1. 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

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

3. 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

4. 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

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

6. 2005 current projects Review of the anatomic pathology subset
Review of the cancer registry subset

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

8. Anatomic Pathology and Cancer Registry Subsets

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

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

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