering.
According to Hurlbut, the biggest change in the field has been the
rise of technology and the increased level of standardization
throughout the registry profession. She said that she has seen a
lot more activity in the role of standardization among agencies
that affect registries such as the Surveillance, Epidemiology and
End Results Program (SEER), the Centers for Disease Control and
Prevention (CDC), North American Association of Central Cancer
Registries (NAACCR), ACoS and NCRA.
“Standardization initiatives have significantly impacted both
registrars and vendors because there’s an expectation that both
stay current on changing requirements and procedures for data
collection, analysis and outcomes,” she explained. “The most
important challenge is keeping the cancer program supported by the
facility, and this is best accomplished through the rigorous
quality standards and record keeping that technology enables,” she
added.
“Now with all of the complexities of the field, registrars’
contributions within companies to interpret changes and
intricacies in standards are critical to the success of the
software to adequately meet all of the needs. Everyone understands
that,” she said. “I participate in as many activities as possible,
ranging from the local, state and national level, to keep up with
standards and to stay competitive. You have to be involved and
make a difference.”
Suzanna Hoyler, CTR
Washington Hospital Center
Suzanna Hoyler, CTR, also sees value in being involved to network
and bring best practices to her facility. Although she has never
worked from the vendor side, she has worked in almost every other
setting—from a state registry to professional association and
teaching hospital. Hoyler has also recently initiated the first
year of a three-year term with NCRA’s Council of Certification and
is currently a member of ACE.
“When I was in school, I never thought I would end up in health
care, but my interest in mathematics and coding brought me to the
registry,” she explained. Hoyler joined the Texas State Health
Department in 1972, and sat for the CTR exam in 1983. As she
explained, working for the registry, even in those early days, she
enjoyed the challenge of doing new things every day. As a
“circuit-riding abstractor,” she worked in a different hospital
almost every day. “Because cancer reporting was voluntary, there
were a lot of opportunities for growth,” she said.
In the 1980s, she took a position with the ACoS working for the
Commission on Cancer, where she consulted for hospital cancer
programs, writing data requirements for centers and working to
develop criteria for patient care evaluation studies. “This was an
exciting time in the field with the rise of computers, which
really shifted the work in the registry from manual record keeping
to data analysis,” she explained.
Hoyler rounded out her experience by returning to a teaching
hospital in the 1990s, where she currently supervises the cancer
program, helping to distribute vital statistics on cancer
treatment and outcomes to physicians, residents, administrators,
social workers and anyone else who uses data. In addition to
managing the registry, she analyzes patient satisfaction,
maintains the Web site and oversees the disease management system.
“The key to a successful program is ensuring that staff is
proactive and has the level of knowledge and skills required for
adequate data collection and entry,” she explained. “In the 70s,
the profession would take anyone with secretarial experience, but
now specific medical knowledge is essential. Much of the field is
still self-taught and the more background in medical terminology
and anatomy, the better,” she added.
Kristie Lilje is the marketing communications manager for IMPAC
Medical Systems, a leading provider of management software for
cancer registries. Prior to joining IMPAC in 2001, Kristie ran a
consulting practice, implementing marketing and promotional
campaigns for medical software companies and physician groups. She
received her bachelor’s degree in Human Biology from Stanford
University.
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Julie DeSantis
Public Relations Manager
IMPAC Medical Systems, Inc.
650-623-8883
pr@impac.com
http://www.impac.com
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