MII IG Kerndatensatz-Modul Onkologie
2027.0.0-ballot.1 - Germany

This page is part of the MII IG Kerndatensatz-Modul Onkologie (v2027.0.0-ballot.1: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Example Bundle: MII EXA Onko KRK Bundle

Content

The KRK bundle example demonstrates the structured assembly of all colorectal-cancer-specific FHIR resources in a single transaction bundle. This bundle shows the practical use of the KRK profiles and how they link to one another in a realistic clinical scenario of a rectal carcinoma.

The bundle implements the transaction pattern and is server-consumable, so that all contained resources can be transmitted as an atomic operation.

Bundle structure

The KRK bundle comprises the following resources:

Primary resources

  • Patient: KRK patient (Klaus KolorektalCa)
  • Condition: primary tumour diagnosis (C18 - malignant neoplasm of the colon)
  • Encounter: inpatient episode of care

KRK-specific Observations

  • Distance to the anal verge: tumour located 6cm from the anal verge (KR1)
  • Circumferential resection margin: minimum distance 2mm (KR3)
  • Aboral resection margin: minimum distance 15mm (KR2)
  • MRI mesorectal fascia: imaging-based assessment of the distance (KR2)
  • Anastomotic leak: postoperative complication assessment (KR8)
  • ASA classification: preoperative risk assessment ASA II (KR9)

Therapeutic resources

  • Stoma marking: preoperative marking of the stoma position (KR7)
  • KRK operation: surgical resection with TME quality assessment (KR4)
  • KRK specimen: surgical specimen with pathological workup

Clinical scenario

The bundle represents a patient with rectal carcinoma with complete preoperative diagnostics and surgical therapy:

Patient characteristics:

  • Diagnosis: C18 colon carcinoma
  • ASA status: ASA II (moderate operative risk)
  • Tumour location: 6cm from the anal verge (low rectum)

Preoperative diagnostics:

  • MRI staging: assessment of the mesorectal fascia
  • Preoperative preparation: stoma marking carried out

Surgical therapy:

  • Rectal resection: using the TME technique (total mesorectal excision)
  • Resection margins: R0 resection with sufficient safety margins
  • Postoperative complications: no anastomotic leak

Technical implementation

Bundle type and structure

* type = #transaction
  • Transaction bundle: atomic transmission of all resources
  • Server-consumable: all entries carry complete request information

Entry pattern

Each bundle entry contains:

  • fullUrl: unique reference URL
  • resource: the actual FHIR resource
  • request.method: HTTP POST for creation
  • request.url: target resource type

Reference integrity

  • Condition: references the patient via subject
  • Observations: reference both the patient (subject) and the Condition (focus)
  • Procedures: reference the patient (subject) and the Condition (reasonReference)
  • Specimen: references the patient (subject) and the collection procedure

Linking pattern

The bundle demonstrates the consistent reference structure between KRK-specific resources:

Patient ← subject ← Condition (primary tumour)
                        ↑ focus
                 Observations (distances, ASA, anastomotic leak)
                        ↑ reasonReference
                   Procedures (stoma marking, operation)
                        ↑ collection.procedure
                    Specimen (surgical specimen)

oBDS mapping

The bundle demonstrates the complete representation of the oBDS data fields for colorectal cancer:

Tumour location

Pathological assessment

Imaging procedures

Surgical data

Use of ValueSets

The bundle shows the practical use of various terminologies:

LOINC

  • Distance to the anal verge: 33748-5 "Distance from anal verge"
  • ASA classification: 97816-3 "American Society of Anesthesiologists physical status score"

SNOMED CT

  • Anastomotic leak: 235919008 "Anastomotic leak"
  • Surgical procedures: various SNOMED CT codes for colorectal operations

ICD-10-GM

  • Diagnosis: C18 "Bösartige Neubildung des Kolons"

oBDS CodeSystems

  • ASA classification: mii-cs-onko-krk-asa-obds#2 "ASA II"
  • Stoma marking: mii-cs-onko-krk-stoma-anzeichnung#durchgefuehrt "Durchgeführt"
  • TME quality: mii-cs-onko-krk-tme-qualitaet#komplett "Komplett"

Individual resource examples

The resources contained in the bundle are also shipped as standalone example instances:

