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IT Infrastructure NHS BCSP

Julietta Patnick

November 2007

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Organisation in England

• 5 Programme Hubs across England, based on IT Local Service Providers (LSP) undertaking call/recall and lab functions

• 1 Programme Hub per LSP

• Each Programme Hub has a number of Screening Centres

Overarching Structure:

Gateshead

Nottingham

London

Guildford

Rugby

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Bowel Cancer Screening System (BCSS)

• A single national database, written in Oracle

• Accessible from anywhere in NHS over secure weblinks

• Manages call, recall, results and appointments into local screening centres

• Collects and analyses clinical data from all returning a kit

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LOCAL HOSPITAL: LINKS

Cancer treatment centres

SC

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Programme

Hub

Screening CentreColonoscopy site

Colonoscopy site

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BCSS Links

• SNOMED Codes used• Will link to

– Cancer registries– NBOCAP– Endoscopy systems?– Pathology systems?

– Depends on National Programme for IT overall strategy

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BCSS Datasets: Cancer types

• can handle synchronous tumours, each tumour described separately– Malignant tumour– Polypoid tumour– Fungating tumour– Frond-like/villous tumour– Ulcerated tumour– Infiltrative tumour– Submucosal tumour– Partial obstructing tumour– Complete obstructing tumour

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BCSS Datasets: InterventionsSNOMED Code Description Cancer Polyp

82035006 Polypectomy No Yes

86273004 Biopsy Yes Yes

413199002 Tissue destruction No Yes

14792009 Tattooing Yes Yes

Mucosal resection No Yes

372034000 Haemostatic technique No Yes

360017003 Clipping No Yes

119266004 Coagulation No Yes

276913007 Laser vaporisation No Yes

413240005 Chromoscopy No Yes

363105001 Dilation No Yes

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Polyp Reporting1. IDENTIFYING THE POLYP

1. Polyp ID2. Diagnostic Test ID3. Polyp Location4. Polyp Class5. Polyp Size Estimate

2. POLYP HISTOLOGY1. Polyp Histology ID2. Polyp ID3. Polyp Type4. Polyp Microarchitecture5. Polyp Excision Complete6. Polyp Size7. Polyp Dysplasia8. Polyp Carcinoma9. Polyp Stalk Invasion10. Polyp Lymphovascular Invasion11. Polyp Margin Distance

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BCSS Datasets: Polyps

• Each polyp separately recorded

SNOMED Code

Description Sessile Pendunculated Adenoma

Kikuchi Sm1 - tumour invades upper 300u of submucosa

Yes No Yes

Kikuchi Sm2 - tumour invades upper 2/3 of submucosa Yes No Yes

Kikuchi Sm3 - tumour invades full thickness of submucosa

Yes No Yes

Haggitt 1 - tumour invades into upper part of head of polyp

No Yes Yes

Haggitt 2 - tumour invades into lower part of head of polyp

No Yes Yes

Haggitt 3 - tumour invades into the top of the stalk No Yes Yes

Haggitt 4 - tumour invades into the submucosal at the base of the stalk

No Yes Yes

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Lesion Lookup List in the Cancer Histology entitySNOMED Code Description Differentiation

Applicable

NBOCAP ID NBOCAP

Description

408645001 Adenocarcinoma Yes 1 Adenocarcinoma

M8140/3

32048006 Adenoma No

17621005 Normal mucosa No

28899001 Squamous cell carcinoma

Yes 2 Other M8000/3

21964009 Malignant lymphoma

Yes 2 Other M8000/3

2092003 Malignant melanoma

Yes 2 Other M8000/3

28755003 GIST Yes 2 Other M8000/3

48554007 Malignant carcinoid

Yes 2 Other M8000/3

253000007 Neuro-endocrine carcinoma

Yes 2 Other M8000/3

2424003 Sarcoma Yes 2 Other M8000/3

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T Category Lookup Listfor cancer audit

NBOCAP Code Procedure Pre-Treatment Pathology

1 Tx Tx Tx

2 T1 T1 pT0

3 T2 T2 pT1

4 T3 T3 pT2

5 T4 T4 pT3

6 pT4

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Changing the system

IT Programme

Board

Hub AdminData

Management/Admin

Endoscopy Pathology

User Group

Hub Biochemistry Nurses

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Thank you for listening

www.cancerscreening.nhs.uk

www.bcsp.nhs.uk