# New Oncology Archetypes **Category:** [Clinical](https://discourse.openehr.org/c/clinical/5) **Created:** 2021-02-22 09:00 UTC **Views:** 3132 **Replies:** 39 **URL:** https://discourse.openehr.org/t/new-oncology-archetypes/1308 --- ## Post #1 by @Dr_Anjali_Kulkarni 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 :) about how best we can design Oncology archeytypes , Will post a example soon , happy to hear more , Thanks . --- ## Post #2 by @ian.mcnicoll 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). --- ## Post #3 by @birger.haarbrandt 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 --- ## Post #4 by @heather.leslie There is standardisation on reporting coming from the ongoing College of American Pathologist's cancer reporting protocols - [CAP Cancer protocol templates](https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates) I've recently started to transfer these latest versions to archetypes that will fit within our OBS for lab tests --- ## Post #5 by @Dr_Anjali_Kulkarni Thanks all . This is very helpful to start . --- ## Post #6 by @Dr_Anjali_Kulkarni Are these public ? --- ## Post #7 by @heather.leslie 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: --- ## Post #8 by @ian.mcnicoll 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 https://www.rcpath.org/profession/guidelines/cancer-datasets-and-tissue-pathways.html 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](http://www.ncin.org.uk/collecting_and_using_data/data_collection/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 !! --- ## Post #9 by @heather.leslie [quote="ian.mcnicoll, post:8, topic:1308"] I’m glad you are doing this round @heather.leslie !! [/quote] Simples :woozy_face: --- ## Post #10 by @Dr_Anjali_Kulkarni Hi All , how can I share a sample archetype here? Which format ? --- ## Post #11 by @siljelb 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|255x54](upload://skrLQccgossiRNwOVVb2LybLXl7.png) --- ## Post #12 by @Dr_Anjali_Kulkarni 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 --- ## Post #13 by @siljelb 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 --- ## Post #14 by @ian.mcnicoll 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. ![image|690x186](upload://mqTa1LJCVun1goG1dsp4mxBxx4z.png) 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. --- ## Post #15 by @Dr_Anjali_Kulkarni will do and let u know --- ## Post #16 by @ian.mcnicoll 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: --- ## Post #17 by @erik.sundvall You may also be interested in the master thesis of @theresehogbergmarder, [FULL TEXT link]( http://liu.diva-portal.org/smash/get/diva2:1343958/FULLTEXT01.pdf) and [publication metadata](http://urn.kb.se/resolve?urn=urn%3Anbn%3Ase%3Aliu%3Adiva-159746). 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. --- ## Post #18 by @ian.mcnicoll 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. --- ## Post #19 by @erik.sundvall 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? --- ## Post #20 by @Dr_Anjali_Kulkarni Hi , is there any way for translation from German to English to view your archetypes ? Thanks --- ## Post #21 by @heather.leslie Hi Anjali, Where translations are available in the archetype you can find the way to switch in the image below. ![2021-03-18_15-02-55|690x494](upload://ckS76XGdgUAn1DCnGhgwkNfqY50.png) 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. --- ## Post #22 by @Dr_Anjali_Kulkarni Thanks , will try . --- ## Post #23 by @ian.mcnicoll Thanks Erik, This is really good paper ... @theresehogbergmarder, [FULL TEXT link ](http://liu.diva-portal.org/smash/get/diva2:1343958/FULLTEXT01.pdf) and [publication metadata ](http://urn.kb.se/resolve?urn=urn%3Anbn%3Ase%3Aliu%3Adiva-159746). 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. --- ## Post #24 by @SDubois 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. --- ## Post #25 by @ian.mcnicoll 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. --- ## Post #26 by @erik.sundvall 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? --- ## Post #27 by @siljelb 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](https://openehr.atlassian.net/wiki/spaces/healthmod/pages/429785090/Archetype+proposals+process) as a candidate archetype. 2. 