Refreshing archetypes related to pathology reporting

Hi!

@heather.leslie, @SDubois, I and others have exchanged som emails regarding refreshing archetypes related to pathology reporting and agreed it would be better to continue (and repeat some of) the discussion here on discourse so that more people can join.

Starting question: What is the status of the project Pathology Synoptic Reporting?

Background: Several pathologists in Sweden are interested in shared development of structured data entry form parts for the pathology investigation and reporting process. A Swedish proof of concept (PoC) project is currently investigating how an openEHR CDR (EHRbase) can be used as a shared read/write-documentation hub for pathology lab systems (from TietoEVRY) and digital imaging/analysis/PACS systems (from Sectra) and possibly EHR systems. A national cander registry is also involved in the project. During this work e.g. both @SDubois and @elham2222 found things that could be improved in the current set of related archetypes. For examle Stefan posted a mindmap at https://ckm.openehr.org/ckm/archetypes/1013.1.386/resourcecentre with parts colleced from different international reporting projects.

Erik asked me to post my email response…

The Pathology Synoptic Reporting project is ancient (2009) and the models are likely to need considerable revision, given pattern evolution since they were drafted and in unfinished review limbo. We could/should consider setting their status to rejected - to discourage active use and create a clean slate to work on reimagining the domain and patterns without being unduly influenced by the existing work. They can still be found with CKM when searching for archetypes in the ‘rejected’ state if we need them for reference. Then we can rejuvenate the Project name/metadata etc for our purposes.

Stefan’s work, plus others who seem to be working in the area in India etc, will be integral to due diligence on the ‘whole of domain’ that will allow us to distil the clinical concepts and repeating patterns that will inform the archetype design. This is potentially a massive project – even to limit scope to one or two cancers requires a deeper and broader investigation to ensure that we have a plan that can cater for future additions. (At least as best we can do without a crystal ball). There is definitely an ‘art’ to deciding how deep and broad we need to go before doing the deep dive design for one cancer.

The OBSERVATION.lab_test_result was designed to be the anchor and generic framework for all lab-related modelling. The current anticipated pattern will require devising a ‘histopathology/anatomical pathology’ framework as a core/universal CLUSTER to nest inside the OBS. This will support more detailed CLUSTERs of the nature that exist in the existing project. I suspect we will revise the concepts considerably if we cast a wide lens on the variety of histopathology reporting requirements, and the new CLUSTERs will be required. You can see a parallel family of genomics archetypes and example templates, designed on these same principles, here: Clinical Knowledge Manager

The same archetype design pattern is intended for modelling microbiology, serology, cytology etc. subdomains within the Lab test result family – a core framework CLUSTER for each subdomain, that will carry more CLUSTERs containing the specific details. This pattern is also underpinning the Imaging result family of archetypes.

Stefan and other domain experts can guide us, but I would imagine using https://documents.cap.org/documents/synoptic_reporting_definition_examples_v4.0.pdf , or similar, as the basis for the histopath framework CLUSTER to ensure that we get the core reporting framework as standardised as possible. Then we can hopefully discern modelling patterns across all cancers, also considering that lymph nodes and metastases and details such as resection margins etc should be good candidates to model for broad reuse across all cancers.

I’m sure it is much better to continue this discussion on Discourse. My concern is that there are a number of people who have already been working in this area, without understanding how to align with these patterns and we need to create a forum to bring this work into one central communication collaboration (ie at announcement/major communication) point. Slack, or similar, may be better for daily/weekly working interaction.

Just thinking out loud. All thoughts welcome.

Editors/CKAs need to help shape this, but we can support you to drive the detailed design and reviews if you’d like.

Cheers

Heather

1 Like

This was discussed again in the Swedish project and we’ve got some patologists willing to help and will also look into funding of some consultancy hours from international archetyping experts.

We’d suggest trying to create a first verison of a general cluster archetype to be used together with a first specific cluster archetype for at least the “micro” part of breast cancer. Then a second specific cancer “micro” archetype could be added and/or heading over to the “macro” part of breast cancer.

Who else in the openEHR community would be interested in getting this started?

1 Like

I agree that designing a generic micro and macro examination findings would be a really valuable starting point.

It will take quite a bit of research/investigation to discern the common patterns from amongst the variations across the common use cases. However I find it is usually worth putting in the effort in the beginning as it means the review process is more a refining than redesigning.

I’d be interested to participate…

Cheers

Heather

2 Likes