LESLIE: Last week I spoke with Laurie Hebert, RHIA, CTR, CCS, CCS-P, director of cancer registry services, Care Communications Inc, about the changing landscape of cancer registries. Laurie recently attended the National Cancer Registrars Association's (NCRA) 35th annual conference, where the spotlight was on the regulatory changes anticipated in cancer surveillance in 2010.

PATTY: I read about some of the expected changes in the article "What to Expect in 2010," featured in the May 2009 issue of ADVANCE. Let's see what Laurie's take is on industry happenings.

LAURIE: Thank you for including me in this month's column. Cancer registries are slated to experience major changes and talking about those changes now will help your readers be more prepared. I was really energized by the NCRA conference as speakers discussed what registrars and registries can expect in the near future. The convention included high-level presentations on regulatory changes to standards, what registrars can expect in the way of education and suggestions for implementation. There was quite a bit of discussion on data collection changes and new data collection procedures as well.

PATTY: Are the details of the changes known at this time?

LAURIE: Some of the changes or clarifications are known and being implemented in 2009, but final changes and clarifications will come over the summer as we get closer to training time and 2010 effective dates for many of these changes. The focus of the NCRA presentations was to provide a preview of what is likely to come. The sheer volume of changes is daunting. For example, in 2010 the American Joint Committee on Cancer (AJCC) staging manual will be on its 7th edition, which includes significant changes. The American College of Surgeons Commission on Cancer (ACoS CoC) Cancer Program Standards manual was revised in 2009 and the FORDS manual has changes or clarifications effective in 2009 and 2010. In addition, the Collaborative Staging manual will also undergo significant changes in 2010. Finally, there will be hematopoietic rule changes to the Multiple Primary and Histology Coding Rules manual.

LESLIE: That isn't all. I understand that North American Association for Central Cancer Registries (NAACCR) is planning changes to its standards, which include significant record layout modifications.

LAURIE: Yes, that is correct. It's a lot of change at one time.

PATTY: It sounds like the rest of the year will be dedicated to becoming educated on the changes. Do you know what training will look like?

LAURIE: The majority of training will be delivered by the major regulatory bodies; ACoS, NAACCR and the National Cancer Institute/ Surveillance Epidemiology and End Results (NCI/SEER).

LESLIE: Is there a sense of how long the training will take?

LAURIE: No, but the investment of time can be expected to be significant. I think we can count on training to be offered via multiple venues such as webinars and presentations provided through state association registry meetings. The NCRA convention in 2010 will be a great source for additional training and clarification. Usually, if the changes are in the process of being implemented or already implemented, NCRA will provide information on sources for more in-depth training and industry clarification.

LESLIE: It still seems like a lot of change at one time to implement.

LAURIE: It is a lot of change but we are dealing with this change as an industry. It's a collaborative process among stakeholders whom have gotten good at coordinating efforts. NCRA is providing leadership through its members who sit on taskforces and represent the cancer registrar's perspective.

PATTY: What can facilities that maintain a cancer registry expect from the upcoming changes?

LAURIE: They can expect there will be a learning curve because of the extent of the changes. It's also likely that productivity will be affected. Facilities will want to be sure they have a budget set aside to support registrar education and information systems changes and support the professional development activities of their registrars.

LESLIE: What can registries and registrars do today to prepare for these changes?

LAURIE: Six activities need to be on every registrar's 2010 readiness action plan:

1. Read: Registrars can expect a lot of communication coming at them from a variety of sources such as ACoS, state associations and registries, NCRA, NAACCR, etc. To stay on top of what's happening, the following Web sites and resources are a must:

• ACoS CoC (www.facs.org/cancerprogram) and CoC Flash newsletter

• NCRA (www.ncra-usa.org) and NCRA Connection newsletter

• NAACCR (www.naaccr.org)

• NCI/SEER (www.seer.cancer.gov)

• State association registry meetings

2. Plan: Create an implementation plan and timeline once all communication and deadlines have been finalized.

3. Prioritize: Determine what needs to occur and when and how current work will be accomplished while preparing for upcoming changes. There are a lot of moving parts and it will be important for registrars to be clear on priorities and to secure buy-in on those priorities from their organization.

4. Manage time: Time management skills will be essential during the transition to updated standards. Time management goes hand and hand with setting priorities and then being disciplined enough to not be distracted and veer off plan.

5. Educate: Educate early and often and that includes educating leadership on the upcoming changes.

6. Update: Update internal policy and procedure manuals.

PATTY: Thank you Laurie for spending time with our readers today. I think I can speak for Leslie when I say we will be keeping an eye on the Web sites you suggested for the details on the variety of standard changes.

LESLIE: Good luck to all of our readers as you prepare for sweeping changes. We will check in with Laurie in the near future to hear how the industry is responding.

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or ptsheridan@care-communications.com.