New Oncology Archetypes

Hello from Dr Anjali Kulkarni , trained Radiation Oncologist based in India . Been associated with many tech ventures as Domain consultant . Currently joined a start-up Karkinos Healthcare based in India and we will be using openEHR platform for our oncology data platform . Been reading all resources and very happy to see the help community provides . Would require direction ,inputs from all experts and not so-experts :slight_smile: about how best we can design Oncology archeytypes , Will post a example soon , happy to hear more , Thanks .

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Hi - please do share - there are quite a few oncology-related efforts going on. Some of that is quite difficult to make international as there are often strong requirements to easily fir national registry/reporting requirements.

https://ckm.apperta.org/ckm/projects/1051.61.28 are some Cancer and Rare disease templates that we built.

@johnmeredith and colleagues in Wales are just finalising some templates around Chemotherapy and Radiation therapy (targets for imported data).

Welcome to the community! In Germany, we created and use multiple Archetypes around oncology as part of the HiGHmed consortium. This might be a good starting point and there should also be some opportunity to further standardize the Archetypes for the international realm: https://ckm.highmed.org/ckm/projects/867.116.5

There is standardisation on reporting coming from the ongoing College of American Pathologist’s cancer reporting protocols - CAP Cancer protocol templates

I’ve recently started to transfer these latest versions to archetypes that will fit within our OBS for lab tests

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Thanks all . This is very helpful to start .

Are these public ?

Yes, indeed. Via the link in my message, above.

I assume they would be a good starting point, but are not developed with a digital record in mind :woozy_face:

At the last effort in doing this I actually found quite a surprisingly high degree of clinical consensus in theCAP, RCPA (Aus/Nz) and RCPath Uk 'Synoptic reports/templates, so probably worth checking these too.

https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer

My lessons learned from last time was the variability of TNM and the recording requirements for tissue invasion, margins, nodal involvement which can be very different for reach cancer type. Trying to use generic archetypes for these worked but only just.

The other issue is that if you work for reporting standards like COSD in the UK, very often these differences are flattened out so they will just ask for a clinical TNM, even though every clinical TNM is practically very different, same it.

The Genomics England Cancer archetypes were very largely based on COSED, though we tried to use ‘front-line’ archetypes where-ever possible.

I’m glad you are doing this round @heather.leslie !!

Simples :woozy_face:

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Hi All , how can I share a sample archetype here? Which format ?

If you’re using the tools.openehr.org Archetype Designer, you can share it directly from there with a link. Click the share button to the left of the archetype ID. :smile:
image

https://tools.openehr.org/designer/#/viewer/shared/Pz9zaGFyZWRJZD0xJDMxNTFhNzA3ODQxMDQ4ZDY5MmQyZjcxODFkMDE2NmM3

Kindly review this Breast cancer surgical pathology related archetype . This is my very first attempt and looking forward for a critical review . Thanks

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Hi Anjali, and thanks for showing us your first archetype! :blush:

It looks like you’ve collected a data set for a pathology report. We have archetypes for a lot of these elements already, and I think this data set would fit well as a template based on those archetypes. I’ve tried to create a template as an exercise to see how your data set could fit with the existing archetypes.

A few elements are missing from the template, such as “Greatest dimension …”, “Residual invasive …”, “Neoadjuvant treatment …”. These can be added using one or more specialised CLUSTER archetypes, which haven’t been made yet.

The archetypes I’ve used in the template includes:

  • COMPOSITION.report
  • OBSERVATION.laboratory_test_result
  • CLUSTER.specimen
  • CLUSTER.anatomical_pathology_exam
  • CLUSTER.tnm-pathological

Have a look at the template here: https://ckm.openehr.org/ckm/templates/1013.26.379

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There is also a historical example here.

https://ckm.openehr.org/ckm/archetypes/1013.1.381

with the template and other material at https://ckm.openehr.org/ckm/archetypes/1013.1.381/resourcecentre

T o view the template press the View template button.

This is so old that CKM was not handling templates properly at the time!! I THese are definitely clinically outdated and our modelling patterns have evolved a bit since then but what you will see is that we tried to split out the for mcontent into a lot of smaller reusable fragments.

I think it is a worthwhile goal to try to incorporate (at least) CAP , RCPathUK, and RCPAN protocols as a maximal dataset as there is good clinical cooperation across these bodies.

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will do and let u know

and don’t worry about initially building it as one mega-archetype . Everyone does that at first (all of us ‘experts’ here included!!).

It is a kind of rite of passage :blush:

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You may also be interested in the master thesis of @theresehogbergmarder, FULL TEXT link and publication metadata.

Section 6.2+ for models of breast Cancer pathology, and section 7.2 if you want to see a resulting GUI built in Better’s EHR Studio.

I also believe Region Stockholm is modelling breast cancer information in openEHR right now.

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Thanks Erik - definitely helpful. There is a lot of work going on in the UK which we are hoping to share soon. @Paulmiller @johnmeredith
I suspect there may be some practical limits to alignment as, at least in theUK, much of the dat modelling/exchange is based around UK reporting standards e.g for Staging/grading, and a lot of local valuesets, not even coordinated within the UK but it will be great to see how others are trying to solve theres issues.

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It may be helpful to see national reporting standards as a moving/modifiable target and not set in stone forever. Getting wider international comparability of data is of interest to most researchers no matter where they live, and some scores etc seem to come from their international clinical/research collaboration organisations.

In Sweden the clinical professionals (and associated organisations) are involved in deciding reporting criteria to national research registries etc. There is now some interest in looking into if openEHR can be helpful in defining documentation patterns also useful for reporting/research.

It would be interesting to get see examples from other countries, so does anybody know of more examples than the ones mentioned earlier in this thread?

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Hi , is there any way for translation from German to English to view your archetypes ?
Thanks