New Oncology Archetypes

Hi Anjali,

Where translations are available in the archetype you can find the way to switch in the image below.

If there are no translations available I often set Google translate to translate the whole page - it works pretty well in most situations, at least enough to get a good sense of the content.

Thanks , will try .

Thanks Erik,

This is really good paper … @theresehogbergmarder, FULL TEXT link and publication metadata .

Anyone interested in oncology archetypes made especially histopathology reporting should have a careful read.

It picks up on some of the work that @heather.leslie and I did for the RCPA some years back but adapts it to both modern pathology practice and more recent archetype patterns. What’s nice is that it shows how what seems like ‘modelling’ theory can come alive as real forms and data persistence. Also great to see the combination of terminology and openEHR, and the fact that only one new archetype needed to be created.

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Referring to Ian’s remarks of the 23rd of February.

I can only imagine the difficulties in producing generic archetypes for different cancers without those becoming too basic and bland! You’re probably aware that the RCPath, RCPA and CAP are all united as founding organisations of the ICCR, the International Collaboration on Cancer Reporting (http://www.iccr-cancer.org). Perhaps this helps explain the homogeneity in their reports/templates.

Indeed Stefan,

Even 6 or 7 years a go the coherence between the various Path organisations around reporting was very apparent and a very pleasant surprise, in contrast to some other disciplines.

What was more surprising to me (as a naive GP) was the disparity between cancers in reporting things like nodal spread and margins, or even TNM because I assumed that this was merely about biology.

But of course, this is not just about pure biology. The reporting of nodal spread and margins reflects the utility in terms of treatment options and prognosis, and though there are commonalities, there is a lot of detailed difference, in part driven by the need to inform best practice.

This is an important principle which is often overlooked - medical records are not ‘virtual humans’ . Of course they do contain physiological and biological facts but many of these facts are re-interpreted or compressed and fused with experience to inform future care. Much of this is very subject to change as research better guides treatment, even though the basic biological facts are unchanged.

The HiGHmed archetype for radiation therapy “Bestrahlung” openEHR-EHR-CLUSTER.radiotherapy.v1 https://ckm.highmed.org/ckm/archetypes/1246.145.602/mindmap authored by @natalia.strauch looks useful also in international contexts. (Example use of this cluster archetype in a template: https://ckm.highmed.org/ckm/templates/1246.169.291)

Are there any plans to add it so the international CKM so that it can be translated (and later reviewed)? What would the first step to do that be?

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Hi Erik! I’m sure this archetype would be a good candidate for the international CKM. The steps would be as follows:

  1. The archetype needs an English language translation
  2. Someone needs to propose it as a candidate archetype.
  3. Someone needs to take on the role as editor, leading the reviews process. This can happen at a later date, if/when review and publication is required by one or more parties.
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@siljelb , if I can be of help in translating to English please let me know.

I tried opening @Dr_Anjali_Kulkarni’s contribution in tools.openehr.org/designer, but failed.

@heather.leslie I’m obviously very interested in knowing how far you’ve got with the transfer of the CAP cancer protocol templates to archetypes.

Work on Synoptic Reporting in Surgical Pathology in Sweden is attempting to combine on the one hand the Functional Design (FD) method used to develop the digital answer proformas for the 30-odd cancer types in The Netherlands in the highly regarded Palga system (Home | Palga.nl, forms only in Dutch on Protocollen | Palga.nl ), and on the other using the thus acquired inclusive functional item sets by pathologists to build pathology report archetypes in OpenEHR.

More detailed: in analogy to the Dutch method, we’ve developed an easy-to-use Excel-based FD interface for pathologists to communicate their needs (items, functionality, calculations) to the IT engineers who build the web-based pro-forma. The collection of items is consistent with international cancer data sets from CAP, RCPath, RCPA, and their combined ICCR, Palga, etc. For clarity and completeness, these international data sets are included in the same Excel-workbook, as well as the Snomed CT codes. In different stages of development are: Lower Urinary tract, Breast, Lung, Liver and Pancreaticobiliary, Colon and Melanocytic lesions. Nothing earth-shattering, I agree.

Introductory work is now being undertaken with Stockholm Region with Elham Gholami, Linda Aulin and Axel Tideholm. We will greatly benefit from @erik.sundvall’s expertise, who, if I’m not mistaken, will join in the effort after the summer holidays - in line with what he predicted in his post of the 17th March! Elham, Linda, Axel and I believe the first step is to start from the users = the pathologist and the clinician he or she is communicating with, and use these FD’s to construct Mindmaps in OpenEHR for organ-specific but hopefully also general pathology archetypes (clinical information, macroscopy, microscopy, ancillary investigations, etc.), so that non-pathologists get a better understanding of the subject matter being mapped. From there we hope to proceed in developing archetypes and templates, inspired by previous work by Ian, Thérèse Högberg Mårder, and others.

