IHE/HL7 Anatomic Pathology C.Daniel (ADICAP, ASIP Santé)

IHE/HL7 Anatomic Pathology C.Daniel (ADICAP, ASIP Santé) & F.Macary (ASIP Santé) January 17, 2012 San Antonio

Anatomic Pathology Technical Framework Current Technical Framework - Revision 2.0 July 23, 2010. Copyright 2010: IHE International, Inc.Trial Implementation Vol. 1 (PAT TF-1): Integration Profiles Vol. 2 (PAT TF-2): Transactions These volumes provide specification of the following profile: Anatomic Pathology Workflow (APW) Supplements for Trial Implementation To be tested at subsequent IHE Connectathons. Supplements extend the IHE Anatomic Pathology Technical Framework, Rev. 2.0 for Trial Implementation. Anatomic Pathology Reporting to Public Health (ARPH) Published 2010-07-23 Anatomic Pathology Structured Reports (APSR) Published 2011-03-31 APSR Value Sets Appendix - Published 2011-03-31 2

IT Infrastructure profiles ATNA CT Security PAM PDQ Patient mgmt. Care Ward IHE Anatomic Pathology Existing and planned profiles Healthcare community Anatomic Pathology Laboratory Order mgmt. Image mgmt Report mgmt. APW: AP workflow Enhanced Imaging workflow ARW:AP reporting workflow Automation APDA: AP devices automation IAPW: Inter AP labs workflow XDS XDS-I XDM Docs./Image sharing APOR: AP opinion request APSR: AP Structured Report ARPH: AP Report for Public H

2011-12 Activity : Selection of2010-11 2011-12 ? Change proposals Change proposals/Profiles/White achieved Content: Anatomic Pathology Structured Reports (APSR) : 10 Integration : Anatomic papers new templates Pathology Structured Order Change proposals : not (APW - PAT-1) Content: Anatomic Pathology Structured Reports (for Biobanks ) (APSR) Integration Profiles Content Profiles White papers in progress Anatomic Pathology Reporting Workflow (APRWF)(G.Rodriguez – Satec) Enhanced Imaging Workflow Integration Profile Integration Profiles - 2012-13 Anatomic Pathology Reporting Workflow (APRWF)(G.Rodriguez – Satec) White papers - 2012-13 Device automation integration profile (with LAB, ITI) Inter-departments workflow (with LAB ITI) Telepathology (with ITI) Opinion request (content and workflow) Relationships between pathology/radiology/endoscopy Sharing templates/terminology (with ITI) 4

Change proposal New APSR templates 5

[APSR] – Anatomic Pathology Structured Report Joint IHE and HL7 anatomic pathology initiative Content profile providing templates for building Anatomic Pathology Structured Reports in all fields of anatomic pathology (cancers, benign neoplasms as well as non-neoplastic conditions) CDA documents including Anatomic Pathology observations bound to images or regions of interest Shared or exchanged within a community of care providers using existing integration profiles defined by IHE Information Technology Infrastructure 6

Background (templates 2010-11) From clinical document models Recent recommendations for required, preferred, and optional elements for any APR of surgical pathology, regardless of report types [Goldsmith 08] National initiatives Anatomic Pathology SR (Netherlands, Germany, Australasia) Cancer APSR US - CAP (College of American Pathologists) 67 cancer checklists and protocols (October 2009) France - SFP (French society of pathology) – INCa (French National Cancer Institute) Minimum data sets for cancer APSR in 20 locations (85% of new cancers in France) (required by accrediting bodies) Australasia 6 templates for cancer APSR UK Royal college Goldsmith, J.D., et al., Reporting guidelines for clinical laboratory reports in surgical pathology. Arch Pathol Lab Med, 2008. 132(10): p. 1608-16.

