Description of Project:

Project Insight Number: 1686 (

This project will use FHIR to support electronic health data exchange of cancer pathology information between a hospital or facility-based laboratory information system (LIS) and hospital or facility-based electronic health record (EHR) system, as well as to a central cancer registry. 

Creating a standard based on US Core profiles should lead to more accurate and complete reporting of information from EHRs/LIS to jurisdiction-based central cancer registries and will allow for reuse of cancer pathology data in EHRs for clinical decision making and research. 

Stakeholder Meeting Updates: 

Weekly Work Session: Wednesdays at 10 am ET - Click here to join.

**The meeting on the Third Tuesday of the Month is regularly rescheduled and will not be available via the link above.

Monthly High-Level Overview: O&O Meeting Last Thursday of the Month at 1:00 pm ET:

Please contact Project Manager Ruby Nash at with questions or concerns about meeting times/info.

DateAttendeesNotesAction Items

November 10, 2021Dave deRoode, Alex Goel, Alex Mays, Sandy Jones

The group discussed prep for the FHIR Connectathon in January. Our team will be testing with the IHE SDC on FHIR IG. We had a lengthy discussion about Bundle type, collection, batch, and transaction. Given the needs of Pathology to avoid duplicative data, the group decided that adding recommended guidance on use of a transaction Bundle is the best path forward.

We would like to speak with O&O about solutions for a ballot comment related to Observation. Options include merging Cancer ePath and IHE SDC on FHIR, creating an abstract "Pathology Specific Observation" in ePath, or addressing the situation in arrative only, while keeping the eCC Observation examples.

Team will bring to O&O WG to discuss.

UPDATE: on 11/11 O&O call, O&O recommended that we do not combine this IG with SDC on FHIR (eCC IG), nor do we create an abreact profile to technically link them, as this will introduce a maintaince and timing around publication challenge/risk, but rather give explicit narrative guidance how how this guide and eCC SDC on FHIR Observation profiles are inteded to be used by implementers in parallel, using strong language (ie implementers SHALL conform to eCC's SDC on FHIR Observation profiles where appliable).

November 3, 2021Dave deRoode, Sandy Jones, Alex Mays, Riki Merrick, Ruby Nash, Sheryl TaylorIHE SDC on FHIR will be ballotinging May 2022. Our project will be testing during the January Connectathon. The team discussed confirming implementers. The track proposal is due November 9, 2021. The team will work on the Track Proposal and follow up with implementers.
October 28, 2021Dave deRoode, Ruby Nash, Alex Goel, Sandy JonesThe team attended the O&O call to discuss specific ballot dispositions and sought O&O feedback on adding ServiceRequest to the IG. O&O recommended checking in with other projects using ServiceRequest, as well as confirm previous mappings from V2 to FHIR are current. Block Vote 2 is almost ready for review and approval.The team will review V2 to FHIR mappings and share with Hans and O&O.
October 27, 2021Dave deRoode, Alex Goel, Sandy Jones, Alex Mays, Rich Moldwin, Ruby Nash, Riki Merrick, Sheryl TaylorThe group discussed making updates to Specimen and ServiceRequest based on ballot comments, as well as changes to the ballot and publish timeline of the IHE SDC on FHIR IG. The team will take proposed changes to O&O for review and discussion.
October 20, 2021Dave deRoode, Alex Goel, Sandy Jones, Alex Mays, Ruby NashBased on feedback from the O&O WG, the Universal IG will be left open in case any other entities are interested in taking it on, refining it, and seeing it through to publication. The team continued with ballot comment dispositions for Block Vote 2.
October 12, 2021Dave deRoode, Alex Goel, Sandy Jones, Rich Moldwin, Ruby Nash, Andrea Pitkus

A new time meeting time has been established - the project will meet on Wednesdays at 10:00 am ET. Attendees will get a new meeting series invitation after the meeting.

The Universal IG needs a champion to refine and test on it's own. Meetings will be held with O&O to get their input and feedback on next steps.

