1. IHE Anatomic Pathology DICOM WG26
Dr Christel DANIEL
IHE Anatomic Pathology co-chair
IHE Anatomic Pathology - San Diego 2011

2. Agenda Results of recent IHE efforts PathLex
Better use of DICOM in Anatomic Pathology workflow
DICOM Modality Work list
Better procedure steps management consistencly with AP device connectivity+++
IHE Anatomic Pathology - San Diego 2011

3. Overview Intra hospital integration profiles Community
Anatomic Pathology Workflow (APW)
Ordering and performing anatomic pathology examinations
Community
Anatomic Reporting for Public Health (ARPH)
Sending anatomic pathology reports to public health organizations
Anatomic Pathology Structured Report (APSR)
Sharing/exchanging structured anatomic pathology reports as CDA documents
IHE Anatomic Pathology - San Diego 2011

4. Organization of Anatomic Pathology Technical Framework
2010
2011
Revision 2.0 July 23, 2010 Draft for Trial Implementation
2010 & 2011 Supplements for Trial Implementation
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5. Anatomic Pathology Workflow (APW)
Establishes the integrity of basic pathology data acquired for examinations being ordered for an identified patient
Defines the actors and transactions involved in
Ordering and reporting aspects of the workflow
Order entry, report creation and transmission.
Imaging aspects of the workflow
Image acquisition, storage and distribution among multiple systems.
IHE Anatomic Pathology - San Diego 2011

6. Anatomic Pathology Workflow (APW)
Hospital
Care Ward
Anatomic Pathology
Laboratory
Image Archive/
Image Manager
(PACS)
Image Mgmt
Order
Mgmt
Order Placer
Acquisition Modality
Report Mgmt
Order Filler
Order result tracker
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7. APW actors & transactions
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8. Standards used HL7 v2.5 DICOM 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 & 6)
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
Supplement 122 : Specimen Identification Module and Revised Pathology SOP Classes
Supplement 145 : Whole Slide Image Information Object Definition (WSI IOD)
IHE Anatomic Pathology - San Diego 2011

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
IHE Anatomic Pathology - San Diego 2011

10. Test cases Specimen model : Usual situation
Specimen can be identified by containers’ ID
Gross imaging
Virtual slide
IHE Anatomic Pathology - San Diego 2011

