George G. Birdsong

Background: Pathology reports contain critical information necessary for the management of cancer patient care. Efforts to structure pathology cancer reports by the College of American Pathologists and the International Collaboration on Cancer Reporting (ICCR) have been successful in standardizing pathology reports. Likewise, standards development organizations have advanced methods to improve data computability and exchange, by enabling interoperability of pathology cancer reports. Objective: This study aimed to provide a tractable method to render pathology cancer reports computable and interoperable using published cancer reporting protocols, SNOMED Clinical Terms (SNOMED CT) and Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). Methods: The ICCR colorectal cancer (CRC) reporting dataset (version 1.0) was evaluated by terminologists and pathologists. SNOMED CT concepts were bound to the data elements. The dataset was then converted into a FHIR structured data capture (SDC) questionnaire using the United States National Library of Medicine tooling and rendered into a FHIR-conformant message for data exchange. Results: The ICCR CRC dataset contained 216 data elements; 207 data elements were bound to SNOMED CT and incorporated into a FHIR SDC construct. The 9 uncoded data elements were ambiguous and could not be reliably encoded. The resultant FHIR SDC form fully represented the ICCR CRC dataset and rendered these data in an R4 JSON format for data exchange. Conclusions: This study demonstrates a tractable and extensible approach to making cancer pathology reports fully computable and interoperable that can be broadly adopted. ICCR datasets are supported internationally and supported by multiple national pathology societies. These datasets can be fully represented using SNOMED CT to render data elements computable and semantically faithful to their intended meaning. The use of the FHIR SDC construct enables widespread and standardized data exchange of clinical information. While challenges remain, including FHIR adoption and the need to maintain current clinical content and standard terminology, this approach provides a clear pathway toward implementation.

BACKGROUND Pathology reports contain critical information necessary to manage cancer patient care. Efforts to structure pathology cancer reports by the College of American Pathologists and the International Collaboration on Cancer Reporting (ICCR) have been successful in standardizing pathology reports. Likewise, methods to improve data computability and exchange by standards development organizations have progressed to make pathology cancer reports interoperable. OBJECTIVE This study aims to provide a tractable method to render pathology cancer reports computable and interoperable using published cancer reporting protocols, SNOMED Clinical Terms (SNOMED CT) and Heath Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). METHODS The ICCR colorectal cancer (CRC) reporting dataset version 1.0 was evaluated by terminologists and pathologists. SNOMED CT concepts were bound to the data elements. The dataset was then converted into a FHIR structured data capture (SDC) questionnaire using the United States National Library of Medicine (US NLM) tooling and rendered into a FHIR conformant message for data exchange. RESULTS The ICCR CRC dataset contained 216 data elements, 207 data elements could be bound to SNOMED CT and incorporated into a FHIR SDC construct. The 9 uncoded data elements were ambiguous and could not be reliably encoded. The resultant FHIR SDC form fully represented the ICCR CRC dataset and rendered these data in a R4 JSON format data exchange. CONCLUSIONS This project demonstrates a tractable and extensible approach to make cancer pathology reports fully computable and interoperable that can be broadly adopted. ICCR datasets are supported internationally and supported by multiple national societies of pathology. These datasets are fully represented using SNOMED CT to render data elements computable and semantically faithful to their intended meaning. The use of the FHIR SDC construct enables widespread, common data exchange of clinical information. While challenges of FHIR adoption as well as maintaining currency of clinical content and standard terminology remain, the presented approach provides a clear pathway towards implementation.

PURPOSE: Over the past 50 years, multiple pathology organizations worldwide have evolved in cancer histopathology reporting from subjective, narrative assessments to structured, synoptic formats using controlled vocabulary. These reporting protocols include the required data elements that represent the minimum set of evidence-based, clinically actionable parameters necessary to convey the diagnostic, prognostic, and predictive information essential for patient care. Despite these advances, the synoptic reporting protocols were not harmonized across the various pathology organizations. Cancer pathology continues to be widely reported and stored in free-text format, or without encoded data such that it is neither computable nor interoperable across organizations. METHODS: In 2020, SNOMED International created the Cancer Synoptic Reporting Working Group (CSRWG). This resulted in international collaboration across multiple pathology organizations. CCRWG's mission was to use SNOMED Clinical Terms (CT) concepts to represent the required content within the College of American Pathologists (CAP) and International Collaboration on Cancer Reporting (ICCR) published pathology reporting protocols. RESULTS: In late 2023, the CSRWG published over 1,300 new or revised SNOMED CT concepts to represent all required pathology cancer data elements for adult and pediatric solid tumors in both CAP and ICCR using the semantic principles of the SNOMED-CT concept model. Thus, computability and interoperability would be broadly established. CONCLUSION: This work brings to fruition the longstanding desire for an international, interoperable, human- and machine-readable cancer pathology report for use in patient care, health care quality improvement, population health, public health surveillance, and translational and clinical trial research. The following report describes the project, its methods, and applications in the stated use cases.

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