Cancer Pathology Reporting: Standards Selection

Good morning,

Please see InfoCentral events for the WebEx/Teleconfernce information for this session.

infocentral.infoway-inforoute.ca/en/news-events/event-calendar/icalrepeat.detail/2018/03/01/2529/142/pathology-webinar

March 1 at 1330 hrs.

All are welcome.

Thank you.

Andrea

Good afternoon everyone,

In advance of our meeting to discuss the encoding of the cancer pathology protocols and checklists, I have added some additional supporting documentation from Dr. Scott Campbell of the University of Nebraska who has been leading the SNOMED CT encoding work with SNOMED International.

The documentation can be found in the documents folder under the SNOMED CT community: infocentral.infoway-inforoute.ca/en/resources/docs/snomedct/presentations/pathology-sct

I will be calling a meeting shortly to provide a summary of a project, some information gathered in various off-line conversations with different Canadian implementers, SNOMED International and the College of American Pathologists.

Anyone who had indicated interest so far, you are on my list of interested participants.

Everyone is welcome.

Thank you.

Regards,

Andrea

Thanks so much for this Dave and the folks at CCO.

I am still doing some investigation myself and have heard from another jurisdiction the support for the CKEY work that has been done to date.

I had a call with Sam Spencer of the CAP last week and am meeting with Mark Kennedy of the CAP tomorrow. I am amassing a list of questions from you, the BC Synoptic Reporting project and others and am endeavouring to pull some additional materials together to convene a call with all interested participants to share what I learn and discuss together next steps and recommendations for how to move forward.

I will be sure to include your posting and questions as part of that discussion.

Hello Andrea,

Cancer Care Ontario (CCO) and College of American Pathologists (CAP) support the mapping of CAP electronic cancer checklists (eCC’s) to SNOMED CT for the purposes of querying and decision support. However, there are very significant issues that make the use of these terminologies for data entry, clinical reporting and data exchange highly problematic.

CCO does not currently use LOINC/pCLOCD to encode the questions in checklists such as these and SNOMED CT to encode the answers. We do not anticipate that LOINC and SNOMED will be helpful for our use cases at this time. Instead, we have found that the built-in eCC item identifiers (“Ckeys”) have met all our needs for concept identification and querying over the past few years. For interoperable forms and data exchange, we’ve found that the IHE Structured Data Capture (SDC) model is a far better technical match for our needs, for example decomposing Data Elements into LOINC and SNOMED for HL7 versus use of CDA for FHIR transmissions. SDC preserves 100% of the form integrity through multiple transmission nodes and is much easier to implement and maintain than the other options. The same applies to our needs with radiology, surgery and oncology synoptic reporting.

The issues with terminology coding with form-based data transmissions include the following major problems. This is a partial list:
• A severe lack of codes to support current data elements
• AJCC does not currently allow the presentation of cancer staging in SNOMED or LOINC.
• Oncology codes are notoriously difficult to create correctly and consistently, and can rarely be ontologically defined for classifier-based subsumption.
• Proper modeling of oncology concepts is subject to significant disagreement, as re post-coordination mechanisms
• Combination of LOINC and SNOMED does not permit computable post-coordination.
• Distribution of form templates (e.g., eCC SDC forms) for EHR vendor implementation requires rapid maintenance cycles that to not provide sufficient time to assign codes or create new ones.
• Assignment of codes in transmission protocols has been documented to result in a high error rate. (documentation available on request)

Despite these well-known issues, we do support the use of SNOMED CT for future use with complex queries on stored oncology data sets. In particular, SNOMED CT will be useful for the creation of rollup queries on datasets collected at varying levels of granularity (e.g., all subtypes of adenocarcinoma). CAP has articulate a desire to produce SNOMED CT and ICD-O-3 maps when appropriate codes and resources are available. It is difficult to see how LOINC would add any value over SNOMED, although the use of the LOINC hierarchical system may, over time, become robust enough to support similar use cases. CAP is already working with the University of Nebraska as well as LOINC and the US National Cancer Institute in an effort to create SNOMED, LOINC and Data Elements for the eCC data elements, and we are considering the same for the radiology and surgical templates. We are working with the new “Cancer Interoperability” group to help create cancer-centric data elements with SDC and CIMI output. NAACCR and CDC are also creating maps from the eCC identifiers to the latest Site Specific Data Items (SSDI) used by cancer registries, including CCO and the Ontario Cancer Registry.

As you can see, there is lot of work on informatic standards for the eCC and other structured oncology data, and much of it involves the SDC model. We are unaware of any group still planning to use LOINC/SNOMED codes for cancer data representation. We strongly encourage Canada Health infoway to follow us in adopting the SDC approach, which is ready to use right now. We will still help to obtain a better list of SNOMED and perhaps LOINC and other codes, so that they will be available for future analytics on the stored SDC-formatted data.

Please let me know if you have any question. If it would helpful, we would be open to arranging for Dr. Richard Moldwin, Lead Physician Informaticist from CAP, to participate in a future session.

Regards David Kwan.

Added. Glad you have you on board Rita.

Can you add me to your list too Please?

Thank you