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Overview

The growing complexity of cancer care increases with each year with new drug regimens and tumor genomics. To deal with this, oncologists need decision support to help standardize care. This combined with rising healthcare costs associated with expensive cancer therapies has led to the rapid growth of oncology clinical pathways. 

Health systems considering or implementing mCODE made clear to MITRE that oncology clinical pathways should be prioritized as a mCODE point-of-care application.  The key reasons for this is the burden on the oncologist on pathway navigation/documentation and the challenges of prior authorization.  The other important factor is the use of mCODE, a HL7 FHIR-based interoperable standard, for pathway data.


OCP Details

ActorOncologist
Description

An Oncology Clinical Pathway (OCP):  detailed decision tree protocol for selection of treatment options by oncologists, primarily focused on anticancer drug regimens for specific patient populations, including type, stage, and molecular subtype of disease.

Trigger

Oncologist launches pathway Smart-on-FHIR application.

Preconditions
  • The EHR system supports FHIR RESTful API and the integration of SMART-on-FHIR applications.
  • The EHR system can consume and produce valid FHIR resources.
  • The pathways content must come from recognized sources, such as academic medical centers or pathway vendors.
Postconditions

The oncologist accepts the treatment recommendation
OR
The oncologist denies the treatment recommendation, gives the rationale, and suggests alternative(s).

Extensions

Pathways contain both oncology and clinical data elements that are not in mCODE for branch navigation.  These need to be modeled into CodeX elements to be used in pathway navigation.

Assumptions
  • The oncologist can enter pathway data elements via EHR forms or other means of structured documentation.
  • The pathways application can access the pathway data elements for navigation.
Scope

This use case covers the use of the pathways application to reach a treatment option.  Clinical data exchange and preauthorization are out of scope for this use case.

Notes





Conference Call Information

Important Dates

EventDate/Time
First demo of Camino to UPenn22 January 2020
First demo of Camino to UCSF30 January 2020



Use Case Team

RoleNameOrganizationEmail
Domain LeadJim O'ConnorThe MITRE Corporation

joconnor@mitre.org

Technical LeadDylan HallThe MITRE Corporation

dehall@mitre.org

Chief EngineerRob DingwellThe MITRE Corporation

bobd@mitre.org