using fhir for the dutch national cancer registry

© 2013 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

Using FHIR for the

Dutch National Cancer Registry

Marc de GraauwNovember 16, 2016


2

Who am I?

Name: Marc de Graauw Company: magrit.nl Background:

Studied Philosophy, IT 27, Health IT 14 years Independent consultant


THE NEW CANCER GUIDELINES


IKNL Independent knowledge and quality institute for oncological and

palliative care (government funded) Most important basis: Netherlands Cancer Registry (NCR)

NCR Population based registry (since 1989) 2.3 million cancer patients (> 200 million data items) Outcome data (e.g. mortality) + 100,000 incidences per year 177 peer reviewed articles (2015)

Guidelines for oncological and palliative care


Is this part of this chapter?

Different definitions on different pages

Contradictory recommendations

Now or never?

When?

Always?


Decision support type 1: Clinical Practice Guidelines


Decision support type 2: Multidisciplinary meetings


Informatie standaard

…

Lab

Radio-logy

Trial Alert

Guideline

Prediction

Adverse events

…

Clin. Gen.

Patho-logy

MDM

NCR

Know-ledge

Closed loopAutomatic guideline evaluation,

New knowledge generation

Decision support

Registration at the source• Standardized tumor

board report

Patiënt

Shared decision making

Information standard

Our healthcare IT innovation program

MDM: Multidisciplinary meetingNCR: Netherlands Cancer Registry


Basic principles

From guideline to decision trees and information standard

Decomposition of care pathway.

Successfully applied to national Clinical Practice Guidelines:

Breast, colorectal, prostate, esophageal, pancreatic, head-neck cancer.

Breast cancer: 229 pages (>100.000 words) 73 decision trees, 115 data-items.


The Working Group recommends a diagnostic laparoscopy in case of tumors in the body or the tail of the pancreas or tumors > 3 cm or patients with a CA 19.9 levels > 150 U/ml , because there is a bigger chance on otherwise occult metastases.

Data-items

Based on which data-items a diagnostic laparoscopy is advised?

Location

CA 19.9

Tumor diameter

CA 19.9

Indication diagnostic

laparoscopy

(/) No diagnostic laparoscopy

Tumor diameter

Location

Consider diagnostic

laparoscopy

Head

≤3cm

≤150ml/U

Body;Tail

>3cm

>150U/ml


CONNECTING THE DOTS


Pathology to EHR


EHR to NCR


ART-DECOR MODELS


15

ART-DECOR / LoMo


16

ART-DECOR / LoMo


DECOR overview


DECOR

dataset

project

name

scenario

copyrightversion info

descriptionauthors

issues

value sets

identi-fications

rules

concept

groupitem

use case

transactionactor

code systemsterminology systems

validation

conditionsconstraints

OID

statusassignment


Datasets (ElementDefs)


ValueSetsr


The scope

50 or so Guidelines No development per guideline:

x times y hours times z consultant rate Generate specs from guidelines Define in ART-DECOR / Logical Models Map to FHIR resources


22

Challenges

Existing environment full featured FHIR servers not feasible just Resource exchange probably v2 or Web Services as transport translate in-house XML / v2 to FHIR

Many partners 50-100 hospitals 2 main vendors, several smaller some can do FHIR, others not (yet)


23

Solutions

DiagnosticReport generic format add terminology to dataset map elements to FHIR resources

MDM -> NKR data from many sources no clear FHIR Resource match Questionnaire(Response)


Map transaction to FHIR Questionnaire

DECOR Transaction FHIR Questionnaireconcept[@type='group'] groupconcept[@type='item'] questionconcept/name question.textconcept terminologyAssociation question.conceptconcept/@id (group | question).linkIdconcept/min- or maximumMultiplicity (group | question).repeatsconcept/valueDomain/@type=boolean | decimal | integer | date …

question.type =boolean | decimal | integer | date …

Data types mappen reasonably wellconcept mapping to valueSet question.options Reference Valueset


25

What do they do down under? Australian Colorectal Pathology Reports

Logical Models Mapping Language FHIR Resources

Similar approach, we use ART-DECOR modelling Transforms FHIR Resources


26

Questions?

http://hl7.org/fhir http://wiki.hl7.org/index.php?title=FHIR

http://hl7.org/fhir

http://wiki.hl7.org/index.php?title=FHIR

using fhir for the dutch national cancer registry

Healthcare