Dave deRoode submitted Block Vote 1 of ballot comments for review and will seek approval on the next O&O call.

Ruby will send out the invitation to the new meeting time and reach out to the Australian team that expressed interest in the Universal IG.

Dave and Ruby will seek approval for Block Vote 1 during the next O&O call.

September 30, 2021Dave deRoode, Alex Goel, Sandy Jones, Alex Mays, Ruby NashA total of 64 ballot comments were submitted. Team discussed a new bi-weekly time. Dave has begun composing ballot dispositions for future review. A poll will be sent out soon to choose a new time. The meeting next week will be cancelled.Ruby will send out a Doodle poll to determine a new meeting time.
September 14, 2021Dave deRoode, Zabrina Gonzaga, Sandy Jones, Alex Mays, Ruby Nash, Scott CampbellTeam discuss close of the Open Ballot Period on September 15. Comment count at that date was 46.Dave will be compiling ballot comments to bring to O&O during the Tuesday Q4 session to initiate ballot reconciliation. 
August 31, 2021NoneMeeting CancelledNone
August 24, 2021David deRoode, Alex Goel, Sandy Jones, Alex Mays, Rich Moldwin, Ruby Nash, Andrea PitkusThe team discussed future plans for the the Universal IG as well as checked in about ballot comments. The IHE SDC team is meeting to review with Sandy Jones and others and contribute collective ballot comments before the period closes. Dave deRoode and Ruby Nash will attend when possible. The group decided to cancel the meeting on August 31.Ruby will schedule time with the O&O WG to discuss future plans for the Universal IG. Ruby will cancel the meeting on August 31.
August 17, 2021NoneMeeting CancelledNone
August 10, 2021NoneMeeting CancelledNone
August 4, 2021Ruby Nash, Dave deRoode, Zabrina Gonzaga, Vince McCauley, Dorota Gertig, Francois Monty, Robyn Mann, Alex Mays, Lorraine ConstableAttendees discussed and compared the current state of cancer data exchange in Australia and the US, as well as the current framework for the Universal IG. The Australian folks will review and plan to submit ballot comments about anything they feel would make it more implementable for them. We plan to meet again in September, and representatives from both US and Australian entities showed an interest in meeting every six months or so to discuss current cancer pathology and interoperability in both countries.Ruby will connect with Vince about scheduling additional meetings.
August 3, 2021Scott Campbell, Zabrina Gonzaga, Alex Goel, Dave Jones, Alex Mays, Rich Moldwin, Ruby Nash, Sandy Jones, Andrea PitkusThe team discussed the upcoming ballot submission time as well as meetings required in August and early September. Attendees discussed an upcoming meeting with folks from Australia who are interested in the Universal IG and possible agenda items. There was some discussion about what kind of FHIR validator will be required (standard or unique), but no conclusions were drawn.

Meetings on August 10 & 17 have been cancelled.

Rich Moldwin will provide functional requirements or high-level specs for a validator specific to the US Realm IG.

July 27, 2021NoneMeeting Cancelled
July 13, 2021 - Meeting with SOA & Australia Vince McCauley, Robyn Mann, Jerry Goodnough, Alex Goel, Rich Moldwin, Lorraine Constable, Stefano Lotti, Dave Jones, Sandy Jones, Dave deRoode, Ruby Nash, Zabrina GonzagaDave deRoode reviewed the US Realm and Universal IGs with attendees from Australia (Vince McCauley and Robyn Mann). Australia has very similar issues with data exchange from LIS systems into EHRs and registries. The next steps will be discussing possible times to meet or ways the Australians can contribute to the Universal IG, which goes to ballot in September.Ruby will follow up with Vince and Lorraine about possible next steps.
July 13, 2021Wendy Blumenthal, Dave deRoode, Zabrina Gonzaga, Alex Goel, Dave Jones, Rich Moldwin, Ruby Nash, Wendy Scharber, Diana Wright

Some attendees will be attending the SOA meeting to meet with representatives from Australian entities interested in the Universal IG later in the day.