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. --- ## Post #28 by @SDubois @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 (https://www.palga.nl/en/, forms only in Dutch on https://www.palga.nl/professionals/protocollen/ ), 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. --- ## Post #29 by @siljelb [quote="SDubois, post:28, topic:1308"] @siljelb , if I can be of help in translating to English please let me know. [/quote] 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. --- ## Post #30 by @natalia.strauch 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. --- ## Post #31 by @damoca [quote="siljelb, post:29, topic:1308"] However, since we need the original language to be English for archetypes in the international CKM, we need to do some ADL hacking. [/quote] Off-topic: Is this a policy or a software limitation? --- ## Post #32 by @siljelb [quote="damoca, post:31, topic:1308"] Off-topic: Is this a policy or a software limitation? [/quote] 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. :) --- ## Post #33 by @heather.leslie [quote="SDubois, post:28, topic:1308"] @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. [/quote] The archetypes, as they were in 2009 are in this project - https://ckm.openehr.org/ckm/projects/1013.8.19. 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 --- ## Post #34 by @SDubois OK, I see that HighMED is doing the translation themselves. Thanks, @siljelb and @natalia.strauch --- ## Post #35 by @natalia.strauch We have translated our archetype openEHR-EHR-CLUSTER.radiotherapy.v1, see below https://ckm.highmed.org/ckm/archetypes/1246.145.602 An openEHR CKM editor can now transfer this to ckm.openehr.org and start further processes there. --- ## Post #36 by @siljelb The archetype referenced into the international CKM: https://ckm.openehr.org/ckm/archetypes/1013.1.5699 --- ## Post #37 by @erik.sundvall 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)](https://ckm.openehr.org/ckm/projects/1013.30.27) or somewhere else? By regime I mean recommended treatment plans like the ones at http://www.regimbiblioteket.se/regimregister.html?id=4 (in the link I have picked breast cancer as example). There we can for example pick [ Docetaxel 100](http://www.regimbiblioteket.se/regim.html?id=1156&b=4) that contains a table like: ![cytostatika|690x201](upload://6Ly4qa3evAgwR3DeFPeazgWJeEo.png) The template [GEL CANCER INTERVENTIONS REPORT (apperta.org)](https://ckm.apperta.org/ckm/templates/1051.57.114) 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](https://specifications-test.openehr.org/releases/PROC/latest/task_planning.html#_computation_context) or similar tools are needed to fully express complex regimes, but a template based on a COMPOSITION with a [Medication Order](https://ckm.openehr.org/ckm/archetypes/1013.1.3124) 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](https://ckm.openehr.org/ckm/archetypes/1013.1.123) and other treatment-related archetypes? (In our settings such medication administration would often be preformed and recorded by e.g. a nurse.) --- ## Post #38 by @thomas.beale Just as possibly useful references that might help (e.g. by reverse-engineering to archetypes / templates): * [RCHOPS chemo plan + logic](https://specifications.openehr.org/releases/PROC/latest/process_examples.html#_multi_drug_chemotherapy) * [Body surface calculation](https://specifications.openehr.org/releases/PROC/latest/process_examples.html#_bsa_body_surface_area) --- ## Post #40 by @erik.sundvall 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)](https://tools.openehr.org/designer/#/viewer/shared/Pz9zaGFyZWRJZD0xJGI2YjA0MGRlYmQyMjQ4ZTVhOGU5NmU1OTJjY2M0ZmIw) that I suspect may expire. Thus also including three screenshots from scrolling through it: ![image|539x500, 50%](upload://x2i2bwSljyMEfp0GxZZWpU8uuXN.png) ![image|593x500, 50%](upload://hXYPatHOhEwCEkqEBlJjYUAU3Ka.png) ![image|690x284, 50%](upload://1xAeswWTxNXd9RTFVa1FGhp4amP.png) I would be great to get a link to the current version (including source files) and continue the discussion here. --- ## Post #41 by @rong.chen Sorry coming late on this.. here is a short paper based on some early modelling and research work in oncology chemotherapy plans, https://pubmed.ncbi.nlm.nih.gov/19745392/ 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. --- **Canonical:** https://discourse.openehr.org/t/new-oncology-archetypes/1308 **Original content:** https://discourse.openehr.org/t/new-oncology-archetypes/1308