Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization

J Am Med Inform Assoc. 2015 May;22(3):577-86. doi: 10.1093/jamia/ocu015. Epub 2015 Jan 20.


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.

Materials and 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.

Discussion: 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.

Conclusion: 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.

Keywords: Breast Neoplasms; Continuity of Patient Care; Electronic Health Records; Health Information Management; Information Science; Medical Oncology.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Neoplasms / therapy*
  • Electronic Health Records / standards*
  • Female
  • Health Level Seven*
  • Humans
  • Medical Oncology / classification
  • Medical Oncology / organization & administration*
  • Medical Record Linkage / standards*
  • Medical Records Systems, Computerized / standards
  • Systems Integration
  • User-Computer Interface