minimal Common Oncology Data Elements (mCODE) Implementation Guide
4.0.0-ballot - STU4 Ballot United States of America flag

minimal Common Oncology Data Elements (mCODE) Implementation Guide, published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions

Extended Pediatric Example

In addition to providing examples of mCODE profiles, this extended example demonstrates how to represent a clinically realistic scenario of a pediatric cancer patient.

  • When information in the scenario does not map on to mCODE profiles, we provide examples using USCore or standard FHIR resources.
  • We condense some repeated patterns. For example, we only show one example of MedicationAdministration when in reality, there could be multiple cycles, the only difference being the day of the administration.

Patient description

Note: patient and clinical data in the narrative example below are linked to the relevant FHIR examples using this styling.

Patient Brian L. is a 3 year old non-Hispanic Asian male with a past medical history of an atrial septal defect that was repaired with surgery. His family history includes a grandmother with breast cancer at age 55.

During January 2024, Brian starts to complain of pain in his knees and his parents notice abnormal bruising. His parents take him to the pediatrician, who orders a complete blood count. The test revealed abnormal blood counts: low hemoglobin (6.7 g/dL), low hematocrit (22.3%), and high white blood cells (88.5 10*3/uL). The pediatrician referred the patient to a hospital for further workup. A bone marrow aspiration and biopsy were performed, which showed a predominance of immature cells, indicating leukemia. To further characterize the cancer, immunophenotyping occurred, which identified the leukemia as B-cell acute lymphoblastic leukemia.

After the initial diagnosis, genetic testing was performed (karyotyping), revealing a chromosomal translocation between chromosomes 12 and 21. To understand if the cancer spread to the brain or spinal cord, a lumbar puncture was performed, revealing negative results.

Treatment options were discussed between the patient’s family and the medical oncologist. With a Lansky Play Performance status of 80, the family agreed to receive a 28-day treatment regimen of cyclophosphamide (750 mg/m² IV once per day on days 1 & 8), idrarubicin (9 mg/m² IV once per day on days 1, 2, 3, 8), vincristine (2 mg IV once per day on days 1, 8, 15, 22), and prednisone (60 mg/m²/day IV or PO on days 1 to 7, 15 to 21). The medication dosage is normalized based on Brian’s body surface area of 0.59 m². After four weeks, a repeat bone marrow aspiration and blood count was performed, showing no evidence of persistent leukemia and normal blood counts. Due to the improved cancer disease status, age, test results, and type of leukemia, Brian was designated as standard risk and then began consolidation therapy.

FHIR instances from mCODE elements

Instance Description mCODE Profile
Cancer Patient: Brian L CancerPatient
Cancer Diagnosis PrimaryCancerCondition
Genomic Variant: Chromosomal Translocation GenomicVariant
Performance Status: Lansky LanskyPlayPerformanceStatus
Medication Request: Cyclophosphamide CancerRelatedMedicationRequest
Medication Request: Idrarubicin CancerRelatedMedicationRequest
MedicationRequest: Vincristine CancerRelatedMedicationRequest
MedicationRequest: Predniesone CancerRelatedMedicationRequest
Medication Administration: Cyclophosphamide CancerRelatedMedicationAdministration
Medication Administration: Idrarubicin CancerRelatedMedicationAdministration
MedicationAdministration: Vincristine CancerRelatedMedicationAdministration
MedicationAdministration: Predniesone CancerRelatedMedicationAdministration
Body Surface Area BodySurfaceArea
Cancer Disease Status: Condition Improving CancerDiseaseStatus
ALL Risk Assessment: Standard ALLRiskAssessment

FHIR instances from non-mCODE elements

Instance Description Profile/Resource
Past Condition: Atrial Septal Defect USCoreConditionProblemHealthConcern
Grandmother With Breast Cancer R4FamilyMemberHistory
Complete Blood Count: Abnormal Blood Counts [USCoreDiagnosticReportLab]
Bone Marrow Aspiration Procedure USCoreProcedure
Bone Marrow Biopsy Procedure USCoreProcedure
Bone Marrow Biopsy Results: Predominance of Immature Cells [USCoreObservationLab]
Bone Marrow Aspirate Results: Predominance of Immature Cells [USCoreObservationLab]
Immunophenotyping [USCoreObservationLab]
Lumbar Puncture USCoreProcedure
Lumbar Puncture Result: Negative [USCoreObservationLab]
Blood Test Result: Hemoglobin [USCoreObservationLab]
Blood Test Result: Hematocrit [USCoreObservationLab]
Blood Test Result: White Blood Cell [USCoreObservationLab]