Reporting Pathology Protocols Projects
The purpose of the Reporting Pathology Protocols (RPP) projects was to implement a new means of collecting and transmitting pathology information using the encoded College of American Pathologists (CAP) Cancer Checklists and Health Level Seven (HL7) messages.
Traditionally, pathology reports are in a narrative form with the cancer registry information contained in the body of the text. The new CAP tool relies on a protocol in a checklist form that enables the pathologist to provide the needed information in a clear and consistent manner. Use of the traditional pathology report requires labor-intensive coding and review by cancer registry staff or, increasingly, by natural language processing software. The new pathology report, in a checklist format, ensures information is recorded and coded in a fixed data set at the pathology laboratory.
In 2001 CDC funded two states, California and Ohio, for a pilot project with a focus on colon and rectum cancers. In fiscal year 2004, CDC initiated a second pilot project for cancers of the breast, prostate, and melanoma of the skin. Three states were selected to participate in this project: California, Maine, and Pennsylvania. Other collaborative partners included Maine Medical Center, Dahl-Chase Pathology Laboratory, University of Pittsburg Medical Center, City of Hope, Cerner DHT, Elekta's Impac Software, and C/NET.
The RPP project for colon and rectum cancers is complete. Participating pathology laboratories used an electronic version of the checklists, and the information was formatted into a project standard HL7 version 2.3.1 message using Logical Observation Identifiers Names and Codes (LOINC) codes as the question and SNOMED CT codes as the answers.
A comprehensive project report concludes, "The use of the checklists in cancer registries can enhance existing systems and obviate much of the task of coding and entering data from the narrative text. In addition, the checklists allow for data capture by the pathologist at the point of analysis rather than the current method of cancer registrars interpreting text to derive the associated code. This allows for more accurate collection of data by standardizing the meaning of the different concepts and the collection of more timely data by the electronic, real-time transmission to the cancer registry."
The RPP project for cancers of the breast, prostate, and melanoma was completed in early 2009. Project participants included representatives from NPCR and hospital cancer registries, hospital anatomical pathology (AP) laboratories, AP laboratory information system (LIS) vendors, SNOMED International, and HL7 messaging consultants. A comprehensive project report is available upon request; an executive summary [PDF-311KB] of that report is available for download.
These participants formed two workgroups: messaging and evaluation. The Messaging Workgroup met to define the common HL7 message data items (or segments) and the associated structure of the CAP checklist data. This Workgroup developed an implementation guide [PDF-3.3MB] describing the specifics on how to transmit the data in a common, project-specific format. The Evaluation Workgroup met to establish evaluation measures. The final report of the Evaluation Workgroup is contained within the comprehensive project report.