The team also reviewed questions from last week in more detail, and concluded we will be focused on the synoptic report within NAACCR Vol 5 for now, but may expand into other areas of the Static Content Model in the future. We also will not further constrain diagnostic.code or narrative references. The bundle will focus on the eCC message format for now. Additionally, we will not profile ServiceRequest, but will be profiling MSH 10 in the Message-Header profile.

Dave will attend a NAACCR Vol 5 Workgroup meeting in early August to review the spreadsheet mappings.
July 6, 2021Rick Geimer, Alex Goel, Sandy Jones, Alex Mays, Ruby Nash, Scott Campbell, Diana WrightThe team discussed alignment with the NAACCR and how to include methods for incorporation of narrative text, as well as MSH 9-12 and where related constraints should appear in the Message-Header profile. The IHE SDC on FHIR IG will not be balloted until January, while this IG will be balloted in September. The team agreed this is not an issue and will proceed as planned. 

Ruby will send the V2 messaging spreadsheet created by Max Nakamura and Dave deRoode to Alex Goel.

The team will continue certain portions of the conversation offline via email.

June 29, 2021Dave deRoode, Alex Goel, Dave Jones, Wendy Blumenthal, Rich Moldwin, Ruby Nash, Wendy Scharber, Diana WrightSandy Jones reported that she has contacted NAACCR about name and content use. The group discussed removing "Sharing" from the IG name, which was done during the call. The topic of expanding the IG beyond cancer pathology was discussed again, but the group would like to avoid scope creep. It is unclear how the Cancer FHIR IG may impact labs that have to adhere to CLIA certification and CAP accreditation requirements. We discussed the use of LOINC in both IGs, and that LOINC code should be included, but do not fit neatly anywhere. Including LOINC codes in diagnostic report or in observations was discussed. The issue of whether or not a lab could fail a CLIA inspection due to our IG implementation was discussed a bit more, but it is unclear what the solution might be or where the responsibility lies. Lantana will continue to pursue the submission of both NIBs (Universal and US Realm).
June 22, 2021Dave deRoode, Alex Goel, Dave Jones, Wendy Blumenthal, Rich Moldwin, Ruby Nash, Scott Campbell, Andrea PitkusAttendees continued to discuss the use of NAACCR vs. generic cancer in the name of the IG as well as content. There is a goal to align with MedMorph as close as possible to use the bundle structure across MedMorph IGs. Dave deRoode reported updating the IDs and removing NAACCR until the use of the name and content has been approved.Sandy Jones will reach out to NAACCR to seek approval for their name and content in the IG.
June 15, 2021Dave deRoode, Rick Geimer, Alex Goel, Dave Jones, Wendy Blumenthal, Sandy Jones, Alex Mays, Rich Moldwin, Ruby Nash, Wendy Scharber, Diana WrightDave deRoode gave a presentation on the Universal IG and naming conventions, which include "common library." We also discussed adjustments to the name of both IGs, given the pivot. The team discussed gaining approval of the use of the NAACCR name, as well as possible expansion of the IG beyond pathology in the future.

Dave will make updates to the naming in the Universal and US Realm IGs based on the discussion.

Lantana will be meeting with O&O to secure approval of NIB submission for both IGs.

