Building a Standardized Cancer Synoptic Report With Semantic and Syntactic Interoperability: Development Study Using SNOMED CT and Fast Healthcare Interoperability Resources (FHIR)

Background: Pathology reports contain critical information necessary for the management of cancer patient care. Efforts to structure pathology cancer reports by the College of American Pathologists and the International Collaboration on Cancer Reporting (ICCR) have been successful in standardizing pathology reports. Likewise, standards development organizations have advanced methods to improve data computability and exchange, by enabling interoperability of pathology cancer reports. Objective: This study aimed to provide a tractable method to render pathology cancer reports computable and interoperable using published cancer reporting protocols, SNOMED Clinical Terms (SNOMED CT) and Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). Methods: The ICCR colorectal cancer (CRC) reporting dataset (version 1.0) was evaluated by terminologists and pathologists. SNOMED CT concepts were bound to the data elements. The dataset was then converted into a FHIR structured data capture (SDC) questionnaire using the United States National Library of Medicine tooling and rendered into a FHIR-conformant message for data exchange. Results: The ICCR CRC dataset contained 216 data elements; 207 data elements were bound to SNOMED CT and incorporated into a FHIR SDC construct. The 9 uncoded data elements were ambiguous and could not be reliably encoded. The resultant FHIR SDC form fully represented the ICCR CRC dataset and rendered these data in an R4 JSON format for data exchange. Conclusions: This study demonstrates a tractable and extensible approach to making cancer pathology reports fully computable and interoperable that can be broadly adopted. ICCR datasets are supported internationally and supported by multiple national pathology societies. These datasets can be fully represented using SNOMED CT to render data elements computable and semantically faithful to their intended meaning. The use of the FHIR SDC construct enables widespread and standardized data exchange of clinical information. While challenges remain, including FHIR adoption and the need to maintain current clinical content and standard terminology, this approach provides a clear pathway toward implementation.