Building a Standardized Cancer Synoptic Report With Semantic and Syntactic Interoperability: Development Study Using SNOMED CT and Fast Healthcare Interoperability Resources (FHIR).
Jieun Hwang, Alexander K Goel, Brian A Rous, George Birdsong, Paul A Seegers, Stefan Dubois, Thomas Rüdiger, Walter S Campbell
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引用次数: 0
Abstract
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.
背景：病理报告包含癌症患者护理管理所必需的关键信息。美国病理学家学会（College of American Pathologists）和国际癌症报告合作组织（International Collaboration on cancer Reporting， ICCR）为构建癌症病理报告所做的努力在标准化病理报告方面取得了成功。同样地，标准开发组织也有先进的方法来提高数据的可计算性和交换，通过实现病理癌症报告的互操作性。目的：本研究旨在提供一种易于处理的方法，使病理癌症报告可计算和互操作，使用已发表的癌症报告协议，SNOMED临床术语（SNOMED CT）和健康水平7 （HL7）快速医疗互操作资源（FHIR）。方法：由术语学家和病理学家对ICCR结直肠癌报告数据集（1.0版）进行评估。SNOMED CT概念被绑定到数据元素。然后使用美国国家医学图书馆工具将数据集转换为FHIR结构化数据捕获（SDC）问卷，并将其转换为符合FHIR的消息，以便进行数据交换。结果：ICCR CRC数据集包含216个数据元素；207个数据元素被绑定到SNOMED CT上，并被纳入FHIR SDC结构。9个未编码的数据元素是不明确的，不能可靠地编码。生成的FHIR SDC表单完全表示ICCR CRC数据集，并以R4 JSON格式呈现这些数据，以便进行数据交换。结论：本研究展示了一种易于处理和可扩展的方法，使癌症病理报告完全可计算和可互操作，可以广泛采用。ICCR数据集得到国际支持，并得到多个国家病理学会的支持。这些数据集可以使用SNOMED CT完全表示，以呈现可计算的数据元素，并在语义上忠实于其预期含义。FHIR SDC结构的使用使临床信息的广泛和标准化数据交换成为可能。尽管挑战仍然存在，包括FHIR的采用和保持当前临床内容和标准术语的需要，但这种方法为实施提供了明确的途径。
期刊介绍：
JMIR Medical Informatics (JMI, ISSN 2291-9694) is a top-rated, tier A journal which focuses on clinical informatics, big data in health and health care, decision support for health professionals, electronic health records, ehealth infrastructures and implementation. It has a focus on applied, translational research, with a broad readership including clinicians, CIOs, engineers, industry and health informatics professionals.
Published by JMIR Publications, publisher of the Journal of Medical Internet Research (JMIR), the leading eHealth/mHealth journal (Impact Factor 2016: 5.175), JMIR Med Inform has a slightly different scope (emphasizing more on applications for clinicians and health professionals rather than consumers/citizens, which is the focus of JMIR), publishes even faster, and also allows papers which are more technical or more formative than what would be published in the Journal of Medical Internet Research.
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