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
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12. Anatomic Pathology Reporting to Public Health (ARPH)
Joint initiative : IHE AP, HL7 AP, NAACCR (North American Association of Central Cancer Registries), CDC (Centers for Disease Control).
Defines the actors and transactions involved in anatomic pathology reporting to public health organizations.
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
1. Proposed Work Item: Workflow for Reporting Anatomic pathology to Cancer Registry
Editors: Wendy Scharber, Christel Daniel
Note: This does not include the structured reporting concept.
2. The Problem
Cancer Registries are data systems that collect data on the occurrence of cancer; the type, extent, and location of the cancer; and the type of initial treatment. In each registry, medical facilities (including hospitals, physicians' offices, therapeutic radiation facilities, freestanding surgical centers, and anatomic pathology laboratories) report these data to the state central cancer registry. The cancer information gathered is critical for Public Health to have the ability to report Cancer Statistics. Cancer registry data is used to provide information on cancer trends, survival, treatment standards, access to healthcare and serves as a resource for research.
Historically, Cancer Registries have received paper reports from anatomic pathology laboratories (if received at all) and the registries are required to send Cancer Registrars into laboratories to manually identify reportable cases and abstract pertinent information into an electronic form. This type of case ascertainment and data collection for the cancer registry is very resource intensive, time consuming, and prone to error in transcription and in missed cases. The process could benefit greatly from the implementation of standards reporting pathology information directly to the central cancer registry.
Further information on the benefits, challenges and the cancer registry's uses of electronic pathology reporting can be found in the:
[1] : North American Association of Central Cancer Registries (NAACCR) Electronic Pathology (E-Path) Reporting Guidelines, Dec 2006.
3. Key Use Case
A woman notices a black jagged mole on her right arm. She makes and keeps an appointment with the clinic dermatologist. The dermatologist performs a biopsy and sends the tissue sample to the anatomic pathology laboratory for review and diagnosis.
The anatomic pathology laboratory receives the specimen. The pathologist analyzes the specimen and makes the diagnosis of: malignant melanoma.
Currently: The pathology staff sends a copy of the completed pathology report to the dermatologist and it is subsequently filed in the patient’s clinic medical record. End of Current Use case….resulting in an unreported cancer diagnosis.
IHE World: The anatomic pathology laboratory information system identifies a notifiable event and transmits the data to the central cancer registry using IHE standards. The patient does not already exist in the Central Cancer Registry database, so the registry creates a record of the patient’s cancer and automatically populates appropriate data items in the cancer registry record. The registrar validates the populated data and the information is available for analysis and research.
4. Standards & Systems
Technical Framework
[2] The North American Association of Central Cancer Registries (NAACCR) Standards for Cancer Registries Volume V: Pathology Electronic Reporting; Version 2.1
HL7 Version 2.5.1
Logical Observation Identifiers Names and Codes (LOINC)
Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT)
NAACCR Search Term List
International Classification of Diseases for Oncology, 3rd Edition (ICD-0-3)
Message Conformance
Message can be validated using:
[3] : NAACCR Volume V Messaging Workbench Profile.
5. Discussion
The World Health Organization reports that cancer is a leading cause of death worldwide. The disease accounted for 7.9 million deaths (or around 13% of all deaths worldwide) in Many countries support cancer reporting and cancer surveillance activities to national cancer programs which serve as the foundation for a comprehensive strategy to reduce illness and death from cancer.
Population-based cancer registries provides information that can be used: By physicians to tell a patient that is just diagnosed with cancer what his/her prognosis is What kind of treatment has the best chance for a cure in his/her situation By public health planners to effectively allocate resources for cancer screening, prevention and control To produce statistics like: 1 in x women will be diagnosed with a breast cancer
In developed countries, between 70 and 95 percent of cancers have one or more pathology reports describing the disease; in the United States, it is approximately 95%. Because anatomic pathology laboratories are a primary source of cancer information, electronic reporting is a timely, accurate, and cost-effective means of obtaining the information.
Retrieved from "
IHE Anatomic Pathology - San Diego 2011

13. Anatomic Pathology Reporting to Public Health (ARPH)
Hospital
Healthcare
community
Care Ward
Anatomic Pathology
Laboratory
Report
Receiver
Order Filler
Public Health
Report Mgmt
Report Sender
Clinics
Anatomic Pathology
Laboratory
Report Sender

14. ARPH actors & transactions
IHE Anatomic Pathology - San Diego 2011

15. Standards used HL7 v2.5 LOINC SNOMED CT NAACCR*
ORU^R01 message (PAT-10)
LOINC
SNOMED CT
NAACCR*
Standards for Cancer Registries Volume V: Pathology Laboratory Electronic Reporting v3.0
Search Term List
International Classification of Diseases, 10th rev (and 9th rev)
*NAACCR - North American Association of Central Cancer Registries (
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16. Anatomic Pathology Structured Report (APSR)
Joint IHE and HL7 anatomic pathology initiative
Content integration profile standardizing Anatomic Pathology Structured Report (APSR) using HL7 CDA
APSR as CDA documents including Anatomic Pathology observations bound to images or regions of interest
Shared or exchanged within a community of care providers using existing integration profiles defined by IHE Information Technology Infrastructure
Unique opportunity to share/exchange Anatomic Pathology Structured Reports that are semantically interoperable at an international level
Royal College of pathologists Australasia
Describes an anatomic pathology report as an electronic document to be published towards a document sharing resource such as a Personal Health Record (PHR) shared by a community of care providers, using one of the document sharing profiles defined in ITI-TF.
Such an electronic document contains the set of observations produced by an anatomic pathology laboratory in fulfillment of an Order or an Order Group
The definition of required, preferred and optional elements in APSR is mainly based on [Glodsmith08] and, in the cancer domain, on clinical document models provided by US CAP and French SFP & INCa
The report is shared in a human-readable format AND contain anatomic pathology observations as well as links to relevant images in a machine-readable format, to facilitate the integration of these observations in the database of a consumer system.
The set of anatomic pathology observations in a machine-readable format, MAY also be used with appropriate content anonymization and patient identification pseudonymization to create shared repositories of anatomic pathology information.
IHE Anatomic Pathology - San Diego 2011

