Electronic Pathology Reporting Digitizing the College of American Pathologists Cancer Checklists Monica E. de Baca, MD; John F. Madden, MD, PhD; Mary Kennedy, MPH T he recent editorial 1 by Mahul B. Amin, MD, reports on the College of American Pathologists (CAP) Cancer Committee’s latest release of the CAP Cancer Protocols and Checklists, and offers perspective on the history and importance of standardized, structured pathology report- ing for effective cancer care. The CAP cancer checklists (CCs) are recognized as the gold standard for pathology reporting of cancer cases. Developed by the CAP Cancer Committee in collaboration with pathology, surgery, oncology, and radiation therapy experts, the synoptic checklist format ensures consistent reporting of scientifi- cally validated elements and enables the medical commu- nity to retrieve, share, compare, and research clinical data for improved patient care. Use of the CAP cancer checklists has become widespread throughout the United States. The American College of Surgeons Commission on Cancer requires the use of the essential data elements in the cancer checklists for accreditation. In addition, they are widely used in Canada (eg, Cancer Care Ontario [CCO]) and have become well known in many other countries. Historically, the CAP cancer checklists had been paper based. As health information technology advanced, it became evident that an electronic version of the checklists was needed. Several years ago, CAP began to offer a SNOMED CT (Systematized Nomenclature of Medicine– Clinical Terms)–encoded checklist version in a database format to software developers. With increased complexity of reporting, dynamic changes in the checklist content, and the need to support a broad range of rapidly evolving health information platforms, CAP formed the Pathology Electronic Reporting Taskforce (PERT) in 2005 with funding support from the Centers for Disease Control and Prevention (CDC). It is composed of CAP member experts in cancer and information technology, and also currently includes representatives from the North Amer- ican Association of Central Cancer Registries, the Amer- ican Joint Commission on Cancer (AJCC) and its Collab- orative Staging initiative, the US Department of Health & Human Services Office of the Assistant Secretary for Planning and Evaluation, the CDC, the Canadian Part- nership Against Cancer, CCO, CAP staff, and other specialists. PERT’s mission is to advance the implemen- tation of the CAP cancer checklists by using health information technology. This goal is one of the mandates of the PERT’s parent department within the CAP, the Diagnostic Intelligence and Health Information Technol- ogy (DIHIT), which aims to improve patient care and extend the role of the pathologist by developing standards and electronic tools for pathology practice. By integrating the CC content with other relevant electronic reporting standards for public health data collection and clinical care (including SNOMED CT, LOINC, caBIG, HL7, and others), PERT aims to make the cancer committee’s work accessible to an ever-wider audience, and to facilitate transmission and storage of CC-compliant patient reports. In January 2009, the PERT-developed electronic cancer checklists (eCCs) were first released in an eXtensible Markup Language (XML) format. This release format parses the paper-based checklists into datasets suitable for incorporation into software products and can be used to standardize the electronic collection and transmission of CC data. XML was chosen for its universal acceptance, ease of use, and its ability to facilitate the sharing of structured data across disparate systems, ranging from laboratory information systems and cancer registry systems to comprehensive electronic health records systems and future personal health records. In addition to patient care, we anticipate its increased use in public health surveillance, research, tissue banking, and quality improvement. An update in this format in December 2009 encoded the October 2009 CAP Cancer Protocols and Checklists and incorporated the AJCC 7th edition staging criteria. Subse- quent releases will follow in the coming months as more cancer protocols are released by the CAP Cancer Commit- tee. SNOMED CT encoding for histology and tumor site will be included in this release; subsequently, additional checklist sections will receive SNOMED CT mappings. In the first quarter of 2010, PERT will offer a preview release of its next-generation XML format incorporating several of the newly published 2009 CAP Cancer Committee Cancer Checklists. This will introduce PERT’s new inclusive framework for creation and distribution of Accepted for publication December 11, 2009. From the Department of Pathology, Avera McKennan Hospital & University Health Center and Department of Pathology, Physicians Laboratory Ltd, Sioux Falls, South Dakota (Dr de Baca); the Department of Pathology, Duke University, Durham, North Carolina (Dr Madden); and Diagnostic Intelligence, College of American Pathologists, North- field, Illinois (Ms Kennedy). Dr de Baca is now located at Pathology Associates of Kitsap County, Bremerton, Washington. The authors have no relevant financial interest in the products or companies described in this article. Drs de Baca and Madden are cochairs of the CAP Pathology Electronic Reporting Taskforce (PERT). Reprints: Monica E. de Baca, MD, Pathology Associated of Kitsap County, Harrison Medical Center, 2520 Cherry Ave, Bremerton, WA 98110 (e-mail: debaca@me.com). Editorial Arch Pathol Lab Med—Vol 134, May 2010 Editorial—de Baca et al 663