Role of the Cancer Registry and P athology Infor m atics in the Cancer Center N A A C C R Cancer Infor m atics Sy m posiu m: Essential Technologies & M ethodologies for Registries Toronto, Canada; Sunday, June 9th, 2002 Michael J. Becich, M D Ph D - becich@ pitt.edu C hair m an of Pathology, UP M C-Shadyside & Hillm a n Cancer Center Associate Professor of Pathology and Infor ma tion Sciences & Teleco m m u nications U niversity of Pittsburgh School Medicine Director, Center for Path ology Inform atics http://path.up mc.edu/cpi Director, Benedu m Oncology Infor matics Center (Hill m an Cancer Center) http:// w w w.upci.up mc.edu/internet/benedu m /index.ht ml Advancing Pathology Infor matics, Imaging and the Internet (APIII) - http://apiii.up mc.edu Association for Pathology Infor matics (API) - http:// w w w.pathologyinforSlide 1 matics.org Benedu m Oncology Informatics Center / Center for Pathology Infor matics 1 OO utline utline •• Introduction to Oncology & Pathology Informatics R esearch at Hillman Cancer Center •• Linkages Between Pathology and Cancer Registries •• Research Use of Pathology Data and Cancer Registries •• Co m prehensive Prostate Cancer Tissue Resource (C P C T R) an d Tissue B a n k Inform ation Syste m s [Clinical, Pathology & Cancer Registry Data] •• The Shared Pathology Informatics Network (SPIN) - Cancer Registry and Anato mic Pathology Data •• Conclusions •• Future Directions – T h e N ee d for Electronic C o m m u nication Strategies Slide 2 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 2 HillmanHillman CancerCancer CenterCenter University of Pittsburgh Cancer Institute and UP M C Cancer Centers Co m prehensive Cancer Center 12 patient care centers, each focusing on a specific typ e or treatm e nt of can cer N ationally a n d Re gion ally Co m p etitive In stitutio n siz e 600+ physicians/researchers N u m b er of ne w cancer patients per year: 10,00 0 + P a rticip atio n in clinic al trials Number of open protocols by sponsor type 247 active protocols (48 phar m aceutical, 28 cooperative group, 45 internal) Number of patients accrued in 2001: 1028 Slide 3 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 3 HillmanHillman CancerCancer CenterCenter P athology Infor m atics 1 8 hospitals – one anato mic laboratory infor m ation syste m (LIS) 1 2 of 1 8 ho s pitals on o n e clinic al path olo g y LI S One tissue banking plan (5 major tissue banks) and no w linked to our Organ Specific Database progra m O ncology Infor matics 1 4 of 1 8 ho s pital on o n e C a n c e r R e gistry (I m P at h, for m erly M R S) N u m ber of ne w index cancer patients per year: 10,000+ Clinical Trials Inform ation Syste m (develope d in house) Organ Specific Databases (research infor mation syste ms) Slide 4 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 4 OO utline utline •• Introduction to Oncology & Pathology Informatics R esearch at Hillman Cancer Center •• Linkages Between Pathology and Cancer Registries •• Research Use of Pathology Data and Cancer Registries •• Co m prehensive Prostate Cancer Tissue Resource (C P C T R) an d Tissue B a n k Inform ation Syste m s [Clinical, Pathology & Cancer Registry Data] •• The Shared Pathology Informatics Network (SPIN) - Cancer Registry and Anato mic Pathology Data •• Conclusions •• Future Directions – T h e N ee d for Electronic C o m m u nication Strategies Slide 5 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 5 PP at at h h olo olo g g y y InforInfor m m atics atics Grade • Seventy percent of the data in Stage the U P M C Electronic Me dical Progression PSA Record is Pathology Data Therapy Type D e m o graphics • Eighty percent of the data us e d Pathology by the UPMC decision support Clinical Genetic syste m is Pathology Data Morphologic G ene Expression• Seventy-plus percent of the Genotype queries against the UPMC EMR Anatomy involve Pathology Data Phenotype • Ti m e P athologists analyze blood and tissue for the prese nce a n d nature of disease • M u c h of this analysis is based or relies on morphology Slide 6 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 6 MM erging erging PathologyPathology && OncologyOncology DataData forfor ValueValue CreationCreation • Pathology & Oncology Data and Value Creation: – Tissue In B ased Archives » Paraffin – Tu mor classification, staging & grading (stored in anato mic pathology lab info syste m or A P LIS) are critical to the Molecular ReClassification (NCI Director’s Challenge) » Cancer Registry (CR) records treat m ent, progression and outco mes critical to res e arc h efforts (S PI N gra nt) » I m p orta n c e of res e arc h m a t erials (tissues) for geno mics » Pathology + O utco mes + Tissue = unprecedented new value – Clinical Data (and Seru m) Archives » Chemistry profiles and tumor markers many times qualify a patient or define success or failure of therapeutic intervention in clinical trials (clinical pathology lab info syste m or CPLIS) » Aggregates of longitudinal medical records in Oncology and for hospital syste ms (clinical infor m ation system s or CIS) has new perceived value for bench marking change Slide 7 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 7 CoCo mponent mponent TechnologyTechnology –– PP athology athology && OO ncology ncology InforInfor m m atics atics •• PathologyPathology InformInform atics atics •• OncologyOncology InformInform atics atics •• AA n n ato ato mic mic PatholoPatholo gy gy •• CancerCancer RegistryRegistry •• ClinicalClinical PathologyPathology •• ClinicalClinical TrialsTrials •• HH e e m m atopathology atopathology && •• OO r r ga ga n n SpSp ecific ecific MM olecular olecular DiagnosticsDiagnostics PrograProgra m m SupportSupport •• LILI M M S S forfor GenoGeno mics mics ••Prostate, andand ProteoProteo mics mics M elano ma, etc.. • •• TissueTissue BankingBanking • TelemedicineTelemedicine (for(for •• oncology)oncology) TelepathologyTelepathology •• •• WW e e b b SiteSite SupportSupport WW e e b b SiteSite SupportSupport •• EE--HealthHealth Slide 8 InitiativesInitiatives Benedu m Oncology Informatics Center / Center for Pathology Infor matics 8 ProposedProposed InforInfor mation mation RR el el atio atio n n s s hi hi p p s s Version 1.0 Synoptic Form s Cancer Pathology R e gistry LIS Nomenclature HL7 R esearch Infor m a tion Tissue B a nk System Slide 9 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 9 RR esearch esearch InforInfor mation mation SysteSyste m m • This syste m acts as an integrator, verifier and honest Cancer Pathology R e gistry LIS broker N o m enclature Synoptic Forms • Version 1.04 of this syste m is Tissue Bank imple mented for prostate with Tissue Bank Infor m ation funding from CP CT R, CaPC U RE System and National Medical Test De identification Beds (NMTB) which is a DOD/TATRC (Telemedicine Organ Specific Research Dataset and Advanced Technology Research Center) funded effort. Intran et N CI interface, collaborator interfaces Slide 10 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 10 Clinical Environ m ent (Id e ntified Data) AP-LIS CP-LIS Clinical Tissue Sources Clinical Infor m ation Sources Clinician Direct Data Entry Fire w all Tissue Bank Honest Tissue Bank Infor mation Syste m Planned Broker Environ ment Cancer Registry (Clinical, Pathology & Outco mes) O ne way interface Fire w all De-identified Data O nly R e s e arch E nviron m e nt (De-identified Data) Organ Specific Research Database R esearch Infor m ation Sources Syste ms Interface cD N A Microarrays Tissue Microarrays Imaging Data (not com pleted) Research Data Server Intra n et A n alysis an d Visualization S ervers (years 2 - 3) Figure 1: Overall architecture OO utline utline •• Introduction to Oncology & Pathology Informatics R esearch at Hillman Cancer Center •• Linkages Between Pathology and Cancer Registries •• Research Use of Pathology Data and Cancer Registries •• Co m prehensive Prostate Cancer Tissue Resource (C P C T R) an d Tissue B a n k Inform ation Syste m s [Clinical, Pathology & Cancer Registry Data] •• The Shared Pathology Informatics Network (SPIN) - Cancer Registry and Anato mic Pathology Data •• Conclusions •• Future Directions – T h e N ee d for Electronic C o m m u nication Strategies Slide 12 Benedu m Oncology Informatics Center / Center for Pathology Infor matics 12 Current Funding and AP-LIS CP-LIS Areas of Influence Clinical Environ m ent (Id e ntified Data) Clinical Tissue Sources Clinical Infor m ation Sources Clinician Direct D ata E ntry De-ID (Clinical Research Infor m ation Service or CRIS) SPIN – Shared Pathology U M LS Based Parser and Autocoder – SPIN Infor m atics Network T w o W ay Hashing for Non-Consented Clinfo and Biosa mples Fire w all Tissue Bank Honest Tissue Bank Infor mation Syste m Planned C P C T R – Cooperative Prostate Broker Environ ment Cancer Registry (Clinical, Pathology & Outco mes) Cancer Tissue Resource One way interface Fire w all De-identified D ata O nly R e s e arch E nviron m e nt Director’s Challenge – Molecular (De-identified Data) R e Classification of Diseas e Organ Specific Research Database R esearch Infor m ation Sources Syste ms Interface Prostate Research Dataset cDNA Microarrays Tissue Microarrays Imaging Data (not co m pleted) Research Data Server Intra n et A n alysis an d Visualization Servers (years 2 -3) Figure 2: Tissue Cube Director’sDirector’s ChallengeChallenge –– MM olecular olecular