Réunion Annuelle IHE France 8 janvier Anatomic Pathology Domain (PAT) Co-chairs : C.Daniel (France), M.Garcia-Rojo (Spain),T.Schrader (Germany) ARPH Supplement : W.Scharber (USA), F.Macary (France)

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 Overview Intra hospital integration profiles Ordering and performing anatomic pathology exams Community Anatomic Reporting for Public Health

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 Organization of Anatomic Pathology Technical Framework

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 Anatomic Pathology Workflow (APW) Addressed by the 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. 4

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 Anatomic Pathology Workflow (APW) ADT Registration Order Placer Orders Placed Modality worklist Acquisition Modality (gross imaging/microscopic imaging) Acquisition completed Order Mgmt Patient Adm Mgmt PACS (Image Archive/ Image Manager) Images stored Order Filler Orders accepted Report created Report Mgmt Care Ward Patient mgmt. Anatomic Pathology Laboratory Report/result Repository Reports stored Image Mgmt

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 APW actors & transactions

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 APW profile dependencies

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 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

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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 9

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 Test cases Specimen model : Usual situation Specimen can be identified by containers ID Gross imaging Virtual slide

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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. 12

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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.

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 Reporting Anatomic pathology to public health repositories (ARPH) 15

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 ARPH actors & transactions

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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, 10 th rev (and 9 th rev) *NAACCR - North American Association of Central Cancer Registries (

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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 18

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 Questions?

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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: Charité Universitätsmedizin Berlin Italy : Udine University US/Canada : CAP, NAACCR (North American Association of Central Cancer Registries) Japan : IHE-Japan 20

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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) 21

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 More information Googlegroup : ihe-anatomic-pathology- Road map & change proposals thology thology 22

Réunion Annuelle IHE France 8 janvier 2008 Webinar IHE August, 2009 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); Marcial García Rojo, 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); Ikuo Tofukuji, MD (Takasaki University of Health and Welfare, Japan), David Booker (HL7 AP, CAP). Informatics technology professionals Karima Bourquard, 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) 23