Welcome to the CodeX April newsletter! CodeX (Common Oncology Data Elements eXtensions) is a HL7 FHIR Accelerator, launched at the end of 2019, that is building a community to enable interoperable cancer data modeling and applications. Check out some of our exciting updates below.
The work of the CodeX Community is moved forward by the dedicated work of our Members, and we are excited to announce the addition of new Members to join in the effort. These new Members represent key perspectives in the cancer ecosystem and will dedicate time and effort to advance CodeX use cases.
New Members include the Michigan Cancer Surveillance Program as a government agency member; the Canadian Organization of Medical Physicists (COMP), the Learning Health Community and the Society for Imaging Informatics in Medicine(SIIM) as sponsored members; and Massive Bio, NeuralFrame and PatientLink as developers/implementers.
Recent CodeX Use Case Achievements
At the March 26 Community of Practice meeting (recording and presentation), Steve Bratt provided an update on progress so far this year on the seven active use case projects under the CodeX umbrella. Four are in the Execution
Stage – mCODE++ Extraction, ICAREdata, Trial Matching, Registry Reporting. Radiation Therapy is in the Planning
Stage, with Members preparing for Execution. Oncology Clinical Pathways, Prior Authorization, and Genomics Data Sharing are in Discovery.
Here are some highlights from the presentation:
ICAREdata (EHR Endpoints for Clinical Trials) is in Phase 2, with several health systems implementing the mCODE-based data collection and extraction tools or planning to do so. Recently, the University of Chicago successfully tested their implementation of the mCODE extraction framework and ICAREdata client with synthetic data. Five health systems have made the ICAREdata collection tools available in their production EHR environments (Massachusetts General Hospital (MGH), Brigham and Women’s Hospital, Dana Farber Cancer Institute (DFCI), Mayo Clinic, and University of Pennsylvania). Collection is underway at MGH, DFCI, and Mayo Clinic. With support from CodeX Member and use case champion the Alliance for Clinical Trials in Oncology Foundation, clinical trial partnerships are expanding. Five clinical trials have or will soon launch with ICAREdata methods embedded in their protocols; a recently approved companion study protocol will enable even broader partnership with Alliance clinical trials. Data modeling work is underway for a new ICAREdata pilot for mCODE-enabled adverse event reporting.
Work is also advancing with Trial Matching; Cancer Insights, Massive Bio, and University of Texas Southwestern Medical Center (UTSW) are pilot testing the use case. Several patients have signed up to participate by joining the Cancer Insights application to test the value and usability of this approach. Additionally, a study has been activated at UTSW and Massive Bio to send patient data through multiple mCODE-enabled matching services to test the discriminatory value of the optimized patient data elements. The team championed by CodeX Member American Cancer Society Cancer Action Network expects to have patient data in place to test matching in April. In tandem with the upcoming HL7 Connectathon, there is a potential opportunity to test mCODE-enabled matching services to find clinical trials and engage with other community members. Register now for the HL7 FHIR Connectathon, May 17 to 19, and join this team to test the CodeX Integrated Trial Matching for Cancer Patients and Providers implementation guide in the Trial Matching Connectathon track.
In Registry Reporting, the terminology and technical architecture sub-workgroups continue to meet, determining items such as data elements for Phase 1 implementation and Pilot Activity reporting capabilities respectively. The Centers for Disease Control and Prevention (CDC) and Center for International Blood and Marrow Transplant Research (CIBMTR) continue to champion this use case, along with the newly added Michigan Cancer Surveillance Program. Contributors are currently scoping a Pilot Activity leveraging the CDC’s MedMorph Reference Architecture, fulfilling a proof of concept with the University of California San Francisco and the California Cancer Registry. All in the effort of collecting data in an EHR once and sharing that data in a registry agnostic and low-burden way.
Radiation Therapy Treatment Data is in the
Planning Stage and is close to moving to execution. Champions for this use case include the American Society for Radiation Oncology (ASTRO) and the American Association of Physicists in Medicine (AAPM). CodeX Members ASTRO, AAPM, MITRE, Varian, COMP, SIIM, and Wemedoo are collaborating with others to develop, test and deploy open data standards that enable interoperable, multi-purpose exchange of radiation therapy treatment summary data for care coordination and data reuse. This team is making progress in defining the radiation therapy treatment data elements that will be generated as a summary report and exchanged between systems. Work in this group is influencing the next version of mCODE.
Parties interested in Prior Authorization in Oncology , including CodeX Members United Healthcare and Mettle Solutions, worked on a proof of concept showing how a patient’s mCODE-based health data could help inform a payer’s prior authorization or requests for additional information for treatments. The team is actively seeking payer and health system collaborators and additional partners from the cancer ecosystem to learn more about current state problems being faced in provider-payer data exchange and where FHIR standardization can add the most value within the oncology ecosystem. Stay tuned for an email invite to the upcoming multi-stakeholder discovery sessions.
Report Shows mCODE Progress
At the March Community of Practice meeting, Dr. Mark Kramer, chief engineer for MITRE, provided a progress report for the mCODE standard.
Proposed updates to mCODE based on CodeX experience and other stakeholder input - mCODE STU2 are being ballots in HL7 now, and through mid-May. Subsequent to the STU2 ballot, Dr. Mark Kramer expects release of the newest version of the standard in the fall.
Because of the range of organizations working on CodeX initiatives supporting these advances, Dr. Mark Kramer believes “the transition from STU1 to STU2 will be relatively smooth.”
Stay in Touch!
If you would like to stay up to date with the latest mCODE and CodeX related news and updates, please go to our CodeX Confluence home page and click "Join a CodeX Listserv." Please contact Steve Bratt or Kim Ball with any questions, comments, or content ideas!