Meeting Announcement

IHE Anatomic Pathology Domain F2F Meeting August 5-6, 2013 Paris

Attending:

Participants IHE AP	August 5	August 6	Organization
David Booker	X	X	College of American Pathologists/LabMedicine PC
Christel Daniel	X	X	CCS Domaine Patient - AP-HP - INSERM
Raj Dash	X	X	College of American Pathologists/Duke University
Gunter Haroske	X	X	Institute für Pathologie KH Dresden-Friedrichstadt HU Berlin Charite FH Brandenburg
Mary Kennedy	X	X	College of American Pathologists
Jacques Klossa	X	X	Telepathology2014
François Macary	X	X	ASIP Santé
Thomas Schrader	X	X	Institute für Pathologie KH Dresden-Friedrichstadt HU Berlin Charite FH Brandenburg
Riccardo Triunfo	X	X	CRS4
Gianluigi Zanetti	X	X	CRS4

NOTE: Presentations referenced can be found on the IHE AP Domain wiki site:

http://wiki.ihe.net/index.php?title=Anatomic_Pathology

Agenda Items

• IHE Lab Overview
• APSR release 2013
• Change proposal modification to incorporate APSR
• Incorporation of Molecular Pathology/Genomics Requirements
• Strategy Session Initiation
• Telepathology
• Organization of Future Meetings

Action Items

#	Item	Responsible	Status
1	Contact Chris Carr to determine if IHE has an IHTSDO namespace we could use	Mary	Open
2	Determine if IHE needs permission from AJCC to use TNM terms in APSR	Mary	Open
3	Create change proposal for APSR	Thomas / Gunter	Completed (see document)
4	Request LOINC codes for Observation codes for APSR	TBD	Open
5	Create a model for workflow use case	Gianluigi/Riccardo	November
6	Create a use case for image reporting to be merged into CRS4 profile proposal	Jacques	November
7	Send out call for new proposals	Co-chairs/Mary	November
8	Update IHE Domain page (change Trial Implementation RePub Request to 2013-10-31,etc.)	Mary	November
9	Creation of examples of cancer/non-cancer (eg, breast/prostate; fibroadenoma) to be developed by France/Germany/US	Christel/Thomas/Raj	November
10	Write summary of discussion and contact Epic development	Raj	November
11	Develop mapping of values based on text using Excel template (Christel will share prototype Excel File)	Christel	Completed