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That would be great! :smiley:

Normally we prefer translating archetypes in their originating CKM (in this case: ckm.highmed.org) before federating them to the adopting CKM (in this case: ckm.openehr.org). However, since we need the original language to be English for archetypes in the international CKM, we need to do some ADL hacking. I̶’̶v̶e̶ ̶u̶p̶l̶o̶a̶d̶e̶d̶ ̶t̶h̶e̶ ̶a̶r̶c̶h̶e̶t̶y̶p̶e̶ ̶i̶n̶t̶o̶ ̶a̶n̶ ̶i̶n̶c̶u̶b̶a̶t̶o̶r̶ ̶o̶n̶ ̶t̶h̶e̶ ̶i̶n̶t̶e̶r̶n̶a̶t̶i̶o̶n̶a̶l̶ ̶C̶K̶M̶ ̶h̶e̶r̶e̶,̶ ̶f̶o̶r̶ ̶t̶r̶a̶n̶s̶l̶a̶t̶i̶o̶n̶:̶ ̶h̶t̶t̶p̶s̶:̶/̶/̶c̶k̶m̶.̶o̶p̶e̶n̶e̶h̶r̶.̶o̶r̶g̶/̶c̶k̶m̶/̶a̶r̶c̶h̶e̶t̶y̶p̶e̶s̶/̶1̶0̶1̶3̶.̶1̶.̶5̶4̶9̶1̶
Edit: Since HiGHmed is doing the translation themselves and in their own CKM, I’m removing this archetype from the international CKM for now.

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Hello Silje and everyone,
we are ready to do the translation into English directly in HiGHmed CKM. At the beginning of July the archetype would be ready for the proposal in international CKM.

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Off-topic: Is this a policy or a software limitation?

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It’s a policy. Translations are always done from the original language to avoid a “telephone game” situation where the semantics diverge between the translations. Having any other language than English as the original makes this a difficult proposition. :slight_smile:

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The archetypes, as they were in 2009 are in this project - Project: Pathology Synoptic reporting [openEHR Clinical Knowledge Manager]. Some of the archetypes started an AU review process but it was never completed as The Royal College of Pathologists of Australasia paused the project after seeing the benefits of standardisation. They then started a collaboration with CAP and Canadian pathologists to pursue a broader standardisation approach. The link from Ian, above, is a likely outcome, but they didn’t come back to modelling. I would suggest these archetypes are not fit for use at present, but may be a good starting point

The TNM archetypes currently published in CKM are solid and ready for use.

Happy to work support a group of interested domain experts to build the archetypes. Anyone willing to put their hands up?

Regards

Heather

OK, I see that HighMED is doing the translation themselves. Thanks, @siljelb and @natalia.strauch

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We have translated our archetype openEHR-EHR-CLUSTER.radiotherapy.v1, see below Clinical Knowledge Manager
An openEHR CKM editor can now transfer this to ckm.openehr.org and start further processes there.

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The archetype referenced into the international CKM: Clinical Knowledge Manager

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Speaking of onocology… does anybody happen to have examples templates of chemotherapy treatment regimes etc? Maybe some example template could be added to Project: Medication Family of Archetypes (ckm.openehr.org) or somewhere else?

By regime I mean recommended treatment plans like the ones at Nationella Regimbiblioteket (in the link I have picked breast cancer as example). There we can for example pick Docetaxel 100 that contains a table like:

The template GEL CANCER INTERVENTIONS REPORT (apperta.org) has a field for regime name at a reasonable place for “after the fact”-reference in a report but no details useful for planning and executing a regime.

Maybe openEHR Task Planning or similar tools are needed to fully express complex regimes, but a template based on a COMPOSITION with a Medication Order with an ACTIVITY (or a couple of activities) and associated inital ACTION(s) would likely be a pedagogical step on the way. (In our settings such an instruction would be recorded by a physician)

I guess the medication administration points (over several days) of the regime would have their own COMPOSITIONs containing Medication management ACTIONs and other treatment-related archetypes? (In our settings such medication administration would often be preformed and recorded by e.g. a nurse.)

Just as possibly useful references that might help (e.g. by reverse-engineering to archetypes / templates):

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I got some responses in the Twitter-thread https://twitter.com/JohnMeredith/status/1456396551019024386 from @johnmeredith and @ian.mcnicoll that suggested continuing the discussion here.

Ian shared a link (to a previous version) of a template (in Archetype Designer) that I suspect may expire. Thus also including three screenshots from scrolling through it:

I would be great to get a link to the current version (including source files) and continue the discussion here.

Sorry coming late on this… here is a short paper based on some early modelling and research work in oncology chemotherapy plans, Representing a chemotherapy guideline using openEHR and rules - PubMed

This is pre-GDL/GDL2 days, now we have better tools to model these regimens using openEHR archetypes/templates, GDL2 or some latest decision support expressions in the near future.

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