17. Scope APSR for surgical pathology Further cycles 21 CDA templates
Generic APSR template
All fields of anatomic pathology (inflammatory, vascular, traumatic, metabolic diseases as well as cancer)
20 organ-specific cancer APSR templates
“Traditional” anatomic pathology observation using light microscopy (including immunohistochemistry, FISH, etc)
Further cycles
Forensic (autopsy, toxicology)
Special ancillary techniques (flow cytometry, cytogenetics, electronic microscopy)
Research (TMA, etc)
IHE Anatomic Pathology - San Diego 2011

18. Background From clinical document models…
Recent recommendations for required, preferred, and optional elements for any APR of surgical pathology, regardless of report types [Goldsmith 08]
National initiatives
Anatomic Pathology SR (Netherlands, Germany, Australasia)
Cancer APSR
US - CAP (College of American Pathologists)
67 cancer checklists and protocols (October 2009)
France - SFP (French society of pathology) – INCa (French National Cancer Institute)
Minimum data sets for cancer APSR in 20 locations (85% of new cancers in France) (required by accrediting bodies)
Australasia
6 templates for cancer APSR
UK Royal college
Anatomic pathology reports (APR) document the pathologic findings in specimens removed from patients for diagnostic or therapeutic reasons. This information can be used for patient care, clinical research and epidemiology. Standardizing and computerizing APRs is necessary to improve the quality of reporting and the exchange of APR information.
As part of joint IHE and HL7 anatomic pathology activities, our objective is to provide a methodology and tools that facilitate the development of consensus-based APR templates and to publish an HL7 “Clinical Document Architecture” (CDA) implementation guide for these templates.
Glodsmith08 [Goldsmith, J.D., et al., Reporting guidelines for clinical laboratory reports in surgical pathology. Arch Pathol Lab Med, (10): p ] provides recent recommendations that delineate the required, preferred, and optional elements which should be included in any APR, regardless of report types.
Several international initiatives intend to define standard structured templates for specific types of APRs. For example, in the cancer domain, in the United States, the CAP (College of American Pathologists) has published 67 cancer APR templates (cancer checklists and background information) [ In France, the SFP (French society of pathology) has published 23 APR templates (cancer checklists associated to Comptes Rendus Fiches Standardisées, CRFS) that cover the main cancer domains [ Together, the recommendations for generic and specific APR reporting requirements have become clinical guidelines, the use of which may be required by accrediting bodies.
In addition to standardizing the cancer APR contents, it is necessary to computerize them. Several studies have focused on defining an appropriate IT standard comprising the structured and encoded clinical documents (e.g. CAP eCC). HL7 CDA is one of the most reliable standards that can support these needs. CDA allows the clinical data to be both machine and human-readable and provides a framework for incremental growth in the granularity of structured, codes-bound clinical information. This document takes into consideration currently very few national initiatives of CDA implementation guides for the APR, one example being developed at the National IT Institute for Healthcare in the Netherlands [ pdf.].
Proposed Workitem:
Proposal Editor: Thomas Schrader, CHristel Daniel
Editor: Thomas Schrader?
Domain: Anatomic Pathology
2. The Problem
The transaction related to the reporting worflow (PAT3-Order Results Management) of the IHE Anatomic Pathologyt Technical Framework is mainly dedicated to storage and sharing of free text anatomic pathology reports.
There are many initiatives in different countries and/or within standardization bodies (HL7, CEN)aiming at proposing standard structured architecture for anatomic pathology reports.
CEN TC 251 WI :2003 : A histology report may be divided into sections describing the: macroscopic appearance, microscopic features and the conclusion of the service provider based on these findings. Each of these sections may consist of free-text, measurements (e.g. size, weight etc.) and code values representing the findings.Different healthcare parties may be responsible for different parts of a report. Furthermore, overall responsibility for reviewing and signing-off the reports may rest with yet another supervisory healthcare party.
CAP Cancer Protocoles and checklists (US)
INCa (France)
Royal College (UK), etc)
Generally speaking, according to “evidence-based pathology”, only features that are reproducible and relevant – with a demonstrated diagnostic or prognostic signification – should be reported in description and corresponding evidence available”.
The obective of this white paper is to collect, analyze and summarize these different initiative in order to discuss the available technical solution to store and share strucred reports in anatomic pathology and to choose the most appropriate one.
Confidentiality issues are out of the scope of this white paper
3. Key Use Case
Activity diagrams and strucured reporting will be defined for the use cases already available in the IHE Anatomic Pathology TF
1 USE CASE 1: SURGICAL PATHOLOGY – OPERATIVE SPECIMEN
1.1: Surgical pathology – one specimen per container
1.2: Surgical pathology - more than one specimen per container
1.3: Surgical pathology – two requested procedure per order
2 USE CASE 2: SURGICAL PATHOLOGY – BIOPSIES
2.1: Biopsies – one specimen per container
2.2: Biopsies – more than one specimen per container
3 USE CASE 3: CYTOLOGY
3.1: Cytology – one specimen per container
3.2: Cytology – more than one specimen per container
4 USE CASE 4 : AUTOPSY
5 USE CASE 5: TISSUE MICRO ARRAY (MORE THAN ONE SPECIMEN FROM MORE THAN ONE PATIENT PER CONTAINER)
4. Standards & Systems
XDS - CDA
cf LAB domain
HL7 v3 : Domaines Laboraory, Specimen, Observation
5. Discussion
Will be especially considered the following issues and barriers :
Medical consensus is not easy to achieve at regional/national/international level about important features that should be reported as well as the vocabulary and/or code system to use.
Standard information models (templates) are not available.
"International" code systems are mainly available in English and ther content coverage with regards to the content of anatomic pathology reports has not been formally evaluated
Structured reports may be built from different sources(APIS, post processing station ("evidence" creation), etc). A crucial issue is to identify a technical solution to handle templates of structured reports including findings and their evidences. It should be possible to link each observation or finding to the specimen source (part(s) (Box ID) for macroscopic findings, tissue item (Slide ID) for microscopic findings)).
Moreover it must be possible to link each observation or finding to the image(s) or region of interest of image(s) acquired from the specimen source. Complex diagnostic structured reports include numeric quantitative measurement, images or graphs, image annotation and links between image (and/or evidence) information and textual information.
Structured reports may be designed for multple uses : patient care but also "secondary use" (clinical research, cancer registries, cancer multi(disciplinary meetings, etc). We have to carefully analyse these different contexts of producing structured reports (workflow) in order to define both templates and IT solution to support these different uses.
Goldsmith, J.D., et al., Reporting guidelines for clinical laboratory reports in surgical pathology. Arch Pathol Lab Med, (10): p

