SNOMED CT® in Surgical Pathology and Cancer Registry Work John F. Madden, MD, PhD Duke University Mary Kennedy, CT(ASCP), MPH SNOMED International SNOMED Users Group September 8-9, 2005 Chicago

Overview History and composition of the surgical pathology working group (SPWG) Current projects Future projects

Overview of SPWG First meeting in 2003 Mission To operate as an open forum and advisory group to the SNOMED International Editorial Board To enable SNOMED to gather input from multiple perspectives about pathology, cancer registry content pertinent to SNOMED CT

Overview of SPWG Goals To review pathology content in SNOMED CT (e.g. ICD-O topography mapping) To review questions to codes assigned to the data elements in the CAP Cancer Protocols To review cancer registry data items for inclusion in SNOMED CT To review the anatomic and cancer registry subsets and extensions To investigate new opportunities to showcase pathology and cancer registry content To forward comments, suggestions and recommendations to the SNOMED Editorial Review Board

Composition of SPWG Pathologists Cancer registrars Software suppliers CDC representation NAACCR representation

2005 current projects Review of the anatomic pathology subset Review of the cancer registry subset

Future projects Demonstrating URI using the cancer registry subset Developing one or both of these subsets into OWL language

Anatomic Pathology and Cancer Registry Subsets

Why a subset? SNOMED CT core is a general-purpose, “context-free” vocabulary A “Rosetta stone” to allow communication across medical contexts But, the terminology as a whole is too big for any particular purpose

What is a subset? By contrast, a subset is a purpose-specific selection of Concepts, Descriptions, and Relationships appropriate to a particular specialty,organization or user context Defines a portion of SNOMED CT crafted for use by a specific audience

Why focus on anatomic and cancer registry subsets? They are ideal models for convergent terminology effort Cut across “hottest” areas of medicine (pathology, public health, epidemiology, oncology, molecular, clinical trials, etc.) Complicated enough to be challenging, not so complicated as to be impossible Leverage the expertise inherent in the membership of the College Can help developers in creating a problem list for end users

Subset definitions Define the parameters or rules that are tested to determine subset membership Level of detail, e.g. for anatomic concepts Component exclusions, inclusions and prioritization Disputed coverage areas, e.g. benign tumors, hematologic diseases (Rappaport, Kiel, REAL, WHO classifications) “Representation style”: pre-coordinated versus compositional Interoperability with healthcare messaging frameworks (HL7, PHIN, etc.) Define the contents of the subsets

Issues for the AP / cancer registry subsets How can we align the many vocabularies to enhance interoperability? Key strategic point: capture the user base that drives the US/Canadian health agenda for these areas What are the traditional users bases? SNOMED = pathologists, general practitioners ICDO-3 = pathologists, cancer registrars ICD9-CM = oncologists, insurance companies, Collaborative staging = registrars, government NCI EVS = researchers NAACCR data set = cancer registrars Any/all = clinical trials and research, pharmaceutical companies

Issues for the AP/cancer registry subsets Current subsets Design decisions Many highly-specific, “ready-made” terms that stand alone (“heavily pre-coordinated vocabulary”) Other terms, along with a grammar that lets users combine them “on-the-fly” to produce more specific assertions (“compositional model”) This is NOT an either-or decision, but a stylistic continuum

Anatomic Pathology subset First created from a combination of the original Surgical Pathology Microglossary and parts of additional SNOMED CT hierarchies Currently over 60,000 concepts Want to reduce the subset to a smaller size

Cancer Registry Subset First created from a combination of ICD-O topography and morphology with cancer registry specific content (e.g. administrative items, occurrence, tumor finding) Used the surgical pathology microglossary as its backbone Want to reduce the subset to a smaller size

SPWG timeline SNOMED is committed to reviewing the anatomic and cancer registry subsets by the end of 2005 SNOMED understands the value of cooperation and a collaborative system to create refined subsets

Future projects Showcasing the revised subset(s) in a different format (resource description framework example) Reviewing the ICD-O topography mapping Gap analysis of the NAACCR data items

Resource Description Framework example Will use either the anatomic pathology or cancer registry subset John Madden, MD PhD will lead the study

Next SPWG meeting Open forum tomorrow, September 10 from 8:00 am – 12:00 pm Room Chicago Ballroom VIII All are invited to attend

Involvement in the SPWG Interested in future meetings or updates on this group? Please contact: Mary Kennedy at mkenned@cap.org Thank you!