AP Domain Minutes 31May2012

Thursday May 31: Joint Meeting IHE Lab- IHE Anatomic Pathology

• See the minutes of the joint Meeting IHE Lab- IHE Anatomic Pathology in the IHE LAB wiki
  • Image management (H.Salomon, GE)(see attached white paper : Lab Workflow for Pathology r02)
• APW Profile
  • The IHE Anatomic Pathology Workflow (APW) Profile specifies the use of DICOM Modality Worklist (MWL) and Modality Performed Procedure Step (MPPS) for managing the imaging activities within the pathology department. In contrast, the IHE Laboratory Analytic Workflow (LAW) Profile and Laboratory Device Automation (LDA) Profile from IHE-Lab specify the use of HL7v2 OML, QBP and OUL messages for lab equipment activity management.
  • The IHE-AP approach for workflow control is not unreasonable if imaging is considered alone, as the images themselves need to be managed under the DICOM protocol. However, when viewed in conjunction with lab device control it places an undue burden on the LIS, which would need to implement two distinct workflow infrastructures for the full complement of equipment.
  • The position paper Lab Workflow for Pathology r02 recommends consolidating all lab workflow management under HL7v2 messaging (the LAW Profile approach). It discusses how DICOM Storage Services can be used in a complementary fashion to manage persistent storage of images and other evidentiary information objects in PACS archives, leveraging that capability already deployed in most institutions with radiology departments. It further shows how this combination of HL7 and DICOM could be profiled to support the anatomic pathology lab, including flow cytometry, gross imaging, whole slide imaging, and microscope field of view imaging.
  • Question: is there any market evidence for the use of WSI in lab? WSI is used in hematology, at least in France.

• Anatomic Pathology Structured Orders
  • Currently, there is no guidance on the information that should be included on a requisition/test order form when a specimen is submitted to a clinical or anatomic pathology laboratory. The lack of guidance means that it is not unusual for clinical diagnosis and other information to be missing on requisition forms (e.g temperature for blood gas).
  • In LDW, it is possible to template clinical content in HL7v2 messages (volume of urine, time).
  • The issue of consistent templating across HL7v2/CDA (at any step of the workflow) was discussed.
    • Other brief proposals defined in collaboration across domains
      • Device automaton integration profile
      • Inter-departments workflow: this profile is used very scarcely
      • Harmonization of CDA implementation guides, MDHT
  • Action:
    • Image management
    • Providing the detailed proposal “Managing imaging activities with Pathology” (H.Salomon, GE) (due date: December 2012)
    • Other brief proposals
      • Device automaton integration profile
      • Inter-departments workflow
      • Harmonization of CDA implementation guides, MDHT
      • Building an harmonized set of observations of Molecular Biology tests (IHE AP (C.Daniel) – IHE Lab (S.Renly)
  • Other items: A.Shabo (IBM, HL7 Clinical Genomics announced that a new IHE domain dedicated to Clinical Genomics will be launched).

Friday June 1

• Update of the wiki – Brief proposal will be accepted in September 2012. Detailed proposal need to be made in December 2012.
• Update of the board report to be sent to C.Carr
• Telepathology (see attached link to presentation below)
  • XDW: Cross-enterprise document workflow should be considered in the context of telemedicine.
• Action:
  • Proposals posted to anapath@ihe.net will be accepted through September 2012. The templates for both brief and detailed proposals are available on Profile_Proposal_Process. A brief proposal is acceptable for September submission. Selection of proposals to be developed as profiles in 2013 will be made in December 2012. A detailed proposal is required for December selection.
  • Anatomic Pathology Structured Order - brief proposal (Wendy Scharber - Registry Widgets)
  • Anatomic Pathology Reporting Workflow (APRWF) - brief proposal (G.Rodriguez – Satec)**Managing imaging activities within Pathology - brief proposal (H. Solomon - GE)
  • Device automation integration profile (with LAB) (T Schrader - University of Applied Sciences, Brandenburg)
  • Inter-departments workflow (with LAB)
  • Enhanced Imaging Workflow Integration Profile (T Schrader - University of Applied Sciences, Brandenburg)
  • Telepathology (Mike Henderson - Eastern Informatics)