19. Background … to IT templates
Non healthcare IT standard
CAP electronic Cancer Checklist
Healthcare IT standard
CEN archetypes
Australia
HL7 CDA
Most reliable standard for clinical document templates
Existing implementation guides for the APSR ?
Netherlands, Germany
Most reliable standard for clinical document templates
International standard (ISO/HL :2009 Data Exchange Standards - HL7 Clinical Document Architecture, Release 2)
Clinical data are both human-readable and machine
In addition to standardizing the cancer APR contents, it is necessary to computerize them. Several studies have focused on defining an appropriate IT standard comprising the structured and encoded clinical documents (e.g. CAP eCC). HL7 CDA is one of the most reliable standards that can support these needs. CDA allows the clinical data to be both machine and human-readable and provides a framework for incremental growth in the granularity of structured, codes-bound clinical information. This document takes into consideration currently very few national initiatives of CDA implementation guides for the APR, one example being developed at the National IT Institute for Healthcare in the Netherlands [ pdf.].
IHE Anatomic Pathology - San Diego 2011

20. Anatomic Pathology Structured Report (APSR)
Hospital
Healthcare
community
Care Ward
Anatomic Pathology
Laboratory
Document Repository
Order Filler
Document sharing
Document Source
Clinics
Anatomic Pathology
Laboratory
Document Source

21. APSR actors & transactions
Content (Anatomic Pathology Structured Report) is created by a Content Creator consumed by a Content Consumer.
Sharing or transmission of content from one actor to the other
XDS, XDM and XDR Integration Profiles, described in Volume 3 of the Anatomic Pathology Technical Framework.
IHE Anatomic Pathology - San Diego 2011

