Guidance to PHOs on the new cervical screening flat file on Connex
Introduction
In recent months the National Screening Unit has been working with metro Auckland DHBs and ProCare to develop a new report on Connex for each PHO. From 15 July 2015 a flat file will be available which will match information held on the National Cervical Screening Programme (NCSP) Register against women enrolled in the PHO. The new file will provide lists of women by practice who are overdue for a smear or due in the current quarter, or who are unscreened.
PHOs can use this file to work with general practice to prioritise invitation and recall for cervical screening.
What’s on the flat file?
The data fields in the new report are outlined in the table below. For security reasons the woman’s name has not been included.
Table One – Description of fields in the flat file
Data field / Commentary1 / Quarter_Start
2 / PHO_ID
3 / Practice ID
4 / Practice Name
5 / NHI
6 / Date of Birth
7 / Ethnicity 1 / This is the ethnicity recorded on the PHO Register
8 / Ethnicity 2
9 / Ethnicity 3
10 / Quintile
11 / Last_Screen / Date of the last screening event on the Register (see Event type below).
12 / Screened_This_Quarter / This will be populated if the woman is screened in the subsequent 2 months of the quarter.
13 / EnrolmentStatus / Enrolled, Withdrawn or Null (i.e. no screen recorded on the NCSP)
14 / Event type / The last screening result type:
1. Cytology
2. An HPV test
3. Histology (from colposcopy)
4. Null (where a woman is not enrolled with NCSP)
If there is more than one event on the same day, only one event will be reported in the flat file.
15 / Location of last screen / The practice or other facility where the last screening event was undertaken.
16 / Clinical Management Indicator (CMI) / Clinical prioritisation based on the smear history:
1. High (High grade)
2. Low (Low grade)
3. Unknown (usually because the smear was unsatisfactory)
4. Negative (“Normal”)
5. Null (i.e. no CMI). Women in this category will also have no due date, meaning they are not on the NCSP Register.
17 / Due date / Date that the next event is/was due
18 / Withdrawal date / This field provides the date a woman has formally withdrawn from the NCSP. If this occurs any clinical information is removed from the Register. Note women in this category may still need to be recalled for a cervical smear.
How to use this file
This file needs to be developed into individual reports for each practice.
DHB Shared Services has sorted the data in the following order:
1. Practice
2. CMI (as per the order in Table One (#16) with women with the highest risk listed first)
3. Due date
4. Ethnicity
5. NHI
Further re-formatting
In addition, PHOs can undertake further re-formatting, for example:
· Adding a column for practice comments
· Adding a column for practice feedback to the NCSP Register
· Adding a column to indicate years overdue as a visual prompt for ‘overdueness’ (i.e. calculating the difference between the date due and the date of the report)
· Adding a column for funding eligibility (e.g. to indicate if the woman is eligible for SIA or other DHB funding)
· Prioritising the ethnicities provided
· Highlighting the women in the list who are not enrolled on the NCSP Register (i.e. those with no CMI and no due date) and emphasising the need to provide follow up
A list to help practices identify women screened elsewhere
In the ProCare data matching pilot practices found that a list of women screened elsewhere was helpful to update the PMS with this information. PHO could consider providing this information in a separate tab, or allowing this information to be ‘filtered’ into a list.
Providing a summary count of the number of women in each clinical priority group (refer to Appendix 1)
In the pilot an overall count of the number of women in each clinical priority group was provided in a summary table at the top of the list. Practices found this helpful as a prompt for action, acting both as a check of total number of women needing to be screened, and as a prompt to recall those with the most clinical risk.
Providing contact information
It is recommended you include contact information for the Regional NCSP-Register and relevant PHO analyst(s) on the spreadsheet, so practice staff can make contact if they have queries.
A list of Regional NCSP Register contacts is provided in Appendix Two.
Understanding the fields in the new report
Hysterectomy information is not provided[1] in the file, however the simple rule of recalling women with a CMI and due date will assist with recall. That is, any woman with a CMI and due date needs to be recalled, regardless of whether or not she has had a hysterectomy – refer below.
Table Two – Interpretation of the fields
Field / Interpretation / CommentThe CMI and a due date are listed / If the woman has a CMI and a due date, the records on the Register indicate she needs to have a cervical smear. / Practices are asked to contact the Regional NCSP-Register if this information is incorrect.
Note that many women who have had a hysterectomy still need to be screened according to the NCSP guidelines. If your records show that a woman has had a hysterectomy that may indicate screening is not required, please contact the Regional NCSP-Register.
The CMI is listed, but there is ‘null’ in the due date field / If the woman has a CMI and no due date ‘tracking’ has been turned off on the Register. Reasons include:
· Hysterectomy and no further smears required
· Gone overseas
· Too ill and further screening is not indicated / Practices are asked to contact the DHB or Regional NCSP-Register if this information is incorrect.
Note that by undertaking a cervical smear, tracking on the NCSP Register will be automatically reinstated.
Enrolment Status field - ‘Withdrawn’ is listed / When women withdraw from the Programme all clinical information is removed. / It is good practice to still work with women who have withdrawn from the NCSP Register and check on the need for screening.
Enrolment Status field - ‘Null’ is listed / These women are not enrolled in the NCSP-Register. / Practices are asked to follow up women who are not enrolled in the NCSP Register and check on the need for screening.
Follow the simple rule of recalling women with a CMI and a due date. These are women identified on the NCSP-Register as needing a cervical smear
Practices are asked to contact the Regional NCSP-Register or their PHO if information provided in the file is incorrect
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Appendix 1 – Sample re-formatted report
Note: Dummy data is used in this example.
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Appendix Two –Regional NCSP Register contacts
Regional NCSP Register ContactsDHB / PHONE / FAX / EMAIL
Northland DHB / 09 470 0575 / 09 470 0576 /
Auckland DHB / 09 630 9943 Ext 27827 / 0800 500 513 /
Waitemata DHB
Counties Manukau DHB
Waikato DHB / 07 834 3631 / 07 858 0982 /
Bay of Plenty DHB / 07 577 3780 / 07 578 7095 /
Tairawhiti DHB / 06 869 2094 / 06 869 2091 /
Taranaki DHB / 06 753 7702 / 06 753 7834 /
Hawke's Bay DHB / 06 834 1877 / 06 878 1693 /
MidCentral DHB / 06 350 8922 / 06 350 8039 /
Whanganui DHB
Capital & Coast DHB / 0800 729 729
04 570 9223 / 04 570 9012 / To be advised
Hutt Valley DHB
Wairarapa DHB
Nelson Marlborough DHB / 03 543 7905 / 03 544 6587 /
West Coast DHB / 03 768 0499 Ext 2853 / 03 768 2793 /
Canterbury DHB / 03 335 4143 / 03 335 4144 /
Southern DHB / 03 476 9849 / 03 476 9859 /
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[1] It has only been mandatory to report hysterectomy information to the NCSP Register in the last five years, and this information is very incomplete.