BRIDG Imaging Project Nov. 25th, 2015

Agenda Project Goals & Objectives Imaging Projects of interest Rationale for aligning with BRIDG Principles on how to decide what goe sin BRIDG BRIDG imaging use cases HL7 FHIR Imaging resources to BRIDG mapping status Summary Detail (examples) BRIDG classes Next Steps?

Attendees Ed Helton Uli Wagner David Clunie Wendy Ver Hoef Smita Hastak

Goal & Objectives Project Goal: To provide the semantic foundation for supporting standards-based interoperability between the imaging, clinical and genomics domains to enable advances in precision medicine. Project Objectives: To align the Imaging concepts from various NCI and external standards initiatives and harmonize or align with the BRIDG model concepts Add Imaging semantics to BRIDG to ensure that BRIDG represents the imaging concepts needed to support NCI efforts – NBIA, AIM, Micro-AIM, CIP, CTIIP. This does not necessarily mean that all imaging concepts will be in BRIDG, but that BRIDG is able to implement modeling-by-reference and point correctly to external standards to enable interoperability.

Imaging related projects of interest 1.External Standards and Initiatives 1.HL7 FHIR – resources developed by the HL7 Imaging Integration WG 2.CDISC Oncology domain/variables 3.DICOM caDSR (has a subset of DICOM attributes); NBIA (subset of DICOM) 4.David Clunie’s project – spreadsheet of data elements used 2.NCI Projects 1.AIM 2.NBIA 3.CIP- CTIP 4.Micro-AIM

Reason for why we may need to have Imaging concepts in BRIDG when we have AIM+NBIA+HL7 FHIR Potential semantic gaps in the AIM+NBIA+FHIR initiatives Lack of support for other imaging types (all these support radiology imaging) Pathology imaging Animal imaging Cellular Imaging Microscopic Imaging Lack of support for Analytics Need for structured data Provide support to enable interoperability between imaging and other sub- domains of biomedical research in a consistent and structured format With molecular biology (genomics); with clinical research; co-clinical trials (running animal trials in parallel to human trials - e.g., MMHC)

How do we decide what needs to be in BRIDG? Some guiding principles: If a standard exists, leverage and re-use the standard rather than represent it again in BRIDG. Align with existing overlapping BRIDG concepts If we use “modeling-by-reference” for Imaging, then we should not model all the Imaging concepts in BRIDG Instead we review what FHIR, AIM and NBIA has Extend these models for BRIDG use cases Maintain semantic alignment with other initiatives Develop a mechanism or methodology to support referencing of other standards efforts, such as DICOM (for Imaging), GA4GH (for clinical genomics), CDISC SDTM Pharmacogenomics (PGx), etc.

What are the BRIDG Imaging use cases? – in order of priority 1.Identification of entities – person, animal, specimen, image DICOM has specimen identification 2.Image acquisition 3.Image Type (modalities) 4.Annotation 5.Structured Reporting (Pat M, Daniel R effort) 6.Pathology (WSI); electron microscopy(J Saltz) 7.Archiving (building a single archive for radiology, WSI and proteogenomic) 8.Support gene panels Need to prioritize the use cases to help define scope of the effort Action Item: David C to send us a link to a Imaging SR book Iteration 1

HL7 FHIResources for Imaging 1.ImagingStudy 2.Patient 3.Organization 4.Location 5.Practitioner 6.DiagnosticOrder 7.Group 8.Medication, (may not be applicable most of the time) 9.Substance (may not be applicable most of the time) 10.Device 11.Encounter 12.Specimen 13.RelatedPerson 14.Any *** (this could be any resource defined in the FHIR inventory)

Summary of the HL7 FHIR to BRIDG mapping activity 284 distinct elements total in the ImagingStudy resource and the other 12 referenced resources 198 of the 284 distinct elements total are already supported in BRIDG (69%) 86 distinct elements remaining are either potential BRIDG changes, derived, or implementation-specific from a BRIDG perspective Note that some concepts are partly supported and partly require potential BRIDG changes so there may be overlap between groups of supported vs BRIDG changes (numbers are necessarily approximate).

Overlap of Imaging Resources with BRIDG 4.0 Extensive overlap on the supporting contextual classes/concepts For example: Patient, Organization, Location, Practitioner, Substance, Medication, Encounter, Device, Related Person, etc. Gap or minimum support/map for very specific Image related classes For example: Image series, details of the imaging diagnostic order, details of Imaging study, etc. Note: Detailed mapping of Imaging related FHIR resources to BRIDG 4.0 is documented in an excel spreadsheet

FHIR mapping discussion topics Questions/Comments? BRIDG contextual classes Representation and data type differences BRIDG Imaging classes that overlap with Imaging Resources Do we remove from BRIDG and point to FHIR? Imaging sub-domain with links/urls to FHIR pages? Do we keep in BRIDG and also point to FHIR? Maintenance; ownership, etc. Overlap between DICOM and FHIR?

Next Steps – Open Discussion Review the BRIDG 4.0 to Imaging Resource mapping with David C. Define next steps on aligning the semantics Identify the priority on Imaging use cases (see slide 4) Meetings: Weekly in December starting Dec 9 th Agenda – Dec 9 th - DICOM overview/ Clinical research in DICOM Dec 16 th – Joel Saltz and Jose Galvez Overview of the project Every other week in January

Back up slides – details of mapping

Existing BRIDG Classes Leveraged to Support ImagingStudy Concepts & Other Referenced Resources Activity Animal AssociatedBiologicEntity BiologicEntity BiologicEntityGroup BiologicEntityGroupIdentifier BiologicEntityIdentifier Container DefinedActivity DefinedEligibilityCriterion DefinedEligibilityCriterionAnswer DefinedObservationResult DefinedSubjectActivityGroup Device ExperimentalUnit HealthcareFacility HealthcareProvider HealthcareProviderGroup HealthcareProviderGroupMember Image Manufacturer Material MaterialIdentifier MaterialName ObservationResultActionTakenRelationship Organization OrganizationIdentfier PerformedActivity PerformedCompositionRelationship PerformedObservation PerformedObservationResult Performer Person Place PointOfContact Processor Product ProductGroup ProductRelationship QualifiedPerson ServiceDeliveryLocation StudySite Subject

Potential Changes to or Addition of These Classes (bold indicates brand new classes) BiologicEntity Device DiagnosticOrder ExperimentalUnit HealthcareProvider HealthcareProviderGroup Image ImagingSeries ImagingStudy ImagingStudySupplementalIdentifier Material PerformedActivity PerformedCompositionRelationship PerformedDiagnosis PerformedObservation Person Place Product ProductGroup Software StorageEquipment Subject