title: Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization.
abstract: OBJECTIVE
  Develop and evaluate a foundational oncology-specific standard for the communication and coordination of care throughout the cancer journey, with early-stage breast cancer as the use case.
  
  
  METHODS
  Owing to broad uptake of the Health Level Seven (HL7) Consolidated Clinical Document Architecture (C-CDA) by health information exchanges and large provider organizations, we developed an implementation guide in congruence with C-CDA. The resultant product was balloted through the HL7 process and subsequently implemented by two groups: the Health Story Project (Health Story) and the Athena Breast Health Network (Athena).
  
  
  RESULTS
  The HL7 Implementation Guide for CDA, Release 2: Clinical Oncology Treatment Plan and Summary, DSTU Release 1 (eCOTPS) was successfully balloted and published as a Draft Standard for Trial Use (DSTU) in October 2013. Health Story successfully implemented the eCOTPS the 2014 meeting of the Healthcare Information and Management Systems Society (HIMSS) in a clinical vignette. During the evaluation and implementation of eCOPS, Athena identified two practical concerns: (1) the need for additional CDA templates specific to their use case; (2) the many-to-many mapping of Athena-defined data elements to eCOTPS.
  
  
  CONCLUSIONS
  Early implementation of eCOTPS has demonstrated successful vendor-agnostic transmission of oncology-specific data. The modularity enabled by the C-CDA framework ensures the relatively straightforward expansion of the eCOTPS to include other cancer subtypes. Lessons learned during the process will strengthen future versions of the standard.
  
  
  CONCLUSIONS
  eCOTPS is the first oncology-specific CDA standard to achieve HL7 DSTU status. Oncology standards will improve care throughout the cancer journey by allowing the efficient transmission of reliable, meaningful, and current clinical data between the many involved stakeholders.
authors.affiliation: Department of Medicine, Division of Hematology & Oncology, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA jeremy.warner@vanderbilt.edu.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Warner
authors.affiliation: Quality and Guidelines Division, American Society of Clinical Oncology, Alexandria, VA, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Maddux
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Hughes
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Krauss
authors.affiliation: Palo Alto Medical Foundation, Sunnyvale, CA, USA.
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: Yu
authors.affiliation: Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.affiliation: UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: Mike
authors.initials: M
authors.lastname: Hogarth
authors.affiliation: Shafarman Consulting, Oakland, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Shafarman
authors.affiliation: Department of Surgery, University of California, San Francisco, CA, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Stover Fiscalini
authors.affiliation: Department of Surgery, University of California, San Francisco, CA, USA Department of Radiology, University of California, San Francisco, CA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Esserman
authors.affiliation: Lantana Consulting Group, East Thetford, VT, USA.
authors.forename: Liora
authors.initials: L
authors.lastname: Alschuler
authors.affiliation: Lantana Consulting Group, East Thetford, VT, USA.
authors.forename: George Augustine
authors.initials: GA
authors.lastname: Koromia
authors.affiliation: Lantana Consulting Group, East Thetford, VT, USA.
authors.forename: Zabrina
authors.initials: Z
authors.lastname: Gonzaga
authors.affiliation: Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Ambinder
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D057208:Health Level Seven; D006801:Humans; D008495:Medical Oncology / Q000145:classification / Q000458:organization & administration*; D008498:Medical Record Linkage / Q000592:standards*; D016347:Medical Records Systems, Computerized / Q000592:standards; D018511:Systems Integration; D014584:User-Computer Interface
keywords: Breast Neoplasms; Continuity of Patient Care; Electronic Health Records; Health Information Management; Information Science; Medical Oncology