MOPA — Medical Oncology Prior Authorization
0.1.1-snapshot-080926 - snapshot-080926 United States of America flag

MOPA — Medical Oncology Prior Authorization - Local Development build (v0.1.1-snapshot-080926) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Data Requirements

Page standards status: Informative

Overview

This page defines the oncology patient data categories that are relevant for prior authorization evaluation. These categories inform what the CRD service queries via FHIR when it receives a FHIR access token in the CDS Hooks fhirAuthorization object.

The CRD service retrieves data directly from the EHR's FHIR server using standard FHIR search queries.

The Separation of Concerns

RequestGroup      ← what is being ordered (patient-specific regimen instance)
PlanDefinition    ← the canonical regimen definition the RequestGroup instantiates
EHR FHIR server   ← source of patient context; queried by CRD service via fhirAuthorization
DTR Questionnaire ← collection instrument for missing data when FHIR query is insufficient

Oncology Data Categories

All cancer-specific evaluations draw on these data categories. For each, the table shows the relevant FHIR resource and the primary mCODE-based query pattern.

Category FHIR Resource Query Basis
Primary cancer condition Condition code:in mCODE primary cancer ValueSet
Stage / extent of disease Observation code:in mCODE staging ValueSet
Biomarkers Observation code:in mCODE tumor marker ValueSet
Treatment intent / setting RequestGroup.extension:category Order-specific Da Vinci CRD ext-request-category value; no FHIR query needed
Line of therapy RequestGroup.extension:category/lineOfTherapy Order-specific profiled CRD category, bound to TreatmentLineVS; no separate FHIR query is required
Prior therapy MedicationRequest / Procedure Completed anti-cancer treatments
Performance status Observation code:in mCODE ECOG/Karnofsky ValueSet
Ordered regimen RequestGroup Passed in context.draftOrders — no query needed

CRD Usage

When the CRD service receives a fhirAuthorization object in the hook request, it issues FHIR search queries against the EHR server to retrieve the categories above. The service then evaluates the ordered RequestGroup against the retrieved patient context.

If required data is missing from the FHIR server (not yet documented), the CRD service returns a DTR launch card so the clinician can enter the missing information.

DTR Usage

DTR collects data the FHIR server does not yet contain. The same oncology data categories drive the DTR questionnaire — the DTR form covers the same clinical domains as the FHIR queries, filling gaps the CRD service could not resolve automatically.

Breast Cancer Data Requirements

See Use Case 1: Breast Cancer PA for the specific data elements, biomarker combinations, and staging constraints applied in the first concrete implementation.