V2-to-FHIR FHIR IG Proposal

Breast Radiology Profiles

Owning Workgroup

HL7 Clinical Interoperability Council (CIC)

Committee Approval Date:

May 2019

Publishing Lead

Richard Esmond (richard.esmond@gmail.com)

Contributing or Reviewing Work Groups

  HL7 Clinical Information Modeling Initiative (CIMI)
  HL7 Imaging Integration / DICOM

FHIR Development Project Insight ID

1363

Scope of coverage

The breast radiology implementation guide intends to formalize the radiology-specific data-elements sufficient to support breast cancer diagnosis, treatment and research, focusing on the key data necessary to facilitate clinical decision-making for medical and surgical oncologists, pathologists and the referring physician community of general practices Obstetrics and gynecology (OB/GYN) clinicians who order the vast majority of screening mammography procedures.

The implementation guide is expected to incrementally cover a wide variety breast radiology use cases, while supporting secondary data use in for clinical research, cancer registry reporting.

Content location

https://github.com/HL7/fhir-breast-radiology-ig

Proposed IG realm and code

us/breast-radiology

Maintenance Plan

The CIC WG is aware and willing to maintain the content in the future. Among participants, at least MITRE, MRS and PenRad are committed to the maintenance of the content.

This IG comprises FHIR Profiles for breast radiology core data elements long established to be critical for breast cancer diagnosis and staging within the scope of radiology.

In the first 'For Comment' cycle the terminology bindings are preliminary, and in some cases, defined in terms of local codes only.

Our team is collaborating with the VA SOLOR groups, RSNA RadLex and Regenstrief (LOINC) to organize and fund the required unique concept authoring efforts that will be necessary to sufficiently define the data-elements and value-sets represented in the 'For Comment' and 'Informative' breast-radiology draft ballot cycles.

Short Description

Breast Radiology CIMI Logical Models and FHIR Profiles.

Long Description

The first iteration of the CIMI logical models and FHIR Profiles for breast radiology reporting will be focused on the core modeling structures, patterns and informational relationships between these architectural elements. Our group has works extensively with the HL7 Orders and Observations workgroup to investigate the numerous 'cross cutting' concerns that confront many similar projects.

This IG defines FHIR profiles for data elements that are either directly or indirectly used in the reporting of breast radiology.

Involved parties

The breast-radiology IG is being authored through a formal collaboration under the HL7-CIC workgroup with a wide range of organizations and individual contributors that informally refer the themselves as the 'Cancer Interoperability' Group, which includes representatives from the FDA, NIH, CCO, SBI, HSPC, CiiC, ACS, various health IT vendors and interested solution vendors.

The American College of Radiology (ACR) has will established and long standing guidelines that have been in common and broad use for almost two decades. The Radiological Society of North America (RSNA) and the Society of Breast Imaging (SBI) which the breast focused arm of the ACR are all represented on the subject matter expert team that is reviewing all content and will be used as the definitive source of truth for all our near-term deliverables.

Expected implementations

  MITRE's Standard Health Record Collaborative
  PenRad, Inc. 
  Mammography Reporting System, inc (MRS). 

  PenRad and MRS represent well over fifty percent of the almost forty million screening mammography studies performed each year. PenRad and MRS are also committed to participating in FHIR Connectathons to proof the draft profiles.

Content sources

  American College of Radiology Breast Reporting Guidelines 
  College of American Pathology (CAP) Breast Reporting SDC Forms
  Society of Breast Imaging Reporting Guidelines
  In addition to sources specifically providing clinical content related to cancer and breast cancer, from a modeling perspective, CIMI models were also used as a source.

Example Scenarios

  Capture and delivery of breast radiology reports to EHR systems
  Reporting to cancer registries
  Reporting for clinical trials

IG Relationships

The breast-radiology project is intended to target compliance with US Core v4.

Timelines

  For Comment September 2019 Ballot
  Informative Jan 2020 Ballot
  STU May 2020 Ballot