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Short Description

Cancer Electronic Pathology Reporting & IHE SDC/eCC on FHIR

Long Description

This project will use FHIR to support structured electronic 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 to a Central Cancer Registry (CCR). The goal of this project is to create one FHIR implementation guide (US Realm) that will complement the currently accepted and widely implemented V2 and NAACCR Standards for Cancer Registries Volume V, Laboratory Electronic Reporting Pathology Version 5, May 2020 (Revised 2020). We will be aligning with the IHE SDC/eCC on FHIR IG and their testing efforts.  

This IG uses the FHIR message bundle paradigm and profile data from NAACCR Volume 5, including MessageHeader, DiagnosticReports, and Specimen. It is based on US Core profiles where possible, binding to terminologies such as SNOMED CT and the North American Association of Central Cancer Registries Volume II, Data Standards & Data Dictionary. It will also include CAP eCC Protocol CKey Identifier to SNOMED translation.  

We will be testing these two implementation guides in tandem to ensure alignment, as well as implementing an app to query an EHR, compile pathology reporting data, and send it to a registry.


Continued testing of alignment between IHE SDC/eCCs on FHIR and Cancer E-Pathology Reporting IGs, as well as use of a backend services app to facilitate reporting to a registry.

Related Tracks?

Call for participants

EHR Vendors
Laboratory Information Systems
Cancer Registries
Backend Service Apps

Track Prerequisites

Understanding of Message Bundles, Observations, & DiagnosticReports required:
Familiarity with MedMorph ( a plus

Track Lead(s)

Sandy Jones, Alex Goel, Dave deRoode, Caitlin Kennedy

Track Lead Email(s);;;

Specification Information

Zulip stream

Track Kick off Call

December 14, 10:00am EST

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If you missed the Kick-Off Call, then please see the recording and slides below:

View file
nameHL7 FHIR Cancer Pathology Data Sharing WG-20221214_100540-Meeting Recording.mp4
View file
nameHL7 FHIR Connectathon - Cancer Pathology Kickoff 20221214-Final.pdf

Specification Information

System Roles

  • EHR (order from clinician/specialist)
  • Laboratory Information System (LIS) / Integration Engine
  • Cancer Registries
  • Health Data Exchange Apps

Testing Scenario:

System roles:

  • EHR (order from clinician/specialist)
  • Laboratory Information System (LIS) / Integration Engine
  • Cancer Registries
  • Health Data Exchange Apps


  • Clinician orders pathological analysis of specimen
  • Triggers specimen collection procedure
  • Specimen sent to lab
  • Specimen sectioned, analyzed
  • Results are collected, prepared outbound to CCR or EHR running Health Data Exchange App (HDEA) (mCode version of FHIR server)
    • EHR to EHR sharing of path result Bundle (lower priority)
  • Systems receive the results


Previously, we simulated a path lab generating a completed synoptic report (through the SDC form filler) and tested turning that into FHIR observations and then wrapping it in a FHIR Bundle. The bundle included Observations, Patient, DiagnosticReport, and MessageHeader. We tested submitting this bundle to an EHR and/or CCR. We also tested the Order of the collection of the Specimen, the collection of the Specimen itself (process and procedure), and the ordering of the path lab analysis, as well as a lab system producing the results of these analysis and send it outbound either to an EHR or to a central registry via collection Bundle.

1. Further refining this (above) interactions using a more complex example of Specimen collection, resulting pathology data, and sending to EHR or central registry.

2. (Re-testing) the use of a HDEA to receive a trigger code (PlanDefinition), query an LIS, compile a pathology report via our bundling, and pushing it to a cancer registry/CCR.

3. EHR to EHR: Test the compiling and sending (POST) to a 3rd party EHR FHIR server.

Success Criteria:  

  • Able to create and submit bundle from LIS to Cancer Registry endpoints in conformance with the profiles defined in both IGs.
  • Successful use of a BSA (MedMorph's HDEA) to collect Cancer path data and send to a cancer registry.
  • Successful bundling of complex Specimen collection from a LIS and sending to an EHR or CCR.

Bonus point:

  • Successful, automatic trigger creation of the report with the PlanDefinition
  • Automatic triggering criteria for creation and exchange for each of the "success criteria" defined above.

  • Data Visualization: Tool to parse and render pathology data received by CCR


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