New developments

For the National Cervical Screening Programme (NCSP), the past year or so has included the implementation of new legislation, a revised reporting system for cervical cytology, the establishment of the Cytology Training Programme, the provision of advice on the benefits of Liquid Based Cytology, and the review of guidelines for the management of women with abnormal cervical smears.

Changes to the programme notified

In February 2005, more than a million women were notified about changes to the National Cervical Screening Programme that resulted from new legislation which came into effect on 7 March. The mail-out was one of the largest undertaken in New Zealand, and required the co-ordinated efforts of a large number of people. The legislative changes will contribute to the ongoing safety and effectiveness of the NCSP. Part 4A of the Health Act sets out the objectives for the NSCP and provides for the appointment of expert evaluators to assess the performance and safety of the programme by ensuring they have access to key information.

Revised reporting system

A revised reporting system for cervical smears was introduced by all New Zealand laboratories reporting cervical cytology on 1 July 2005. The new codes introduced a more streamlined and user-friendly system, focussed around patient management and in line with international practices. The Bethesda 2001 changes standardised reporting of cervical smears, reduced ambiguity in interpreting laboratory findings and aligned reports with clinical management.

Recommendation on use of LBC

Since 1997, Liquid Based Cytology (LBC) has been offered to women as an alternative to the conventional cervical (Pap) smear (CPS). Internationally, there have been many studies comparing the use of LBC and the CPS in cervical screening. In March 2005, NCSP brought together a multidisciplinary working group to consider the evidence and make recommendations about the use of LBC in the New Zealand programme. The NCSP was advised that, from a clinical and technological point of view, both conventional smears and liquid–based preparations were of an acceptable standard.

The group also recommended that there may be clinical situations where liquid-based preparations offer some advantage over conventional smears – for example, in the case of women presenting to smear takers with excessive cervical mucus, discharge or blood, or women with recurrent inflammatory or unsatisfactory smears. The introduction of ancillary tests, for example HPV, and automated screening devices is evolving rapidly. These developments together with long-term workforce issues may become deciding factors in the future for the wider use of LBC.

NCSP key messages on the use of LBC

Development of the new NCSP-Register

The NCSP-Register is a management tool for the NCSP, recording a woman’s cervical screening history, ensuring quality assurance processes and providing reporting information to inform programme and provider performance.

The current register is being replaced, with a new register scheduled to be operational from 27 September 2008. It is expected that the new register will strengthen quality assurance for the programme and enable secure real-time exchange of information with service providers and other key stakeholders.

The NSU expects the new register to deliver improved functionality that will strengthen and streamline current business processes while enabling new methods of interaction with women and provider organisations where appropriate. It will also streamline business processes by increasing efficiency and effectiveness and reducing the resources required to manage them. The specific achievements / improvements are anticipated to be:

elimination of multiple and manual points of data entry and re-entry
implementation of data quality checks at source
secure web-based access to cervical screening histories
electronic integration with provider systems
streamlined, electronic Cancer Registry, National Health Index and Health Practitioner Index interface.

One of the major changes will be the ability of the new register to electronically interface with NCSP provider information systems. This integration will enable streamlined information exchange and business processes through information only needing to be entered once at source and then sent via a HL7 message to the NCSP-Register. This will significantly improve operational efficiency and data quality. Technical details are available from the Health Professionals section of the NSU website.

The new register will offer an opportunity to improve the electronic interface between providers who provide services along the cervical screening pathway. The interface will provide easy, secure access to the NCSP-Register for health providers and will eliminate the requirement for hard copy forms. Providers will also be able to access performance reporting data to monitor their performance against programme targets and inform planning.

The NSU has selected RHE & Associates (RHE) in consortium with Medtech Global Ltd and Sequel Software Ltd as its solution partner for the NCSP-Register redevelopment. RHE will be developing both the NCSP-Register and its interfaces to NCSP provider systems.