Cancer Pathology Data Sharing
0.1.0 - STU 1 Ballot

Cancer Pathology Data Sharing, published by HL7 International - Orders and Observations. This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of https://github.com/HL7/cancer-reporting/ and changes regularly. See the Directory of published versions

Background

The NAACCR Standards for Cancer Registries Volume V, Laboratory Electronic Reporting Pathology Version 5.0, May 2020 (Revised 2020) defines the standard message format for transmitting pathology laboratory information to central cancer registries using the HL7 Version 2.5.1 Message format. At present, patient and specimen data flow from the clinic and EHR to the pathology lab in a variety of formats (HL7 V2, CDA, etc.). While discrete data elements are captured in electronic format in most laboratory information systems (LISs), typically, synoptic cancer pathology reports then flow from the LIS to EHRs in non-discrete data formats (e.g., pdf format).

There is a need for an electronic data exchange standard that maintains the discrete cancer data when exchanging information among pathology laboratories, hospital systems, and registries for continuity of care, cancer reporting, and research. In addition, starting in December 2022, CMS and ONC require a FHIR-based API to be in place for certified HIT vendors (see ONC’s Cure Act Final Rules).

This cancer pathology reporting FHIR IG has been developed by Cancer ePathology Reporting Project in collaboration with the IHE SDC/eCC on FHIR Project, both under the Orders & Observations Working Group, and with other stakeholders. It provides an alternative to the HL7 Version 2.5.1 Message approach used by the NAACCR Standards for Cancer Registries Volume V for cancer pathology synoptic reports. The following table illustrates the mapping of the well-established NAACCR segments to FHIR resources.

FHIR Profiles to Capture NAACCR Volume V, Table 7: ORU Unsolicited Observation Message (event R01)

ORU Message Segments HL7 V2 Section FHIR Cancer Pathology Data Sharing: US Pathology Bundle
Message Header segment (MSH) 2.6.1 US Pathology MessageHeader
Software segment [SFT] 2.15.12  
PATIENT RESULT    
PATIENT:    
Patient Identification segment (PID) 2.6.2 US Core Patient Profile
Next Of Kin segment (NK1) 2.6.2 US Pathology Next of Kin
Patient Visit segment (PV1) 2.6.2 US Core Encounter Profile, US Pathology-Related PractitionerRole, US Core Patient Profile
ORDER RESULT:    
Common Order segment (ORC) 2.6.3 US Pathology-Related PractitionerRole
Observations Report ID segment (OBR) 2.6.3 US Pathology Diagnostic Report, US Pathology-Related PractitionerRole
Notes and Comments segment (NTE) 2.6.4 US Pathology Diagnostic Report
RESULT:    
Observation/Result segment (OBX) 2.6.4 US Pathology Diagnostic Report (results)
Notes and Comments segment (NTE) 2.6.4 US Pathology Diagnostic Report
SPECIMEN INFORMATION:    
Specimen (SPM) 7.4.3 US Pathology Specimen
Observation Related to Specimen (OBX) 7.4.2 US Pathology Diagnostic Report
Continuation Pointer (DSC) 2  

Relation to IHE SDC on FHIR

The IHE Structured Data Capture (SDC) standard, IHE SDC eCC on FHIR, (under development) uses a form driven workflow to capture and encode data and then create FHIR Observations from the captured data. The College of American Pathologists has implemented IHE SDC for collection of electronic Cancer Checklists (eCCs). The goal of IHE SDC eCC on FHIR is to extract data from these cancer checklists and create FHIR Observations for interoperability between systems.

This Cancer Electronic Pathology Reporting FHIR IG and the future IHE SDC eCC on FHIR should complement each other.

Ongoing Project Efforts

This project acknowledges that there is an ongoing discussion about how LOINC vs. SNOMED terminologies serve cancer pathology, but it does not propose to resolve that discussion. Future development of this standard may explore new use cases, such as microbiology laboratory reporting. Future revisions may also include guidance on CAP eCC Protocol CKey Identifier to SNOMED translation.

Project Team

Cancer ePathology Reporting Project Contributors

Role Name Affiliation Contact
Primary Editor David deRoode Lantana Consulting Group david.deroode@lantanagroup.com
Primary Editor Rick Geimer Lantana Consulting Group rick.geimer@lantanagroup.com
Co-Editor Zabrina Gonzaga Lantana Consulting Group zabrina.gonzaga@lantanagroup.com
Co-Editor Wendy Wise Lantana Consulting Group wendy.wise@lantanagroup.com
Co-Editor Ruby Nash Lantana Consulting Group ruby.nash@lantanagroup.com
Co-Editor Diana Wright Lantana Consulting Group diana.wright@lantanagroup.com
Co-Editor Max Nakamura Lantana Consulting Group max.nakamura@lantanagroup.com
Subject Matter Expert Wendy Blumenthal Centers for Disease Control and Prevention (CDC) wfb6@cdc.gov
Subject Matter Expert David Jones Centers for Disease Control and Prevention (CDC) pvl1@cdc.gov
Subject Matter Expert Sandy Jones Centers for Disease Control and Prevention (CDC) sft1@cdc.gov
Subject Matter Expert Temitope Alimi Katmai Government Services contract to CDC nyj4@cdc.gov
Subject Matter Expert Wendy Scharber Katmai Government Services/Registry Widgets contract to CDC wendy@registrywidgets.com
Subject Matter Expert Richard (Rich) Moldwin College of American Pathologists rmoldwi@cap.org
Subject Matter Expert Alex Goel College of American Pathologists agoel@cap.org
Subject Matter Expert Walter (Scott) Campbell University of Nebraska Medical Center wcampbel@unmc.edu

Current Work Group includes those who participated in the Cancer FHIR IG project: Hans Buitendijk, David Burgess, Lorraine Constable, Robert Hausam, Ralf Herzog, Patrick Loyd, Ulrike (Riki) Merrick, John David Nolen, James Alexander (Alex) Mays, Andrea Pitkus, Craig Newman, James Tcheng, Laura Heermann, and Calvin Beebe.