June 8, 2021Wendy Blumenthal, Dave Jones, Alex Mays, Alex Goel, Dave Jones, Ruby Nash, Andrea Pitkus, Wendy Scharber, Wendy Wise, Diana WrightAttendees discussed the upcoming NIB deadline, as well as edits to the PSS and narrative content of the IG based on the pivot to align with IHE SDC on FHIR. The edits were presented to O&O, which voted to approve, as well as PHWG and CQI.Lantana will post the edits to the PSS.
June 1, 2021Wendy Blumenthal, Sandy Jones, Ruby Nash, Rich Moldwin, Diana Wright, Wendy Scharber, Dave Jones, Dave deRoode, Rick Geimer, Alex Goel, Andrea PitkusAttendees discussed progress made during the Connectathon, requirements for the Concept Map between IHE SDC on FHIR and the Cancer FHIR IG, as well as edits to the Project Scope statement. The project will maintain two IGs, one US realm and one Universal.Ruby Nash will circulate new edits to the Project Scope Statement to attendees for review. Ruby Nash and Dave deRoode meet with O&O, PHWG, and CQI to review the edits as well.
May 11, 2021Wendy Blumenthal, Scott Campbell, Dave deRoode, Rick Geimer, Zabrina Gonzaga, Alex Goel, Dave Jones, Sandy Jones, Alex Mays, Rich Moldwin, Ruby Nash, Craig Newman, James Tcheng, Diana Wright Zabrina Gonzaga presented a draft of the Connectathon Orientation slidedeck for review and feedback. Attendees provided input on workflow and order. Dave deRoode gave a high level overview of the new IG, which includes V2 messaging and alignment with IHE SDC. Attendees discussed opportunities for alignment with MedMorphAlex Goel will provide the Lantana team with slides on Cancer FHIR IG / IHE SDC alignment, as well as additional samples to test.
May 4, 2021Wendy Blumenthal, Scott Campbell, Dave deRoode, Rick Geimer, Max Nakamura, Dave Jones, Zabrina Gonzaga,  Sandy Jones, Wendy Scharber, Diana Wright,  Rich Moldwin, Alex Goel, Alex Mays, Ruby Nash, Craig Newman, Wendy WiseAttendees discussed plans for the Connectathon. Cancer FHIR IG Track Orientation will be on May 13 from 12:00 - 1:30 pm ET. The Lantana team has finished mapping the V2 spec to NAACCER Vol 5. The group also discussed best process to represent a specimen with multiple parts and/or many labs involved in the testing. There is some overlap between MedMorph Vol 2 and the Cancer FHIR IG and that will be part of testing at the Connectathon. While the IG is US realm-based, there was a request from O&O to also provide a high-level Universal version. That work is on-going and will be fleshed out after the Connectathon.The team will continue discussions to prep for and finalize Connectathon plans.
April 27, 2021David deRoode,, Sandy Jones, Wendy Blumenthal, Wendy Scharber, Zabrina Gonzaga, Rick Geimer, Alex Goel, Scott Campbell, Rich Moldwin, Diana WrightDuring the FHIR Connectathon 27, Lantana will test exchanging information from a cancer pathology LIS system to an EHR using FHIR.  The Cancer Reporting FHIR IG will be specified using NAACCR Standards for Cancer Registries Volume V, Laboratory Electronic Reporting Pathology Version 5, May 2020 (Revised 2020).  The Cancer Pathology Report will includes everything but the OBX segment in the NAACCR Volume 5 -   MSH, PID, PV1, ORC, OBR, and SPM. (See Ch 2, Table 7). 

CDC to contact mTuitive and Cerner about updates to Connecthon Plan and to remind them sign up by Friday, April 30th.

Scott will share a small sample of codes with Dave and Alex for the Connectathon.

Wendy B. and David D. will attend Thursday’s O&O call to provide an update on the Connectathon plan.

