Applied Surveillance Teaching Artifact
Author: Rauf Shah, MS, PhD, MPH-Epidemiology (Expected Fall 2026)
Lead Health Data Coordinator Level II, University of Nebraska Medical Center | Department of Internal Medicine, Division of Hematology and Oncology
A structured breakdown for teaching core surveillance concepts and practice.
Modules 1–2: Definition & Purpose
One-liner aims + why it matters; anchors content.
Modules 1–2: Definition & Purpose
| Topic | Original Detail | Instructional Detail |
|---|---|---|
| 1. Definition | Systematic cancer data tracking. Population-based registries; standard codes. Outputs: burden, stage, survival, and trends. | Emphasize completeness and timeliness. Train on ICD-O-3 (site, morphology) and AJCC (TNM→stage group). |
| 2. Purpose | Define burden & distribution. Track trends & disparities. Support programs, policy, research. | Use concrete disparity examples (late-stage share by race/rurality). Link to policy (targeted screening/navigation). |
Module 3: Types of Surveillance
Menu of approaches; when/why to use each.
Module 3: Types of Surveillance
| Type | Original Detail (Pros/Cons) | Instructional Detail (Practicalities) |
|---|---|---|
| 3a. Passive | Facilities/providers submit reportable cancers to the registry. | Challenge: variable staff priorities/training. Mitigation: standardized forms + ongoing training. |
| 3b. Active | Registry staff proactively identify/verify cases (visits, queries). | Action: on-site abstractors; deep EHR queries to complete fields and verify codes. |
| 3c. Sentinel | Selected sites provide high-quality, timely data. | Use case: rare cancers or exposure-linked patterns where speed/depth matter most. |
| 3d. Syndromic | Early signals from ED, labs, pharmacy, EHR. | Signals: chemo dispensing volume; lab markers (e.g., neutropenia) for early toxicity/patterns. |
| 3e. Rapid Case Ascertainment (RCA) | Pathology-driven rapid reporting. | Workflow: e-path feeds + NLP filters to flag reportable cases within days. |
Module 4: Case Definitions & Classification
What’s reportable, how to date, stage, and handle primaries.
Module 4: Case Definitions & Classification
| Classification Element | Original Detail | Instructional Detail (Coding/Application) |
|---|---|---|
| 4a. Reportable Cancers | Site (Topography); Morphology (Histology). | Use ICD-O-3: Topography (e.g., C50.9) and Morphology (e.g., 8000/3). Practice code look-ups. |
| 4b. Status | Suspected; Probable; Confirmed. | Confirmed usually requires histology; Probable may rely on imaging/clinical data in research. |
| 4c. Primary vs recurrent | — | Multiple primaries rules (new site/histology or temporally distinct). Critical for incidence accuracy. |
| 4d. Diagnosis date rules | — | Use first definitive diagnosis (often pathology date) as anchor for incidence/survival. |
| 4e. Stage | AJCC TNM; SEER Summary Stage. | TNM needs tumor size, nodes, mets; follow algorithm. SEER Summary Stage aggregates for population analysis. |
| 4f. Key biomarkers | Molecular; Genetic. | Examples: ER/PR/HER2 (breast); KRAS/NRAS/BRAF (CRC). Abstract from molecular reports. |
Module 5: Data Sources
Where data come from; how to standardize and link.