22. CDA Document Content Module (n=21)
Any APSR CDA document content module is composed of a header and a structured body.
2 types of CDA Document Content Modules
Generic APSR ( )
20 organ-specific cancer APSR
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23. CDA Section Content Modules (n=6)

24. CDA Entry Content Module (n=5) e.g Diagnosis entry
Diagnoses on all specimens that are delivered to the pathology reported separatly
Additional pathologic finding(s), results of ancillary studi(es) & images
In case of cancer, this section includes the cancer checklists

25. Anatomic Pathology Observation
[0..*] <value> (zero to many response)
coded (code, coding system, version, display name)
[0..*] <qualifier> (post coordinated expression)
numeric (integer or real, unit)
textual

26. The CDA Iceberg Pathologist/clinician sees Machine sees
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27. The pathologist/clinician sees…
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28. The pathologist/clinician sees…
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29. The machine sees… IHE Anatomic Pathology - San Diego 2011
<ClinicalDocument xmlns='urn:hl7-org:v3'> <typeId extension="POCD_HD000040" root=" "/> <!-- conformance to a generic APSR content module --> <templateId root=' '/> <!-- conformance to a cancer APSR content module --> <templateId root=' '/> <!-- conformance to a breast cancer content module --> <templateId root=' '/> ...remainder of the header not shown ... <component> <structuredBody> <section> <templateId root=' '/> <code code=' ' displayName=’Pathology report relevant history' codeSystem=' ' codeSystemName='LOINC'/> <title>Relevant information provided by the ordering physician</title> <text> Tissue submitted: left breast biopsy and apical axillary tissue </text> <entry> ... </entry> <code code=' ' displayName= ‘Reason for referral’ <title>Reason for anatomic pathology procedure</title> <text>Breast mass - left breast</text> </section> </component>
IHE Anatomic Pathology - San Diego 2011

30. Better use of DICOM in Anatomic Pathology workflow
DICOM Modality Work list
Supplement for Anatomic Pathology Reporting to Public Health that will be presented by Wendy Scharber. The Trial Implementation version of this supplement is available inthe ihe.net website since yesterday. CDC & NAACCR
This document, the Anatomic ¨Pathology Technical Framework (IHE PAT TF) is produced with the help of these organizations:
ADICAP (Association pour le Développement de l’Informatique en Cytologie et Anatomie Pathologique)
SEIS (Spanish Health Informatics Society)
SEAP (Spanish Society of Pathology)
SFP (French Society of Pathology)
IHE Anatomic Pathology - San Diego 2011

31. What is anatomic pathology? It is not radiology
Order
=> report
Imaging procedure step is optional
Specimen-driven
One study = one or more specimen (one or more patients)
Slides always available
Order
=> imaging procedure => report
Patient driven
One study = one patient
The diagnostic process in anatomic pathology also differs from that in radiology since it is specimen-driven.
Images of the same study corresponding to the same order may be related to different specimen (parts and/or slides) from one or even from different patients (e.g. in anatomic pathology imaging for research e.g in case of digital Tissue Micro Array). Unlike patients in radiology, in AP, slides are always available to acquire more images, if needed.
In digital AP imaging, for a single procedure, images are performed by many types of imaging equipments (gross imaging, microscopic still imaging, whole slide imaging, multispectral imaging, etc).
In radiology, the diagnostic process is patient-driven, an examination (study) usually involves a single image acquisition modality and all images of the study are related to one and only one patient.
IHE Anatomic Pathology - San Diego 2011

