2005 Scientific Session Abstracts
Establishing a National HL7 Standard for Electronic Pathology Reporting to Cancer Registries
Eric B. Durbin, MS (ericd@kcr.uky.edu), Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY.
Context: Electronic pathology (E-Path) reporting is becoming increasingly important to central and hospital cancer registries. As registries have increased their requests for E-Path reports, pathology laboratories have used a variety of data formats to accommodate them. The proliferation of transmission formats between pathology laboratories and cancer registries has impeded E-Path implementations and increased costs for both. These factors clearly demonstrate the need for a common data transmission standard. To address this issue the North American Association of Central Cancer Registries (NAACCR) formed the E-Path Transmissions Work Group in 2003. The work group consists of volunteers representing pathology labs, registries, and government agencies. As chair of the work group, the author will present the standard and work group progress to date.
Technology: The work group has collaborated through e-mail and bi-weekly conference calls. The work group determined that Health Level 7 (HL7) was the most appropriate standard for the transmission of electronic pathology reports. The work group targeted HL7 version 2.3.1 as it was the most widely supported version in 2003.
Design: The standard is defined through an HL7 implementation guide. The work group used CDC’s HL7 infectious disease reporting implementation guide as a template and incorporated elements from NAACCR’s previous delimited E-Path transmission standard. The E-Path HL7 guide specifies that pathology information be reported through ORU^R01 Unsolicited Observation messages. Applicable HL7 message segments include MSH, PID, NK1, PV1, ORC, OBR, OBX, NTE, FHS, FTS, BHS, and BTS segments. Segment definitions indicate which components are required or optional. The guide provides HL7 examples throughout, as well as a sample cancer pathology report and corresponding HL7 message as an appendix.
Results: These efforts have produced the Draft Implementation Guide for Transmission of Laboratory-Based Reports to Cancer Registries using Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol. The Draft has been available for comment on the NAACCR web site since January 2005. A final revision is targeted for ratification and publication by NAACCR no later than January 2006.
Conclusion: The formation of a work group representing the primary stakeholders in electronic pathology reporting has been highly successful. The technical nature of HL7, however, has required the expertise of HL7 consultants from CDC. The initial draft implementation guide has been improved by feedback and the need for additional tissue-banking support has been identified. The work group also plans to provide tools for conformance testing and certification and an HL7 parser for cancer registries.