Saturday June 2

• APSR
  • Developers need guidelines for the development of intuitive and use friendly forms generating APSR.
  • Moving from current processes (free text dictated report +/- a set of codes (global set of codes or set of codes per specimen) to structured reporting is an issue.
• SNOMED CT in pathology (see link to presentation below)
  • Procedures & specimen: in Spain, SEAP has built a catalogue of SNOMED CT encoded specimen and procedures. 8 hospitals participated to this effort.
  • Diagnosis: SEAP will publish SNOMED CT encoded diagnoses
  • SNOMED CT should include TNM and address the issue of versoning
  • Conclusions
    • Pathology IS allow both local terms and mapping to SNOMED CT
    • Digital slides management can be improved with SNOMED CT
    • SNOMED CT needs to be improved in morphology hierarchy
    • Pathologists need to understand better the SNOMED CT works
• Open questions to Alexis Carter (IHTSDO)
  • Should pathology diagnosis be coded using the morphological abnormality sub-hierarchy (part of the Body Structure hierarchy) or should they be coded using Clinical Finding hierarchy?
  • Should we try to use mainly morphological codes, and when they are not available, could some diagnoses in pathology reports be coded using clinical (disorder or finding hierarchies)?
  • Does using a mixture of hierarchies (Body Structure and Clinical Finding) in pathology diagnosis coding make sense when implementing data exploitation of information systems?
  • Should we ask IHTSDO to complete the list of morphological codes to add all those codes missing in the morphological abnormality sub-hierarchy?
  • Alexis Carter (IHTSDO)- IPaLM is interested in working with IHE AP in terms of submitting PathLex terms to the IHTSDO for inclusion into SNOMED. IPaLM is interested in picking one particular cancer checklist (e.g., breast, lung, melanoma, etc.) and creating a joint proposal outlining the issues to the IHTSDO as well as providing a suggested solution to incorporate missing terms from the checklists into SNOMED
  • Action:
    • Providing to IPaLM is interested in using one on of the cancer checklists that includes molecular testing data items since this is the focus of the current IPaLM group. In the proposal, we could mention that all the APSR checklists that have missing SNOMED codes would need to be included, but the use case that IPaLM would bring to the IHSDO would specify one checklist as an example of the issues as well as the solutions.

Appendix

• Jeremy Rodgers – email June 06, 2012
  • Jeremy Rodgers worked as part of the Consultant Terminologist Training Programme related to cancer.
  • An ‘inception phase’ analysis of the following topics is available (the first two sub-bullets from the above list of topics were progressed to an ‘Elaboration Phase’ document)
  • How SNOMED should model
    • whether a malignant neoplastic disease process (cancer) has metastasized or not
    • whether a given malignant tumour instance is the primary site of origin of the disease, a metastatic secondary tumour instance, or not determined whether primary or secondary
    • recurrent tumours vs recurrent disease.
  • The extent to which SNOMED content should be expanded to include (many more) precoordinated codes for metastatic disease and/or tumours, Whether the SNOMEDID assigned to precoordinated concepts for metastatic disease (or tumour instances) can continue to be aligned with the ICD-O coding structure and, more generally, the extent to which SNOMED can remain aligned with ICD-O at all [simple answer: it can’t. A mapping rather than an alignment relationship is needed, especially once SNOMED has different concepts for metastatic tumours vs disease whereas ICD-O conflates the two]
  • How (whether) to incorporate AJCC 7th edition staging concepts within SNOMED CT in the same way that the 6th edition is/was [simple answer: no – that way madness lies]. The politically hot topic (at least, in the US) of the link to AJCC 7th Ed is especially challenging: I would personally predict that what most people expect and want (expansion of existing SCT content in exactly the same style as for the 6th edition) is actually a recipe for mis-coding disaster, for the reasons outlined in the inception document. By contrast, the ideal solution (postcoordination) is almost certainly not consumable by existing systems. Satisfactorily addressing this tension will, IMHO, required a significant and sustained engagement between the relevant stakeholders and IHTSDO: there are significant political, technical and financial tradeoffs that exist to be understood and made outside the IHTSDO. By contrast, if the IHTSDO simply gives the oncology community the naïve and cheap solution they’re asking for now, they may not be so grateful for the associated data quality and system sophistication tradeoffs inherent to that solution but that won’t surface until further down the line.

Presentations During Meeting

Media:Profile Proposal-AP Opinion Request Presentation.pdf

Media:SNOMED CT in Pathology Presentation.pdf

Media:Joint Lab-AP Meeting Presentation.pdf