Kenya National Cancer Control Programme (NCCP) FHIR Implementation Guide, published by Digital Health Agency (DHA), Kenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/nccpFHIRIG/ and changes regularly. See the Directory of published versions

Use Cases

Use Cases

This page describes the primary clinical and administrative workflows supported by this Implementation Guide. Each use case maps to one or more FHIR profiles defined in the Artifacts section.

UC-01: Cancer Diagnosis Registration

Actor: Oncologist / Pathologist at a cancer treatment facility
System: Electronic Medical Record (EMR) / Cancer Registry System
Trigger: New cancer diagnosis confirmed (pathology report received)

Workflow:

1. Oncologist records a new cancer diagnosis as a FHIR Condition constrained by the OncologyDiagnosisCondition profile.
2. Morphology is recorded as a MorphologyObservation (ICD-O-3 code + method).
3. TNM staging is recorded as a TNMStagingObservation with T, N, M components.
4. An OncologyEpisodeOfCare is opened, linking the patient, diagnosis, care team, and facility.
5. Performance status (ECOG or Karnofsky) is captured as a PerformanceStatusObservation.

Key Profiles Used: OncologyDiagnosisCondition · MorphologyObservation · TNMStagingObservation · OncologyEpisodeOfCare

UC-02: Chemotherapy Prescription and Administration

Actor: Medical Oncologist (prescribing), Oncology Nurse (administering)
System: Oncology Pharmacy / EMR
Trigger: Decision to initiate or continue a chemotherapy regimen

Workflow:

1. Oncologist creates an OncologyCareplan specifying the regimen code, planned cycles, cycle length, and treatment intent (curative, palliative, adjuvant, neo-adjuvant).
2. Each cycle's medication orders are grouped in an OncologyRequestGroup with a cycle number.
3. Individual agents are prescribed as ChemotherapyMedicationRequest instances with BSA-based dose, route, and cycle day start/end.
4. On the day of administration, the oncology nurse records each agent as an OncologyMedicationAdministration linked to the encounter and session.
5. Adverse events (e.g., nausea grade 2) are captured as CTCAEAdverseEventObservation records.

Key Profiles Used: OncologyCareplan · ChemotherapyMedicationRequest · OncologyMedicationAdministration · OncologyRequestGroup

UC-03: Radiotherapy Planning and Treatment

Actor: Radiation Oncologist (prescribing), Radiation Therapist (delivering)
System: Radiotherapy Information System (RIS) / EMR
Trigger: Decision to initiate radiotherapy

Workflow:

1. Radiation oncologist creates a RadiotherapyServiceRequest with intent, technique, target volume, and body site.
2. A RadiotherapyCarePlan is authored capturing the full treatment protocol (total fractions, dose per fraction, technique).
3. Each fraction is recorded as a RadiotherapyTreatmentProcedure with fraction number, cumulative dose, beam type, and treatment machine.
4. A RadiotherapyDoseObservation summarises cumulative dose at course completion.

Key Profiles Used: RadiotherapyServiceRequest · RadiotherapyCarePlan · RadiotherapyTreatmentProcedure · RadiotherapyDoseObservation

UC-04: Oncology Referral and Pre-Authorisation

Actor: Referring clinician (e.g., county hospital), Receiving oncologist (referral centre)
System: Referral Management System / SHA Portal
Trigger: Patient requires oncology care beyond referring facility's capability

Workflow:

1. Referring clinician creates an OncologyReferralServiceRequest specifying the reason, diagnosis reference, and priority.
2. An OncologyCoverageEligibilityRequest is submitted to SHA to verify the patient's cancer benefit coverage.
3. SHA responds with a CoverageEligibilityResponse confirming covered services.
4. On authorisation, the oncology centre begins treatment and submits OncologyClaim instances for reimbursement.
5. SHA adjudicates and returns an OncologyClaimResponse with payment details.

Key Profiles Used: OncologyReferralServiceRequest · OncologyCoverageEligibilityRequest · OncologyClaim · OncologyClaimResponse

UC-05: Multidisciplinary Tumour Board

Actor: Multidisciplinary team (oncologist, surgeon, pathologist, radiologist, nurse, social worker)
System: EMR / MDT Coordination System
Trigger: New cancer case or treatment response review

Workflow:

1. An OncologyCareTeam resource is created, listing all participating practitioners and their roles for the patient's case.
2. The OncologyPlanDefinition is referenced as the treatment protocol template.
3. A new OncologyCareplan is authored based on the MDT consensus.
4. An OncologyEncounter of type "MDT Meeting" is recorded, linked to the episode of care.

Key Profiles Used: OncologyCareTeam · OncologyPlanDefinition · OncologyCareplan · OncologyEncounter

UC-06: Treatment Response Assessment (RECIST)

Actor: Oncologist / Radiologist
System: EMR / PACS
Trigger: Imaging review after chemotherapy cycles or radiotherapy course

Workflow:

1. Radiologist performs imaging assessment using RECIST 1.1 criteria.
2. A RECISTResponseObservation is recorded with timepoint and overall response category (CR, PR, SD, PD).
3. A new cycle of chemotherapy is initiated or the care plan is modified based on response.

​Key Profiles Used: RECISTResponseObservation