Anatomic Pathology Domain (PAT)

1. Anatomic Pathology Domain (PAT) Co-chairs : C.Daniel(France), M.Garcia-Rojo(Spain) ,T.Schrader(Germany) ARPH Supplement : W.Scharber (USA), F.Macary (France)

2. Overview • Intra hospital integration profiles • Ordering and performing anatomic pathology exams • Community • Anatomic Reporting for Public Health

3. Organization of Anatomic Pathology Technical Framework

4. Anatomic Pathology Workflow (APW) • Addressed by the 2007-2008 cycle • Establishes the continuity and integrity of basic pathology data • Ordering and reporting aspects of the workflow • Transactions maintaining the consistency of ordering information, specimen management information and anatomic pathology reports. • Imaging aspects of the workflow • Acquisition, storage and distribution processes of images among multiple systems, enterprises and remote workstations.

5. Anatomic Pathology Workflow (APW) Patient mgmt. Care Ward Anatomic Pathology Laboratory Image Mgmt Modality worklist PACS (Image Archive/ Image Manager) Images stored Acquisition Modality (gross imaging/microscopic imaging) Acquisition completed Patient Adm Mgmt Order Mgmt Report Mgmt Report/result Repository Reports stored Order Placer Orders Placed Order Filler Orders accepted Report created ADT Registration

6. APW actors & transactions

7. APW profile dependencies

8. HL7 & DICOM standard versions used • HL7 v2.5 • OML^O21/ORL^O22 (PAT-1, 2 &4) • ORU^R01 + report (PAT-3) • DICOM • DICOM 2003 PS 3.4: Modality Worklist SOP Class (PAT-5) • DICOM 2007 PS 3.4: Storage Service Class • DICOM 2007 PS 3.4: Storage Commitment Push Model SOP Class • DICOM 2007 PS 3.4: Query/Retrieve Service Class • Supplément 122 : Specimen Identification and Revised Pathology SOP Classes

9. Test cases • Different « subspecialties » • Surgical pathology (4 cases) • Biopsies (2 cases) • Cytopathology (2 cases) • Autopsy (1 case) • TMA (1 case) • Complex relationships specimen/container • 1 specimen per container • several specimen per container

10. Test casesSpecimen model : Usual situation Specimen can be identified by containers’ ID Gross imaging Virtual slide

11. Test cases Unusual situation: Tissue Micro Array • More than one derived specimen on slide coming from the different blocks coming from different parts and from different patients

12. Reporting Anatomic pathology to public health repositories (ARPH) • Editors: W.Scharber, C.Daniel, F.Macary • Public Health organizations collect data of diseases diagnosed in anatomic pathology laboratories such as cancers or premalignant conditions. • The ARPH profile defines the actors and transactions involved in anatomic pathology reporting to public health organizations. • This integration profile will make it easier for anatomic pathology laboratories, public health agencies, and software vendors to adopt a uniform method for report or data transmission and processing. It will facilitate international electronic reporting of anatomic pathology data in public health domain.

13. Global Perspective of Cancer Surveillance • International Association of Cancer Registries • 241 Registries (Voting Member) from all 6 continents • North American Association of Central Cancer Registries • All Canadian Provinces • All US States • All US Territories and Jurisdictions

14. ARPH Use Case • Patient notices a black jagged mole on her right arm. • Dermatologist does a biopsy and sends the tissue sample to the pathology laboratory for review and diagnosis. • Pathologist analyzes the specimen and makes the diagnosis of: malignant melanoma. • Anatomic pathology LIS identifies the report as having a diagnosis of cancer (reportable event) and creates an HL7 2.5 message to send to the central cancer registry. • The Central Cancer Registries receives the message, codes the diagnosis and adds the case to the database.

