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 Mamma Bundle

Content

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

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 Mamma bundle comprises the following resources:

Primary resources

  • Patient: breast cancer patient (Martha MammaCa)
  • Condition: primary tumour diagnosis (C50.3 - lower inner quadrant of the breast)

Breast-specific Observations

  • Menopause status: premenopausal status of the patient
  • Estrogen receptor status: positive finding with 5% positive cells, weak staining intensity
  • Progesterone receptor status: positive finding with 25% positive cells, weak staining intensity

Additional elements

  • Tumour size determination: largest dimension 25mm
  • Preoperative marking: example of a marking procedure

In addition, the bundle contains an Encounter representing the inpatient episode of care that the remaining resources refer to.

Clinical scenario

The bundle represents a premenopausal patient with a hormone-receptor-positive breast carcinoma in the lower inner quadrant of the breast:

Patient characteristics:

  • Age/status: premenopausal (relevant for therapy planning)
  • Tumour location: C50.3 (lower inner quadrant)
  • Tumour size: 25mm (T2 category)

Receptor status:

  • Estrogen receptor: positive (5% positive cells, weak intensity)
  • Progesterone receptor: positive (25% positive cells, weak intensity)
  • Therapeutic consequence: candidate for antihormonal therapy

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)

Linking pattern

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

Patient ← subject ← Condition (primary tumour)
                        ↑ focus
                 Observations (menopause, receptor status)
                        ↑ reasonReference
                   Procedures (marking)

Use of ValueSets

The bundle shows the practical use of various terminologies:

SNOMED CT

  • Menopause status: 22636003 "Premenopausal state"
  • Anatomical location: 110494001 "Structure of upper inner quadrant of right breast"

LOINC

  • Estrogen receptor: 40556-3 "Estrogen receptor Ag [Presence] in Tissue by Immune stain"
  • Progesterone receptor: 85339-0 "Progesterone receptor Ag [Presence] in Breast cancer specimen by Immune stain"
  • Tumour size: 21889-1 "Size Tumor"
  • Receptor status: LA6576-8 "Positive"

ICD-10-GM

  • Diagnosis: C50.3 "Bösartige Neubildung: Unterer innerer Quadrant der Brustdrüse"

Individual resource examples

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

Language: en

Profile: Bundle

Bundle mii-exa-onko-mamma-example-bundle-1 of type transaction

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

Resource Patient:

Language: en

Martha MammaCa (no stated gender), DoB Unknown

Request:

POST Patient

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

Resource Condition:

Condition Asserted Date: 2020-03-07

clinicalStatus: Active

verificationStatus: Confirmed

category: Neoplastic disease

code: Bösartige Neubildung: Unterer innerer Quadrant der Brustdrüse

subject: Martha MammaCa (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-mamma-bundle-encounter

Resource Encounter:

Language: en

status: completed

class: inpatient encounter

subject: Martha MammaCa (no stated gender), DoB Unknown

Request:

POST Encounter

Entry 4 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-mamma-menopause-status-1

Resource Observation:

Language: en

Profile: MII PR Onkologie Menopausenstatus Mamma version: 2027.0.0-ballot.1

status: Final

code: Menopause, function (observable entity)

subject: Martha MammaCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung: Unterer innerer Quadrant der Brustdrüse

value: Premenopausal state (finding)

Request:

POST Observation

Entry 5 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-mamma-rezeptorstatus-estrogen-1

Resource Observation:

Language: en

Profile: MII PR Onkologie Rezeptorstatus Estrogen version: 2027.0.0-ballot.1

status: Final

code: Estrogen receptor Ag [Presence] in Tissue by Immune stain

subject: Martha MammaCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung: Unterer innerer Quadrant der Brustdrüse

value: Positive

component

code: Percent of cells with estrogen receptor in primary malignant neoplasm of breast by immunohistochemistry (observable entity)

value: 5 %

component

code: Intensity of stain of estrogen receptor in primary malignant neoplasm of breast by immunohistochemistry (observable entity)

value: Weak

Request:

POST Observation

Entry 6 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-mamma-rezeptorstatus-progesteron-1

Resource Observation:

Language: en

Profile: MII PR Onkologie Rezeptorstatus Progesteron version: 2027.0.0-ballot.1

status: Final

code: Progesterone receptor Ag [Presence] in Breast cancer specimen by Immune stain

subject: Martha MammaCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung: Unterer innerer Quadrant der Brustdrüse

value: Positive

component

code: Percent of cells with progesterone receptor in primary malignant neoplasm of breast by immunohistochemistry

value: 25 %

component

code: Intensity of stain of progesterone receptor in primary malignant neoplasm of breast by immunohistochemistry (observable entity)

value: Weak

Request:

POST Observation

Entry 7 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-mamma-tumorgroesse-1

Resource Observation:

Language: en

Profile: MII PR Onkologie Tumorgröße version: 2027.0.0-ballot.1

status: Final

code: Size Tumor

subject: Martha MammaCa (no stated gender), DoB Unknown

focus: Condition Bösartige Neubildung: Unterer innerer Quadrant der Brustdrüse

effective: 2024-01-02 10:00:00+0000

value: 25 mm (Details: UCUM codemm = 'mm')

bodySite: Structure of upper inner quadrant of right breast (body structure)

Request:

POST Observation

Entry 8 - fullUrl = https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Procedure/mii-exa-onko-mamma-praeoperative-markierung-1

Resource Procedure:

Language: en

Profile: MII PR Onkologie Präoperative Markierung Mamma version: 2027.0.0-ballot.1

status: Completed

category: Diagnostic procedure (procedure)

code: Insertion of guide wire into breast using ultrasound guidance (procedure)

subject: Martha MammaCa (no stated gender), DoB Unknown

Request:

POST Procedure