[APSR] – Anatomic Pathology Structured Report Clinical Use Case to implement this profile Sharing/exchanging APSR for surgical pathology 21 CDA templates (Document Content Modules) Generic APSR template All organs & fields of anatomic pathology (inflammatory, vascular, traumatic, metabolic diseases as well as cancer) 20 organ-specific APSR templates Cancer-specific organizers covering 85% of incident cancers 490 observations & procedure templates 21 procedure templates 469 observation temples (including 73 TNM observation templates) 8

New APSR templates (201112) Thematic needs Patient care coordination Surgical pathology New organ-specific templates (n 20 - 80) All specimen types (biopsies, cytology, etc) Autopsy Public health (e.g screening) Research (e.g bio-banking) AP observations for biomarkers National needs France : 7 new templates Corresponding to 10 CAP cancer checklists 9

10 CAP cancer checklists Neuroendocrine tumor of the stomach Neuroendocrine tumor of the colon and rectum Neuroendocrine tumor of the small intestine and ampulla Neuroendocrine tumor of the appendix Carcinoma of the endocrine pancreas Carcinomas of the nasal cavity and paranasal sinuses Tumors of the brain/spinal cord “Lymphoma” Hodgkin lymphoma Non-hodgkin lymphoma “Sarcoma” Tumors of soft tissue Rhabdomyosarcoma 10

HL7 CDA implementation guide How to update APSR Reports Anatomic Pathology Structured (APSR) Providing OID for new templates APSR Value Sets Appendix Providing OID for new observations/procedure templates Providing PathLex codes for new observations, procedures, and their value sets 11

National extensions Differences at the level of the document templates Examples US Neuroendo 4 templates crine NET of tumors - the stomach - the colon and rectum - the small intestine and ampulla - the appendix Carcinoma s of the pharynx 12 France 1 template Neuroendocrine tumors of digestive tract 1 template 3 templates Carcinomas of the pharynx Carcinomas of -the oropharynx - the nasopharynx (biopsy) - the nasopharynx (resection)

National extensions Other differences At the level of the observation templates Harmonisation is possible At the level of the value sets Harmonisation is difficult Managing international/national/local value sets 13

APSR templates Maintainance (new profiles & versions) Issue Proposing new templates New US CAP Cancer checklists Other needs (e.g France INCa-SFP Cancer checklists) Taking into account versions US CAP Cancer checklist versions Other? Organizational issues - International governance? Harmonization? US CAP Cancer checklist/ RCPA (Australasia)/UK RCP Technical Automation of the process Deriving HL7 CDA implementation guides from eCC Intellectual properties rights? 14

Significant deployment activities Timeline 15

Significant Deployment Activity APW : implemented by vendors in "real world" in Spain (Hospital General de Ciudad Real) and on-going implementation in Paris (AP-HP) (ADICAP, ASIP Santé) ARPH: North America (NAACCR, CDC) Successfully tested at 2010 (One sender, one receiver) & 2011 (one sender, same receiver as 2010) NA Connectathon APSR : on-going implementation by vendors in "real world" in France (ADICAP, ASIP Santé – INCa). National pEHR project (DMP & DCC project) 16

Timeline/Milestones Date Activity Location 2011 Sept 13-15, Submission of of 2011-12 IHE AP & HL7 AP - HL7 WGW - San Diego 2011 Profiles/White papers Dec 2011 Selection of 2011-12 Profiles/White papers 2012 Jan 2012 US Connectathon Jan 16-18, 2012 IHE AP & HL7 AP - HL7 WGW - San Antonio April 2012 European Connectathon May 13-18, PC&TC meeting IHE AP & HL7 AP - HL7 WGW – Vancouver 2012 (to be confirmed) June 8, 2012 Publication of public 11th Telepathology & 5th Virtual (to be confirmed) comment supplement microscopy – Venice August, 2012 Publication of trial Ihe.net implementation supplement Sept, 2012 Submission of of 2011-12 IHE wiki Profiles/White papers Sept, 2012 Selection of 2011-12 IHE AP & HL7 AP - HL7 WGW – Cambridge Profiles/White papers 17 (to be confirmed)

11th ECT/5th ICVM Venice - Friday June 8, 2012? Contact : [email protected] 18

HL7 Working Group Meeting Vancouver, BC, May 13-18, 2012 19

Learn More about IHE Anatomic Pathology Googlegroup : ihe-anatomic-pathology- [email protected] Wiki http://wiki.ihe.net/index.php? title Anatomic Pathology