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 https://github.com/HL7/fhir-mCODE-ig/ and changes regularly. See the Directory of published versions
In addition to providing examples of mCODE profiles, this extended example demonstrates how to represent a clinically realistic scenario of a pediatric cancer patient.
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), idarubicin
(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.
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] |