32. Modality Work list: Requested procedure, accession number & Study
Order & Requested procedure
The Order Filler translates the received Orders into Requested Procedure(s) identified by Order Filler Numbers and automatically assigns Study Accession Numbers
Accession number <-> Order Filler Number
The unique identifier assigned by the Pathology Information System of an Anatomic Pathology laboratory to an imaging Study.
As expressed in DICOM Supplement 122: The concept of “accession” in Anatomic Pathology has been determined to be sufficiently equivalent to an “accession” in Radiology so that the existing Accession Number at the Study level may be reused for the same purpose and with essentially the existing definition.
For Anatomic Pathology, like in Radiology, the Accession Number may correspond to the Order Filler Number, as specified in HL7 v2.x.
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33. Modality Work list Procedure step & Series
A Procedure Step (“Work Order Step”) is an atomic operation belonging to Requested Procedure, to be performed on one specimen by a single type of device (e.g. immune-histo-chemistry automaton, staining automaton, image acquisition modality).
Some Procedure Steps are dedicated to image acquisition
Series
A subset of an imaging Study acquired from a single specimen by a single acquisition modality.
Whenever an image is acquired from a new specimen or involves a new acquisition modality a new Series is created.
A new series is also created when an image is acquired for an existing study after the original order has been fulfilled.
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34. Modality Work list Requested procedures & procedure steps
OR123: Lungectomy
DP07110: Lungectomy
DP07110-A: Left upper lobe (gross image)
DP07110-A-1: Frozen section, mass
DP07110-A-1-1: FS
DP07110-A-1-2: H&E
DP07110-A-2: Entire mass
DP07110-A-2-1: H&E (WSI)
Order
Study
“Case”
OrderFiller ID
Accession Number =
One Requested procedure
Series
Two “ (imaging) procedure steps”
Two “procedure steps”
IHE Anatomic Pathology - San Diego 2011

35. Modality Work list Requested procedures & procedure steps
Order : “AP examination of Breast biopsy”
Requested procedure : “Imaging of AP examination of Breast biopsy” (at the patient level)
= ACCESSION NUMBER = OrderFiller ID
(Imaging) procedure step: “scanning Slide DP07110-A-5-1”
(at the specimen/derived specimen level)
Order : “Mammography”
Requested (imaging) procedure : “mammography”
(at the patient level)
= ACCESSION NUMBER = OrderFiller ID
IHE Anatomic Pathology - San Diego 2011

36. Modality Work list
A mechanism defined to support the imaging workflow, by which the Patthology Information System provides the attributes of the imaging subject to modalities.
In anatomic pathology, the imaging subject is a specimen derived from the patient.
Query Modality Worklist: “Based on a query entered at the Acquisition Modality, a modality worklist is generated listing all the items that satisfy the query. This list of Scheduled Procedure Steps with selected demographic information and information about specimen is returned to the Acquisition Modality.”
The Modality Worklist provides patient, order (study) and specimen identification and description to be included in the acquired images.
The attributes of the Specimen Module have been defined in a ‘Macro’ construct, and added to the Scheduled Procedure Step Module of Modality Worklist.
IHE Anatomic Pathology - San Diego 2011

37. Modality Work list Requested procedures & procedure steps
Order : “AP examination of Breast biopsy”
Requested procedure
Procedure step: “scanning Slide DP07110-A-5-1”
Worklist (attributes of the imaging subject)
List of requested procedures (patient/study level)
List of procedure steps (specimen/series level)
Order : “Mammography”
Requested (imaging) procedure : “mammography”
Worklist (attributes of the imaging subjec )
List of requested procedures (patient/study level)
IHE Anatomic Pathology - San Diego 2011

38. Modality Work list Specimen description
DICOM Supp 122 : “Robust new Specimen Module at image level of hierarchy”
Specimen short/detailed textual description
Including specimen ancestry description in case of derived specimen
In conformance with DICOM supp122, the short textual description of a specimen retrieved from the Order Filler is a concatenation of the short description of the specimen and all the short descriptions of the specimen ancestry
Example : Whole Slide Image of DP07110-A-5-1
DP07110-A: Left upper lobe
DP07110-A-5: Left upper lobe/Tumor
DP07110-A-5-1:H&E
DP07110-A-5-1: Left upper lobe/Tumor/H&E
IHE Anatomic Pathology - San Diego 2011

39. More information
Googlegroup :
Road map
In 2005, ADICAP (French Association for the Development of Informatics in Cytology and Anatomic Pathology), GMSIH (Group promoting the Modernization of Hospital Information Systems in France), SEAP (Spanish Society of Anatomic Pathology), SEIS (Spanish Health Informatics Society) and IHE-Japan launched an IHE initiative in the Anatomic Pathology domain.
IHE Anatomic Pathology - San Diego 2011