Module 5: Data Sources
| Source | Original Detail | Instructional Detail (Practical Skill/System) |
|---|---|---|
| 5a. Pathology | AP, CP, Synoptic Reporting Templates. | CAP synoptic reports structure required elements → better completeness/consistency. |
| 5b. Tumor Registry | Hospital-based; Population-based (SEER); NAACCR/CoC standards. | NAACCR is the definitive standard (field definitions, formats) for SEER/NPCR submissions. |
| 5c. EHR & Clinical Documentation | Encounters, Radiology Reports, Oncology Notes. | Radiology RECIST details help determine progression/recurrence. |
| 5d. Laboratory Systems | Hematology, Molecular, Biomarker Panels. | Standardize via LOINC/terminology mapping; build interfaces for ingestion. |
| 5e. Vital Records | Death Certificates, Cause of Death. | Mortality-only case finding; survival follow-up. |
| 5f. Claims & Pharmacy Data | Administrative claims; pharmacy dispensing. | Validate treatments (CPT/HCPCS) or flag cases; rarely definitive for stage/diagnosis. |
| 5g. Patient-Reported & Consent Data | PROs; consent logs for research linkage. | Adds quality-of-life/function context often absent in registry data. |
Modules 6–7: Core Parameters & Evaluation Indicators
What you measure (burden) vs how good your data are (quality).
Modules 6–7: Core Parameters & Evaluation Indicators
| Metric Type | Original Detail | Instructional Detail (Interpretation & Calculation) |
|---|---|---|
| 6.a. Incidence Rate | (per 100,000, age-adjusted). | Use 2000 U.S. Standard Population; allows fair comparisons. |
| 6.b. Mortality Rate | — | Cancer deaths ÷ population (per 100,000). |
| 6.c. Stage at Diagnosis | — | Earlier (localized) stage share indicates screening impact. |
| 6.d. Survival Metrics | Overall; Relative Survival. | Relative survival = observed ÷ expected survival (matched general population). |
| 6.e. Reporting Lag | — | Diagnosis → case closure time; core timeliness measure. |
| 6.f. Case Capture % | — | Target >95% in high-quality registries; validates completeness. |
| 6.g. Missingness | — | Track missing stage/race-ethnicity; mitigates bias in disparity work. |
| 6.h. Coding Accuracy | — | Re-abstraction agreement vs gold standard; aim ≥98% for core fields. |
| 6.i. Deduplication Rate | — | High rates imply matching/casefinding inefficiency. |
| 7.a. Timeliness | — | Measured via Reporting Lag. |
| 7.b. Completeness | — | Measured via Case Capture % (validate with external sources). |
| 7.c. Consistency/Validity | Edit Checks. | NAACCR Edits enforce site-morph/date/value logic. |
| 7.d. Equity Metrics | Race/Ethnicity completeness; Geographic variation. | Address unknown race/ethnicity via linkage or careful imputation. |
Module 8: Workflow
End-to-end steps; where QC and consent fit.
Module 8: Workflow
| Workflow Step | Original Detail | Instructional Detail (Tool/Technique) |
|---|---|---|
| 8a. Case Finding | Identify; match/dedup. | Deterministic keys (MRN, SSN) + probabilistic matching (name, DOB). |
| 8b. Eligibility Screening | Residency; date range; reportable site/morph. | Apply jurisdiction rules; ensure in-scope period and reportable histologies. |
| 8c. Approach & Consent | Permissions; refusals. | For research linkage; IRB-approved process; track opt-outs. |
| 8d. Abstraction & Coding | ICD-O-3; behavior; grade; stage; first-course treatment. | First-course treatment = initial therapy window (e.g., ≤4 months) or until progression. |
| 8e. Quality Checks | Automated edits; re-abstraction audits. | Target complex sites or lower-accuracy abstractors; route findings to training/system fixes. |
| 8f. Publish & Visualize | Indicators; dashboards. | Tools: Tableau, R Shiny, or registry platform read-only dashboards. |
| 8g. Monitor & Improve | Feedback; periodic reviews. | Regular data quality reports to facilities; track corrective actions. |
Module 9: Data Quality Framework
Dimensions, checks, and audits to build trust.
Module 9: Data Quality Framework
| Topic | Original Detail | Instructional Detail (Context & Importance) |
|---|---|---|
| 9a. Goal | — | Fitness-for-use (incidence, policy); builds trust. |
| 9b. Dimensions | Completeness; Accuracy; Timeliness; Consistency; Uniqueness. | Consistency example: treatment date cannot precede diagnosis date. |
| 9c. Checks | Not-null; Controlled vocabularies; Code edits; Cross-record concordance. | Use SNOMED CT/LOINC to harmonize across systems where applicable. |
| 9d. Audits | Re-abstraction; Discrepancy review; Corrective action. | Implement targeted training or system fixes from root-cause analysis. |
Modules 10–12: Security, Policy & Public Reporting
Privacy, legal authority, and safe public outputs.
