gantt
title CancerSurv Implementation Timeline
dateFormat YYYY-MM
section Planning
Needs Assessment :2025-01, 2M
Requirements Gathering :2025-02, 3M
section Development
Core Platform :2025-04, 4M
Interoperability :2025-07, 3M
Analytics :2025-09, 2M
section Deployment
Pilot Testing :2025-10, 2M
Training & Rollout :2025-11, 3M
section Evaluation
Post-Implementation :2026-01, 3M
4.1 The CancerSurv Case Study
Throughout this book, we use a single comprehensive case study to illustrate concepts: CancerSurv, a cloud-based cancer surveillance and registry system. This chapter introduces the project context, stakeholders, and objectives that will appear in examples across all subsequent chapters.
4.1.1 Project Overview
A state public health department partners with TechHealth Solutions, a health IT company, to develop CancerSurv: a modern, cloud-based platform for cancer surveillance and registry operations.
4.1.1.1 The Business Context
| Attribute | Detail |
|---|---|
| Public Health Partner | State Cancer Registry (Department of Health) |
| Technology Partner | TechHealth Solutions (cloud software vendor) |
| Funding Source | CDC National Program of Cancer Registries (NPCR) grant |
| Timeline | 18-month phased implementation |
| Scope | Replace legacy mainframe system with modern cloud solution |
4.1.1.2 The Public Health Context
Cancer registries serve a critical public health function. They collect, process, and analyze data on cancer incidence, treatment, and outcomes. This data informs:
- Prevention program targeting
- Early detection initiatives
- Health disparity identification
- Research and clinical trials
- Healthcare resource planning
The state’s current system, built on 1990s mainframe technology, cannot meet modern demands for interoperability, real-time analytics, and remote access.
4.1.2 Stakeholder Landscape
Understanding who participates in this project requires seeing stakeholders through both BA and PH lenses:
| Role | BA Term | PH Term | Key Concerns |
|---|---|---|---|
| Project Sponsor | Executive Sponsor | Registry Director / State Epidemiologist | Budget, timeline, CDC compliance |
| End Users | System Users | Cancer Registrars, Epidemiologists, Data Analysts | Usability, efficiency, data quality |
| Subject Matter Experts | Business SMEs | Oncologists, Pathologists, Tumor Board Members | Clinical accuracy, coding standards |
| External Partners | Vendors / Integrators | Hospitals, Laboratories, Vital Records | Data submission, interoperability |
| Oversight Bodies | Governance Board | NPCR Program, NAACCR Standards Committee | Standards compliance, data quality metrics |
ImportantTerminology Note
While we use “stakeholder” here for its familiarity in BA contexts, public health practitioners often prefer alternatives: community partners, interest holders, rights holders, or beneficiaries. The choice of term signals values: “stakeholder” implies an interest or stake, while “rights holder” acknowledges inherent claims and dignity. See Chapter 3 for detailed discussion.
4.1.3 System Functions
CancerSurv must support five core functional areas:
4.1.3.1 Case Abstraction
Cancer registrars enter and code cancer cases from medical records. This involves:
- Extracting relevant data from pathology reports, discharge summaries, and treatment records
- Coding diagnoses using ICD-O-3 (International Classification of Diseases for Oncology)
- Staging tumors using TNM and SEER summary staging
- Linking cases to patients across multiple treatment facilities
4.1.3.2 Data Quality
Automated processes ensure data completeness and accuracy:
- Edit checks flagging inconsistent or missing data
- Duplicate detection identifying potential duplicate case records
- Linkage to vital records for death clearance
- Inter-rater reliability monitoring
4.1.3.3 Reporting
The registry must meet external reporting requirements:
- Annual submissions to NPCR (National Program of Cancer Registries)
- Data exchange with SEER (Surveillance, Epidemiology, and End Results Program)
- Ad-hoc queries for researchers (with appropriate IRB approval)
- Public health reports for state legislature and media
4.1.3.4 Analytics Dashboard
Modern surveillance requires real-time analytics:
- Cancer incidence trends by site, stage, and demographics
- Geographic mapping of cancer clusters
- Survival analysis and outcomes tracking
- Health disparity indicators
4.1.3.5 Interoperability
CancerSurv must integrate with external systems:
- HL7 FHIR APIs for hospital EHR integration
- Electronic pathology reporting from laboratories
- Vital records linkage for death data
- National data exchange protocols
4.1.4 Project Phases
The 18-month implementation follows a phased approach, which we will revisit throughout the book:
4.1.5 How CancerSurv Appears in This Book
Each chapter includes CancerSurv examples demonstrating concepts in practice:
- Planning (Chapter 4): Needs assessment comparing cancer data gaps with CDC reporting requirements
- Elicitation (Chapter 5): User stories from registrars; clinical guidelines from oncologists
- Requirements (Chapter 6): Functional specifications for case entry; NFRs for HIPAA compliance
- Design (Chapter 7): System architecture; CFIR implementation readiness assessment
- Implementation (Chapter 8): Agile sprints mapped to grant milestones; PDSA cycles for workflow adoption
- Evaluation (Chapter 9): KPIs (data completeness ≥95%) mapped to health outcomes
TipUsing the Case Study
When reading subsequent chapters, refer back to this overview to ground abstract concepts in the CancerSurv context. The case study makes the BA-PH bridge tangible.
4.1.6 The Dual Mandate
CancerSurv illustrates the fundamental tension bridged by this book. The project must simultaneously satisfy:
Technology Requirements:
- Modern cloud architecture
- API-first design
- Agile delivery methodology
- Vendor best practices
Public Health Requirements:
- CDC/NPCR compliance
- NAACCR data standards
- HIPAA security
- Health equity focus
Success requires translation between these worldviews. That is what Bridgeframe provides.