April 20, 2021CancelledThe meeting with stakeholders was not held on April 20, given a standing conflict the third Tuesday of every month.
April 14, 2021David deRoode, John Spinosa, Ruby Nash, Sandy Jones, Wendy Blumenthal, Wendy Scharber, Zabrina Gonzaga, Rick Geimer, Alex Goel, Scott Campbell, Laura Heermann, Rich MoldwinRich Moldwin and Alex Goel discussed their IHE SDC on FHIR, which would be a generic implementation guide that is not content specific about how to get info out of a SDC form via xml. The parser pulls out SDC xml, creates hierarchical FHIR observations, and puts it into a document reference or diagnostic report. They need a NAACCR Vol 5 clone for FHIR, which was proposed as the new structure for the Cancer FHIR IG, built on vanilla FHIR resources without extensions using SDC identifiers (cKeys) for Chapter 3, Synoptic Report eCC. Lantana is concerned that FHIR observations tied to this messaging spec will require terminology mapping which is not included. Lantana also has concerns about making this kind of change this close to the Connectathon. It is unclear if there will be a meaningful IG ready to test by May 17.Lantana will follow up with Alex Goel to discuss NAACCR and Scott Campbell to assess SNOMED mapping. Lantana will evaluate the timeline internally to determine impacts and interoperability of the proposed pivot.
April 6, 2021Davie deRoode, Diana Wright, Ruby Nash, Sandy Jones, Wendy Blumenthal, Wendy Scharber, Zabrina Gonzaga, Scott Campbell, Craig Newman, Rich MoldwinThe team discussed the IHE SDC on FHIR IG and possible alignment. External stakeholders (Rich Moldwin and Scott Campbell) discussed the possibility of developing an IG mapped to NAACCR Vol 5 only, rather than the current Cancer FHIR IG structure. This would align with the IHE SDC on FHIR IG via parser, but will require mapping to "vanilla" FHIR observations.The Lantana team will meet with Alex Goel to get more information on IHE SDC IG structure, as well as review NAACCR Vol. 5 to discuss next week.
March 30, 2021Dave deRoode, Diana Wright, John Spinosa, Ruby Nash, Sandy Jones, Temi Alimi, Wendy Blumenthal, Wendy Scharber, Zabrina Gonzaga, Alex Goel, Scott Campbell, and Laura HeermannThe team discussed the use of LOINC or SNOMEDCT for the Question Value. Canada has officially declared SNOMEDCT as the Code System for Questions for CAP Protocols. Wendy Scharber will be working with Scott Campbell to determine which SNOMED codes will work for the project, particularly in the arena of pathology, but the team may need to use mCODE and LOINC for other domains where there is no overlap. The team agreed to remove biomarker protocols from the project and continued to discuss possible alignment with the IHE SDC IG.

Dave deRoode will be attending SDC WG this week to determine alignment between IHE SDC and the Cancer FHIR IG.

Wendy Scharber will meet with Scott Campbell to discuss SNOMEDCT.

March 25, 2021

O&O WG Meeting - Project Update

Dave deRoode, Ruby Nash, Wendy Blumenthal, Sandy Jones, Temi Alimi

Dave deRoode gave a brief presentation on IG development progress. The group discussed whether the US Realm Profiles should be based on US Core or the Universal Realm Profile, and while no final determination was made, the O&O recommended that the Universal Realm IG could use example binding strengths.

O&O reminded the team about a conflict with the Tuesday at 2:00 pm ET Cancer FHIR IG working session and the O&O on FHIR meeting at the same time. Ruby Nash will work with the Cancer FHIR IG team to determine options for another time.

Sam Spencer was listed as a possible contact at Royal College of Pathologists of Australasia (RCPA), which may be interested in contributing resources to the Universal Realm IG.

Ruby Nash will determine possible options to remedy the conflict between Cancer FHIR IG working sessions and the O&O on FHIR meeting at the same time.

Ruby Nash will reach out to Sam Spencer at RCPA.

March 23, 2021Zabrina Gonzaga, Dave deRoode, Diana Wright, Ruby Nash, Wendy Blumenthal, Wendy Scharber, Temi Alimi, Scott Campbell, Alex Goel

The team and stakeholders discussed the value of incorporating SNOMED structure and RefSets into the Cancer IG design, as well as how it will be incorporated into the Grouping Value Sets. 

Alex Goel (IHE SDC) discussed possible areas for alignment between this project and his IG. Dave deRoode will attend a SDC WG meeting to discuss the mapping of a parser from IHE SDC and our Cancer FHIR IG.

FHIR Structured Data Capture

Dave deRoode will be attending SDC WG next week to determine alignment between IHE SDC and the Cancer FHIR IG.
March 17, 2021

Dave deRoode, Zabrina Gonzaga, Diana Wright, John Spinosa, Ruby Nash, Wendy Blumenthal, Wendy Scharber, Sandy Jones, Temi Alimi, Rick Geimer, Calvin Beebe, Kurt Allen, Rich Moldwin, Scott Campbell, Craig Newman, 

The team discussed US Realm IG and possible paths forward:

1) Create a General eCC Protocol Framework that is bound to US terminology and the value sets referenced are all inclusive (e.g. histology type contains all values for all anatomical sites). 