15. Reporting Anatomic pathology to public health repositories (ARPH)

16. ARPH actors & transactions

17. Standards Used • HL7 v2.5 • ORU^R01 message (PAT-10) • LOINC • SNOMED CT • NAACCR* Standards for Cancer Registries Volume V: Pathology Laboratory Electronic Reporting v3.0 • NAACCR Search Term List • International Classification of Diseases, 10th rev (and 9th rev) *NAACCR - North American Association of Central Cancer Registries (www.naaccr.org)

18. White paper : Anatomic Pathology Structured Reports • Editors: C.Daniel, H.Kussaibi, F.Macary, M.Kennedy, D.Booker • Objective • Analysis of national initiatives for standardizing Anatomic Pathology structured reports • e.g CAP Cancer Checklists (US), SFP templates (France) • Choice of the IT format to store and share structured reports in anatomic pathology • Standards & Systems • HL7 CDA • HL7 v3 : Domains Laboratory, Specimen, Observation • DICOM SR

19. Questions?

20. More information IHE Anatomic Pathology - Users • France : ADICAP (Association for the Development of Informatics in Cytology and Pathology), SFP (French Society of Pathology) • Spain : SEIS (Spanish Society of Health Informatics), SEAP (Spanish Society of Pathology), SESCAM, Servicio de Salud de Castilla-La Mancha • Germany: CharitéUniversitätsmedizin Berlin • Italy : Udine University • US/Canada : CAP, NAACCR (North American Association of Central Cancer Registries) • Japan : IHE-Japan

21. More information IHE Anatomic Pathology - Vendors • Acquisition modalities: Tribvn/Aperio, Zeiss, VMScope, Hamamatsu, Aurora • LIS: Technidata (Montbonnot Saint Martin, France), Infologic (Valence, France), Satec, Isoft, Nexus, Paschmann GMBH • PACS Vendors: Agfa, GE, ETIAM (Rennes) • EHR: Medasys (Gif/Yvette)

22. More information • Googlegroup : ihe-anatomic-pathology-committee@googlegroups.com • Road map & change proposals • http://wiki.ihe.net/index.php?title=Anatomic_Pathology

23. Contributors to the IHE Anatomic Pathology Technical Framework • Practicing pathologists • Dominique Henin, MD, PhD (ADICAP, AP-HP, Paris, France); Fréderique Capron, MD, PhD (ADICAP, AP-HP, Paris, France); Bettina Fabiani, MD (ADICAP, AP-HP, Paris, France); Jean-Marc Guinebretière, MD (Centre René Huguenin, ADICAP, France); MarcialGarcíaRojo, MD, PhD (Hospital General de Ciudad Real, Ciudad Real, Spanish Society of Health Informatics-SEIS, Spain); Ernesto Moro (Universidad Rey Juan Carlos, Madrid, Spanish Society of Pathology-SEAP, Spain); Thomas Schrader, MD, PhD (La Charité, Berlin, Germany); John Gilbertson, MD (Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, United States); Bruce A. Beckwith, MD (Laboratory Medicine Department of Pathology, Salem, United States); Luis Goncalves, MD (Hospital de Evora, Portugal); IkuoTofukuji, MD (Takasaki University of Health and Welfare, Japan), David Booker (HL7 AP, CAP). • Informatics technology professionals • KarimaBourquard, PhD (GMSIH, Paris, France); Christel Daniel, MD, PhD (AP-HP, INSERM, ADICAP, Paris, France); Vincenzo Della Mea, PhD (Department of Mathematics and Computer Science, University of Udine, Udine, Italy); François Macary (GMSIH, Paris, France); Carlos Peces (SESCAM, Spain); Miguel Angel Laguna, PhD (HGCR-SESCAM, Spain); Eric Poiseau, PhD (IHE, France), Mary Kennedy (HL7 AP, CAP), Wendy Scharber (CDC-Contractor), Lori A. Havener (NAACCR) • Vendors • Didier Adelh (Samba Technologies); Jean-Christophe Cauvin, PhD (Medasys, Gif/Yvette, France); Emmanuel Cordonnier (Etiam, Rennes, France); Jacques Klossa, PhD (Tribvn, Chatillon, France); François Lecertisseur (Technidata); Damien Mazoyer (Infologic); Takashi Okuno (Olympus Medical Systems); Harry Solomon (GE, Chicago, United States)