Minutes

1. Welcome/Introductions
   • No domain sponsor announcements; however, the IHE AP meeting roster was updated.
   • Agenda reviewed and approved
   • Objectives of meeting:
     • Enumerate current projects and statuses
     • Lower barrier to incorporation of concepts into SNOMED CT
     • Identify ways to incorporate multinational vendor engagement
2. Overview of IHE Lab work (Francois)
   1. ILW has a change proposal from Harry Solomon that could be used for AP
      1. Telepathology consultation
   2. Lab Code Set distribution profile (IPI domain?) (Francois to share?)
      1. LOINC recommended (Japan incorporating LOINC)
      2. JLAC-10 Japanese required coding system
   3. Implementation of IHE Lab profiles in France
      1. XD-LAB accepted as national framework for France
         1. Lab reports need to be conformant to XD-Lab to go into EHR
         2. LTW (APHP); LCSD and LTW deployed in France
         3. LOINC has been selected for France and has been partially translated in French (20,000 codes to date)
3. CRS4 presentation: Can/How do we put data intensive biology in the picture? (see presentation)(Riccardo/Gianluigi)
   1. CRS4 is an interdisciplinary, not for profit research center focused on computational sciences
   2. Focus on clinical domain interconnection and traceability; semantic and computable management of biomedical data; telemedicine and distributed medicine
   3. Main IHE experience in the IHE Lab and ITI domains
      1. Technical framework supplement for lab specimen barcode labeling
      2. One CRS4 monitor at Connectathon 2013
   4. Currently dealing with production, managing and analysis of data intensive biology outputs (NGS, proteomics, etc) and moving toward confluence with digital pathology
      1. Support to large scale population studies
      2. Genetic therapy quality control
   5. Building a biobank system
      1. To provide consistent computable platform
      2. To support scalable error propagation/graph of dependency data model
   6. Industrial consulting
      1. Pre-analytic automation and clinical lab automation systems
   7. Support to regional healthcare systems
      1. HL7/IHE integration
      2. Clinical processes modeling
      3. Real time telemedicine systems
   8. Reasons for approaching IHE AP domain WG:
      1. Research interests and their intersection
      2. Is there a basis for a new IHE profile for this?
      3. New profile could fuse data intensive molecular biology with digital pathology using extensive automation of pathology lab (tissue transport; processing; imaging; NGS and mass spectrometry; archive and storage)
      4. A new profile could also include ordering ancillary techniques and molecular biology (Review IHE Lab automation profile/LAW)
   9. New profile needs to address the following
      1. Ways to do referencing
      2. Expressions to show that result is tied to a specific area of a specific specimen
      3. How to deal with links
      4. Reference implementation
      5. Need for a model for workflow (Gianluigi/Riccardo to write use case)
      6. Need for a use case to show integration with AP
      7. Will need to review previous DICOM work on workflow
      8. Develop a use case for image reporting that can be merged into the profile (Jacques)
4. APSR overview of current work (see presentation)(Francois/Christel)
   1. APSR in a CDA format
      1. Six 1st level sections
      2. Only one mandatory and mandating structured data elements
   2. Handling “none” in an observation of the <entry>
      1. “None” and “None known” represent effective values which are part of the value sets attached to the observation
   3. Handling missing information in an observation of the <entry>
      1. These situations are handled with the nullFlavor attribute
   4. Handling unexpected information in an observation of the <entry>
      1. “Other, specify” – The actual value does not belong to the assigned value set and the author of the report provides this foreign value
      2. The value set is open to extensions
      3. No code is available in any terminology for the value observed
   5. New APSR templates
      1. Ten new templates representing cancers
5. APSR change proposal discussion (see presentation)(Thomas/Gunter)
   1. Background for German/Austrian proposal
      1. HL7 background reviewed
      2. HL7 Germany has solutions for reporting to cancer registries using generic TNM and ICD-O
      3. Uses Detailed Clinical Models (DCM)
      4. Recommend using a generic model of meaning vs perpetuated specific observations (DCM)
      5. Organ specific templates well suited for data entry and communication but are not suited for system maintenance
      6. Can be supported by CDA
      7. PathLex is logical consequence of organ specific template approach but causes unnecessary multiplication of terms
   2. Proposed changes to APSR by German/Austrian workgroup:
      1. Create HL7 generic model value for concepts (eg, TNM; tumor descriptions; assessment scales;)
      2. Open APSR 05 and replace by TNM/ICD-O German, with consecutive changes in PathLex
      3. Cancel 4.1.2.2 organ-specific APSR document content modules with consecutive changes in PathLex
      4. Create generic document modules and templates only and organ-specific templates are now part of the appendix to be used for example, as blueprints for data entry forms (checklist functionality)
      5. Re-launch of an ontology based PathLex (for AP observations)
      6. Need to differentiate between terminology models, specimen and problem organizers
      7. Advantages to this approach are few, easy to implement generic templates that can be reused in other profiles (eg, QRPH-Ca; XDS-MS)
      8. Separate validation using schematron can be used
      9. Would need approximately 15 required elements in total
   3. Discussion of new proposal/next steps
      1. Acceptance of concept of a more generic model
      2. Current APSR files will be used as examples
      3. Thomas/Gunter to submit a change proposal (see document)
      4. Determine if IHE needs agreement with AJCC to use TNM in a profile
      5. Decision is to accept many proposed changes
      6. A generic model for APSR will be created and the appendix will contain examples of specific malignant and benign conditions
      7. The general structure of APSR will not change and follows the CDA hierarchical tree of section, entries, organizers
      8. Need to correlate radiology/pathology diagnosis (Birads)(Tumor board templates within IHE France may serve as a model)
      9. Examples of cancer/non-cancer (eg breast/prostate ca; fibroadenoma) will be developed by France/Germany/US (Chirstel/Thomas/Raj)
      10. Share mapping of values based on text using Excel template (Christel will share prototype Excel file)(see spreadsheet)
      11. Write summary of discussion and contact Epic development (Raj)

Note: A change proposal was submitted by Thomas/Gunter post-meeting. Christel reviewed and edited the CP. (See document). Further discussion of the CP and final determination will occur on the next IHE AP conference call.

1. APSR/CDISC (Christel)
   1. Possible collaboration with CDISC
   2. Clinical Data Warehouse and i2B2
   3. Unicare – clinical data warehouse
   4. Uses IHE QRPH Exchange profile
   5. Should we collaborate with CDISC SHARE OPEN project?
   6. Christel will forward information of next IHE AP conference call
2. IHTSDO/SNOMED CT and AJCC
   1. Discussion regarding APSR example concepts (eg, cancer staging)
   2. PathLex developed as stop gap for concepts without SCT codes
   3. Should we build an SCT extension for concepts not covered in SCT?
      1. Determine if IHE has an IHTSDO namespace (Mary)
      2. Draft proposal for assignment of extension namespace to IHE vs IHE AP or draft joint proposal with IPaLM SIG and submit from within the IHTSDO governance
      3. Alternatively, use LOINC codes immediately for observation names until such time as a SNOMED CT option is available
   4. AJCC / UICC discussion
      1. Determine if an IP agreement is needed between staging organizations and IHE
      2. Use LOINC codes until such time as IP agreement established
   5. Further discussion is needed on next steps
   6. Discussion of Procedure/Specimen Type
      1. Review Marcial’s work (possibly have him present on next conference call)
3. 12th European Congress on Digital Pathology
   1. Formerly “12th European Congress on Telepathology and 6th International Congress on Virtual Microscopy”
   2. To be held in Paris 18-21 June 2014
   3. Plan on a joint DICOM 26/IHE AP F2F
   4. All are encouraged to attend (see brochure)
4. New business
   1. Send out call for new proposals
   2. Need to update the IHE Domain page (Trial Implementation RePub Request; Call for Proposals; Proposal Deadline; # of white papers)
5. Next IHE AP Meetings
   1. Next conference call November 12 (9am Central US)??
   2. F2F meeting planned for Paris around June 18-21, 2014
   3. Proposed F2F to take place during 12th European Congress on Digital Pathology meeting