Electronic Reporting in Pathology: Requirements and Limitations

A Paradigm for National Electronic Health Records Implementation

The ASPE Expert Panel on Cancer Reporting Information Technology
College of American Pathologists

and

The Altarum Institute
Washington, DC

September 2009

This report is available on the Internet at:
http://aspe.hhs.gov/sp/reports/2010/erpreqlim/index.shtml

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Abstract

This white paper originated in the fall of 2008 from work carried out by the Pathology Electronic Reporting Taskforce (PERT) of the College of American Pathologists (CAP). Under contract support from the Centers for Disease Control (CDC), the PERT was tasked to propose electronic implementations of the CAP Cancer Committee's reporting templates. During Discussions, it became obvious to participants that current frameworks for implementing structured reporting had distinct limitations, and that in particular problems of cross-terminology mapping and context representation posed serious hurdles for any possible implementation that aimed to support downstream use cases as complex as clinical decision support.  These limitations seemed to be more than transient barriers that might be overcome by incremental technological enhancements to existing frameworks.  Rather, they were in many cases inherent limitations of any computer-processable representation of complex medical reports.  The Pathology use case, situated in the midrange of the complexity of medical reports.  The Pathology use case, situated in the midrange of complexity of medical report types, provided a superb paradigmatic case for the investigation of these inherent limitations.

Material contained in this publication is in the public domain and may be reproduced, fully or partially, without permission of the Federal Government. The courtesy of attribution is requested. The recommended citation follows:

Office of Science and Data Policy, ASPE(2010) Electronic Reporting in Pathology: Requirements and Limitations
Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

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Table of Contents

Preface
Acknowledgements
Executive Summary
Section 1. Use Case
Section 2. Evidence of Value
Section 3: Common Identifiers
Section 4: Standard Terminologies
Section 5: Beyond Semantic Interoperability
Conclusion & Future Directions
Bibliography
Appendix 1: Unstructured (Traditional) Pathology Report
Appendix 2: Structured Pathology Report
Appendix 3: XML Pathology Report
Appendix 4: Semantic Web (RDF/N3) Pathology Report
Appendix 5: Relevant Tumor Registry organizations & projects

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Last updated:  05/10/2010