Modules 10–12: Security, Policy & Public Reporting
| Topic | Original Detail | Instructional Detail (Context & Application) |
|---|---|---|
| 10. Security | Minimum necessary; RBAC; audit logs; secure transport/storage. | Use encrypted channels (VPN, SFTP) for identified data transfers. |
| 11. Policy & Compliance | HIPAA; State laws; DUAs; IRB; De-identification. | Cancer is mandatorily reportable; state public-health authority enables reporting despite some HIPAA limits. |
| 11.a. DUAs | — | Legally binding terms for use/protection/destruction of non-public data. |
| 12. Public Reporting | Aggregates; small-cell suppression. | Suppress subgroup cells below thresholds (e.g., <5 or <10) to prevent re-identification. |
Module 13: Tools & Standards
Coding specs, interoperability, and core analytic methods.
Module 13: Tools & Standards
| Standard/Tool | Original Detail | Instructional Detail (Use Case) |
|---|---|---|
| 13a. Coding & Data Structure | ICD-O-3; AJCC; NAACCR; SEER Edits. | NAACCR Volume II = definitive data dictionary/spec for submissions—teach where/how to look up a field. |
| 13b. Systems & Interoperability | Registry platforms (SEER*DMS); EHR; HL7/FHIR. | FHIR supports granular, secure exchange of Condition/Observation elements. |
| 13c. Analytics & Methods | Age-standardization; Joinpoint; Survival (KM, Relative). | Joinpoint identifies significant trend changes (inflection points) in rates. |
Module 14: Deliverables & Micro-Checks
What learners submit; quick ways to verify understanding.
Module 14: Deliverables & Micro-Checks
| Deliverable | Format | Linked Micro-Check |
|---|---|---|
| 14a. Objective | 1 sentence (population/time). | MCQ: choose correct outcome/measure for a prompt. |
| 14b. Workflow | 6–8 nodes + QC touchpoint. | Mark where QC/edit checks occur. |
| 14c. Mini-table | Source → Field → QC → Safeguard (≥3 rows). | Pick best source for field X. |
| 14d. Privacy list | ≥2 safeguards. | Identify fields to remove for de-ID in a scenario. |
Teaching Packet (PDFs)
Presentation: Surveillance: From Data to Public Health Action Participant Handout: Surveillance Assessment: Surveillance Assessment Answer Key: Surveillance
Slide Deck Preview (inline)
Synchronous Distance Public Health Teaching/Training Project
PDF Versions
Slides (PDF) - Synchronous Session Assessment - Breakout Case (PDF) Skeleton Notes - Participant (PDF)
PPT and DOCX Versions
Slides (PPTX) - Synchronous Session Assessment - Breakout Case (DOCX) Skeleton Notes - Participant (DOCX)
Course Outline & Plan (Synchronous Assessment)
Asynchronous Online Session: Public Health Teaching/Training Project
Asynchronous sessions are self-paced learning modules that learners complete on their own time. In public health teaching/training, these pair short content (slides/video/handouts) with applied checks and reflection prompts so participants can pause, practice, and revisit concepts without losing continuity.
PDF Versions
Presentation (PDF) - Asynchronous Session Participant Handout (PDF) - Asynchronous Session Assessment (PDF) - Asynchronous Session Assessment Answer Key (PDF) - Asynchronous Session
Presentation Recording (MP4)
PPTX & DOCX Versions
Slides (PPTX) - Asynchronous Session Participant Handout (DOCX) - Asynchronous Session Assessment (DOCX) - Asynchronous Session Assessment Answer Key (DOCX) - Asynchronous Session
Slide Deck Preview (inline)
Notes
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