Laboratory Information Systems (LIS) in use in Australia are generally not currently capable of fully supporting structured pathology. Several areas of improving this situation have been explored:
1) To direct the type of development needed in our LIS to support structured reporting two documents have been produced:
- a SPR LIS Functional Requirements document which provides a background and discussion of general principles in relation to structured reporting eg standards and guidelines; and also describes specific functionality requirements eg “The pathologist must be notified and asked to complete those standards (mandatory fields) that have not been completed when attempting to verify the report (signout)”. The functional requirements are divided into mandatory and recommended items.
- a Universal Design Requirements document which contains a set of design principles which should govern all LIS development eg “Nothing should ever require human entry, which the computer should be capable of synthesizing from known information.”
The documents are posted to:
www.rcpa.edu.au/Publications/StructuredReporting/LISfunctionalrequirements.htm
2) The project developed an electronic form (e-form) which worked very well and was very useful for educational purposes however it is difficult to maintain for widespread/ every day use by the pathology community.
3) In conjunction with the development of the first six structured reporting protocols for cancer, NeHTA commissioned Ocean Informatics to develop archetypes for each of the protocols for the purpose of enabling HL7 messaging between applications. Ocean Informatics worked in parallel to the protocol development and in October 2009 the archetypes were at the stage to have key clinicians review them to ensure that the intent and logic of the protocols had been preserved. However, the review was very limited as we were unable to engage the protocol authors in reviewing the archetypes in CKM satisfactorily. CKM proved quite challenging and time consuming for the pathologist authors of the protocols, who were already time poor.
4) NEHTA recently adopted Ocean’s CKM for the development of its DCMs and templates. Following this, discussions with NEHTA were held regarding the potential local development of archetypes under the oversight of NEHTA. Local development of the archetypes was hoped to eliminate the complexity of review and issues introduced by third party development. The DCM tools were also hoped to provide a means to develop XMLs for implementation and facilitate HL7 messaging.
XML’s were initially raised by LIS vendors during the functional requirements reviews – see point 1 above. Vendors asked if it was our intention to provide XML’s to facilitate implementation. Most laboratory systems being implemented in Australia are American and the vendors are therefore familiar with the process of the CAP XMLs. Further investigation provided the information that US and Canadian laboratories implement their cancer checklist via XML’s distributed from the College of American Pathologists (CAP).
After some education in the tool it was determined that the level of expertise required to develop an archetype locally is quite prohibitive; resources able to do this in Australia extremely limited and review of the resulted archetype very challenging.
5) Discussions with the College of American Pathologists – SNOMED Technology Solutions (CAP STS) were undertaken to investigate the process that CAP use. CAP STS have a very simple tool to edit from the paper checklist to an electronic checklist (eCC) which includes the construct of a simple information model. From this, XMLs are created and when ready, these are distributed to vendors for installation – this ensures a level of conformity with the checklist that individual implementations at a local level from a paper model will not achieve. The XML also includes terminology mapping such as SNOMED CT, ICDO etc.
As a result of these discussions a proposal was developed in which CAP STS have proposed to undertake development of XML’s for the RCPA Protocols.
6) Cancer Control New Zealand (CCNZ) are revamping their cancer registry system and including a wider range of information such as the TNM staging. This additional range of information will be possible only if the RCPA protocols are adopted and therefore CCNZ is mandating their use. To facilitate implementation of the protocols they are progressing development of an e-form (similar to that noted in point 2 above). The beta test copy of the RCPA e-form was distributed in late 2010 and this is the version that CCNZ have had recommended by their pathologists. The SPR project has proposed a collaboration agreement to work on the development of the e-form together with CCNZ.
7) The project has also investigated the potential to pilot the implementation of structured reporting and messaging of cancer data from a laboratory to a registry. Cancer Council Victoria are extremely keen to progress this, however laboratory implementation has been slow to progress.
8) Another challenge to successful implementation is getting the macroscopic recorded as structured information as most macroscopics are dictated and will continue to be dictated. Therefore in order to encourage people to still record the data as structured, a web page has been designed which is designed to use a minimum of key touches either from an iPad or PC/laptop. The person accesses the macroscopic webpage and then clicks on the icon representing the cancer they are interested in. The checklist for the macroscopic from the specific structured pathology reporting protocol will open and provides all the information the pathologist needs to record (via dictation) during cutup. There is a word template which matches each of these checklists for the typist posted to the cancer protocol website. Help is available from the checklist via a question mark icon (?) including specimen handling information. The draft website can be accessed via the following link.
www.rcpa.edu.au/Publications/StructuredReporting/macroscopic.htm