2) Create FHIR Document Bundles for each eCC Protocol(for each anatomical site) that is bound to site specific value sets.

There was a great deal of conversation around modeling, design, and the Cancer IG landscape overall. The Cancer FHIR IG cannot change eCC process or protocol and must work within that framework to meet the need and transmit data to EHRs. While other projects are doing similar (but not exactly the same) work, this project will maintain its focus on developing a standard that will allow for data in a CAP protocol to be shared and stored as accurate FHIR resource types within the EHR.

Consensus agreement was reached regarding approach to create one US Realm IG that will contain abstract profiles.  For example, the team will create an abstract Histology Type Profile constrained to a parent (grouping value set) Histology Value Set that will contain all concepts within respective individual anatomical value sets. The Cancer FHIR IG team will move forward with this approach and present a draft of this design next week.

Review draft design of the Histology Type Profile

Weekly – continue to review developed content profiles and associated parent values sets

Prepare for Update with O&O Primary Sponsor on Thursday, March 25.

Plan for Connectathon.

March 8, 2021

Dave deRoode, Zabrina Gonzaga, Diana Wright, John Spinosa, Ruby Nash, Wendy Blumenthal, Wendy Scharber, Sandy Jones, Temi Alimi, James Tcheng, Laura Heermann

Team discussed modeling and value sets. Want to proceed with FHIR best practice without making the ask too "heavy" for users. Modeling options are:

1)Create a General eCC Protocol Framework that is bound to US terminology and the value sets referenced are all inclusive (e.g. histology type contains all values for all anatomical sites). 

2) Create a separate Profile for each eCC Protocol(for each anatomical site) that is bound to site specific value sets.

Invite Scott Campbell and Rich Moldwin to weigh in on modeling and value sets.

Project Team & Contact Information:

Project Facilitator:  David Jones, (CDC/DDNID/NCCDPHP/DCPC),

Subject Matter Experts: 

Wendy J. Blumenthal (CDC/DDNID/NCCDPHP/DCPC),,



Wendy Scharber (CDC/DDNID/NCCDPHP/DCPC) (Contractor) (CTR),

Vocabulary Facilitators: 


Wendy Scharber (CDC/DDNID/NCCDPHP/DCPC) (Contractor) (CTR)

Technical FHIR Expert:

David deRoode,

Business/Clinical Analyst:

Zabrina Gonzaga,

Project Manager

Ruby Nash,

Quick Links:

Project Proposal PSS-1682 - Getting issue details... STATUS

Project Scope Statement PSS-1688 - Getting issue details... STATUS



       IG Proposal US Realm IG Cancer Pathology Reporting to EHR


      GitHub  (link pending, requested)

      IG Proposal UV Realm Cancer Pathology Common Libraries

Current Timeline for Requirements Gathering:


Tue 3/2



Tue 3/9

Breast/ Lung

Breast/Lung Biomarkers?

Overlapping VS

Discuss Modeling - mCode slicing vs. individual eCC Protocols

Confirm there are no lung biomarkers - remove from the scope

Wed 3/17

US Realm Framework Discussion / Value Sets

Tue 3/23

Lung, Colon/Rectum

Tue 3/23

FHIR Connectathon Proposal Deadline

Tue 3/30


Tue 4/6


Tue 4/13


Melanoma biomarker

Tue 4/20


Tue 4/25

PSS approved by TSC

Tue 4/27


May 17 - 19

2021 May FHIR Connectathon 27

May 24 - 28

2021 May Work Group Meeting

Additional References: 
NAACCR Standard for Cancer Registries Volume V; Pathology Laboratory Electronic Reporting V4.0.
FHIR Breast Cancer IG.
FHIR mCode IG:


  File Modified
Microsoft Word Document PSS-1688_Draft_05032021.docx May 13, 2021 by Zabrina Gonzaga

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