Language: en

Profile: Bundle

Bundle mii-exa-onko-krk-bundle of type transaction

Entry 1 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Patient/mii-exa-onko-krk-bundle-patient

Resource Patient:

Language: en

Klaus KolorektalCa (no stated gender), DoB Unknown

Request:

POST Patient

Entry 2 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Condition/mii-exa-onko-krk-diagnose

Resource Condition:

Condition Asserted Date: 2020-03-07

clinicalStatus: Active

verificationStatus: Confirmed

category: Neoplastic disease

code: Bösartige Neubildung des Kolons

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

recordedDate: 2024-01-02

Request:

POST Condition

Entry 3 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Encounter/mii-exa-onko-krk-bundle-encounter

Resource Encounter:

Language: en

status: completed

class: inpatient encounter

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

Request:

POST Encounter

Entry 4 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-tumor-anokutanlinie

Resource Observation:

status: Final

code: Distance from anal verge

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung des Kolons

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

effective: 2024-03-10 14:30:00+0100

value: 8.5 cm (Details: UCUM codecm = 'cm')

Request:

POST Observation

Entry 5 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-circumferelle-resektionsebene

Resource Observation:

status: Final

code: Distance of tumor from circumferential resection margin [Length] in Specimen by Macroscopy

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung des Kolons

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

effective: 2024-03-20 10:15:00+0100

value: 2.5 mm (Details: UCUM codemm = 'mm')

Request:

POST Observation

Entry 6 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-resektionsrand-aboral

Resource Observation:

Language: en

Profile: MII PR Onkologie Abstand Aboral

status: Final

code: Distance of tumor from closest margin [Length] in Specimen by Macroscopy

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung des Kolons

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

effective: 2024-03-20 10:15:00+0100

value: 15 mm (Details: UCUM codemm = 'mm')

Request:

POST Observation

Entry 7 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-mesorektale-fascie

Resource Observation:

status: Final

code: Distance to MRF

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung des Kolons

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

effective: 2024-03-12 16:00:00+0100

value: 3.2 mm (Details: UCUM codemm = 'mm')

Request:

POST Observation

Entry 8 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-anastomoseninsuffizienz

Resource Observation:

status: Final

code: Large intestine anastomotic leak (disorder)

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

focus: Procedure Rektumresektion unter Sphinktererhaltung: Tiefe anteriore Resektion: Laparoskopisch mit Anastomose

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

effective: 2024-03-25 08:00:00+0100

value: Anastomoseninsuffizienz Grad B

Request:

POST Observation

Entry 9 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-asa-klassifikation

Resource Observation:

status: Final

code: American society of anesthesiologists morbidity state

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung des Kolons

effective: 2024-03-15 08:30:00+0100

value: ASA II

Request:

POST Observation

Entry 10 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Procedure/mii-exa-onko-krk-stoma-markierung

Resource Procedure:

status: Completed

statusReason: Not performed (qualifier value)

category: Surgical procedure

code: Marking position of planned stoma site (procedure)

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

note:

Präoperative Markierung der geplanten Stoma-Position im rechten Hemiabdomen nach Rücksprache mit dem Patienten

Request:

POST Procedure

Entry 11 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Procedure/mii-exa-onko-krk-operation

Resource Procedure:

MII EX Onko Operation Intention: kurativ

status: Completed

category: Surgical procedure

code: Rektumresektion unter Sphinktererhaltung: Tiefe anteriore Resektion: Laparoskopisch mit Anastomose

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

note:

Laparoskopische Resektion beim kolorektalen Karzinom

Request:

POST Procedure

Entry 12 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Specimen/mii-exa-onko-krk-specimen

Resource Specimen:

Language: en

Profile: MII PR Onkologie Specimen

accessionIdentifier: KRK-2024-001234

status: Available

type: Specimen from colon obtained by rectal/rectosigmoid (low anterior) resection (specimen)

subject: Klaus KolorektalCa (no stated gender), DoB Unknown

Collections

-Collected[x]
*2024-03-22 08:30:00+0100

condition: Grad 1 (gut)

note:

Sigmaresekat mit Primärtumor und regionären Lymphknoten

Request:

POST Specimen