College of American Pathologists Cancer Protocols: From Optimizing Cancer Patient Care to Facilitating Interoperable Reporting and Downstream Data Use

Abstract

The College of American Pathologists Cancer Protocols have offered guidance to pathologists for standard cancer pathology reporting for more than 35 years. The adoption of computer readable versions of these protocols by electronic health record and laboratory information system (LIS) vendors has provided a mechanism for pathologists to report within their LIS workflow, in addition to enabling standardized structured data capture and reporting to downstream consumers of these data such as the cancer surveillance community. This paper reviews the history of the Cancer Protocols and electronic Cancer Checklists, outlines the current use of these critically important cancer case reporting tools, and examines future directions, including plans to help improve the integration of the Cancer Protocols into clinical, public health, research, and other workflows.

FIG 1.

CAP Cancer Protocol for invasive carcinoma of the breast (case summary). The case summary in the CAP Cancer Protocol for Invasive Carcinoma of the Breast is one of over 100 summaries that are maintained and updated by the CAP on a regular basis as science, medicine, and clinical practice evolve. Each protocol consists of a cover page, case summary, explanatory notes, and references. The case summary contains all elements that a pathologist needs to include in their pathology cancer report in order for it to be considered complete to help optimally direct patient care. The Cancer Protocols are freely accessible via the CAP website. CAP, College of American Pathologists.

FIG 2.

Reporting on invasive carcinoma of the breast cases electronically using the CAP eCC. The case summary in the CAP Cancer Protocol for invasive carcinoma of the breast can be represented in the CAP eCC in computer readable Structured Data Capture XML format. This standard XML technical file is then rendered by vendors and other software systems into a human-readable DEF. CAP, College of American Pathologists; DEF, data entry form; eCC, electronic Cancer Checklists.

FIG 3.

Structured Data Capture (SDC) enables systems to retrieve, display, fill, and submit structured forms to a receiver. A user, such as a pathologist, requests a specific form to report on an invasive breast cancer case they are reviewing. The correct form is retrieved, and the user reviews and completes the form with all relevant data. The completed form can then be submitted to one or many receivers, who receive these data in the same format in which it was completed. The data can also be transformed into other formats such as a human readable patient report, cancer registry message, or ingested into a database as structured data.

FIG 4.

Vision of an interoperable future for cancer data exchange, patient care, and downstream data use. Multidisciplinary reports are currently issued in varied formats, and translation and integration of these may be limited by the allowable outputs from their electronic health record systems. We envision harmonizing reporting structures using a technical standard such as Structured Data Capture (SDC) to be used in direct patient reporting and to communicate these data accurately and effectively to downstream data users.