Cancer Pathology Data Sharing
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Cancer Pathology Data Sharing, published by . 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 and changes regularly. See the Directory of published versions


Relationship to NAACCR Volume V

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.

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 Rule).

Relationship 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.

Relationship to MedMorph

The Making EHR Data More Available for Research and Public Health (MedMorph) is seeking to advance public health and patient-centered outcomes by establishing HL7 standards in FHIR and Clinical Quality Language (CQL). The [Central Cancer Registry Reporting Content IG] ( leverages the MedMorph Reference Architecture (RA) IG to facilitate reporting cancer data to regional, state, and territorial public health central cancer registries.

FHIR Profiles to Capture NAACCR Volume V

The mappings below show where there is significant overlap between data elements in HL7 Version 2, NAACCR Volume 5, and FHIR, but V2 segments and FHIR profiles are not perfect translations of each other. For more detail on V2 to FHIR Mapping, refer to the the HL7 Version 2 to FHIR IG.

V2 Message Elements NAACCRR Section FHIR Artifact
Message Header segment (MSH) 2.6.1 US Pathology MessageHeader
Software Segment (SFT) 2.15.12
Patient Identification segment (PID) 2.6.2 US Core Patient Profile
Patient Visit segment (PV1) 2.6.2 US Core Encounter Profile, US Pathology-Related Practitioner, US Core Patient Profile
Common Order segment (ORC) 2.7.1 US Pathology-Related PractitionerRole, US Pathology Service Request
Observations Report ID segment (OBR) 2.7.2 US Pathology Diagnostic Report, US Pathology-Related Practitioner Role, US Pathology Service Request
Notes and Comments segment (NTE) 2.6.4 US Pathology Diagnostic Report
Observation/Result segment (OBX) 2.7.3 US Pathology Diagnostic Report results
Notes and Comments segment (NTE) 2.7.4 US Pathology Diagnostic Report
Specimen (SPM) 2.7.5 US Pathology Specimen
Observation Related to Specimen (OBX) 2.7.3 US Pathology Diagnostic Report
Continuation Pointer (DSC)

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.

There are also several cancer pathology exchange initiatives underway internationally, including:

Project Team

Cancer ePathology Reporting Project Contributors

Role Name Affiliation Contact
Primary Editor David deRoode Lantana Consulting Group
Primary Editor Rick Geimer Lantana Consulting Group
Co-Editor Zabrina Gonzaga Lantana Consulting Group
Co-Editor Wendy Wise Lantana Consulting Group
Co-Editor Ruby Nash Lantana Consulting Group
Co-Editor Diana Wright Lantana Consulting Group
Co-Editor Max Nakamura Lantana Consulting Group
Subject Matter Expert Wendy Blumenthal Centers for Disease Control and Prevention (CDC)
Subject Matter Expert David Jones Centers for Disease Control and Prevention (CDC)
Subject Matter Expert Sandy Jones Centers for Disease Control and Prevention (CDC)
Subject Matter Expert Caitlin Kennedy Centers for Disease Control and Prevention (CDC)
Subject Matter Expert Temitope Alimi Katmai Government Services contract to CDC
Subject Matter Expert Wendy Scharber Katmai Government Services/Registry Widgets contract to CDC
Subject Matter Expert Richard (Rich) Moldwin College of American Pathologists
Subject Matter Expert Alex Goel College of American Pathologists
Subject Matter Expert Walter (Scott) Campbell University of Nebraska Medical Center

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.