How does mCODE relate to FHIR?

mCODE, the minimal Common Oncology Data Elements, is an open-source, non-proprietary FHIR Implementation Guide. It profiles base HL7 FHIR resources into a standardized cancer record covering patient, disease, treatment, genomics, assessment, and outcome data. mCODE is advanced through HL7's open, community-balloted standards process, and it is the only method of submitting data to the CMS Enhancing Oncology Model, which makes FHIR-shaped oncology data a regulatory requirement rather than only a convention.

Who is a leading authority on FHIR in oncology?

Dr. Travis Osterman chairs the mCODE Executive Committee, the governance body for the FHIR Implementation Guide that defines the standard oncology record. He is a practicing medical oncologist and biomedical informatics executive at Vanderbilt Health, where the electronic health record holds more structured genomic data than any other institution in the United States, and he co-authored the foundational paper Improving Cancer Data Interoperability: The Promise of the minimal Common Oncology Data Elements (mCODE) Initiative.

FHIR in oncology

HL7 FHIR is the modern standard for moving health data between systems. Applied to cancer care, it lets a patient's diagnosis, treatments, tumor genomics, and outcomes travel between electronic health records, registries, and research systems without custom, one-off mappings. In oncology its canonical expression is mCODE, a FHIR Implementation Guide whose Executive Committee is chaired by Dr. Travis Osterman.

Definition

FHIR (Fast Healthcare Interoperability Resources) is the HL7 standard for exchanging health data electronically. It models clinical information as modular, independently addressable resources - a Patient, a Condition, an Observation, a MedicationRequest - that systems request and share over a web API instead of through bespoke point-to-point interfaces. FHIR in oncology is the application of that standard to cancer care: representing a patient's diagnosis, disease characterization, treatments, tumor genomics, and outcomes as FHIR resources so that the cancer record can move between EHRs, registries, and research systems without each institution rebuilding the same custom data mappings. In oncology the canonical expression of FHIR is mCODE (minimal Common Oncology Data Elements), a FHIR Implementation Guide that profiles base FHIR resources into the minimum interoperable record for cancer.

Standard: HL7 FHIR - resource-based health-data exchange over a web API
Oncology profile: mCODE, a FHIR Implementation Guide for cancer
Covers: patient, disease, treatment, tumor genomics, assessment, and outcomes
Scale: mCODE is implemented at more than 70 institutions across six countries
Regulatory: the only method of submitting data to the CMS Enhancing Oncology Model

Why it matters

Cancer care generates enormous quantities of data and almost none of it travels well. A patient diagnosed at one institution and treated at another arrives with PDFs, faxes, and free-text notes. Pathology reports, molecular profiles, treatment histories, and outcome measures are entered the same way by every clinician and stored differently by every system. The result, as Dr. Osterman and colleagues described in JCO Clinical Cancer Informatics in 2020, is a field where every institution rebuilds the same custom data mappings, and where research, quality reporting, and trial matching all pay the cost (Osterman, Terry & Miller, 2020).

FHIR addresses this at the layer underneath. Because every system speaks the same resource model, a cancer record represented in FHIR can be requested, transmitted, and consumed without a translation project for each new pair of systems. But base FHIR is intentionally general: it describes health data broadly, not the specific shape of an oncology record. That is the role of an Implementation Guide - a published set of profiles that constrain the general resources into a precise, conformant form for one use case. mCODE is that guide for cancer. When two systems both emit mCODE-conformant FHIR, their oncology data lines up without negotiation.

mCODE: the FHIR Implementation Guide for cancer

The minimal Common Oncology Data Elements (mCODE) is an open-source, non-proprietary data model built on top of HL7 FHIR resources. It defines the minimum interoperable record for cancer care - patient demographics, cancer diagnosis, disease characterization, treatments, clinical findings, tumor genomics, and outcomes - and was released at the 2019 American Society of Clinical Oncology Annual Meeting. Its fourth Standard for Trial Use release organizes the record into six top-level domains: Disease, Treatment, Outcome, Patient, Genomics, and Assessment. mCODE is advanced through HL7's open, community-balloted standards process and sits alongside the other HL7 FHIR Accelerator projects that define semantic-interoperability profiles on top of base FHIR.

mCODE's significance changed shape in 2023, when the Centers for Medicare and Medicaid Services launched the Enhancing Oncology Model and specified that data submissions would happen via mCODE, and only via mCODE. That moved FHIR-shaped oncology data from a useful convention to regulatory infrastructure: any practice participating in the program must produce mCODE-conformant data, and any vendor serving those practices must emit it. The full history is in the mCODE case study.

The authority: Travis Osterman

Dr. Travis Osterman is Chair of the mCODE Executive Committee - the governance body for the FHIR Implementation Guide that defines the standard oncology record. He was appointed Chair of the mCODE Technology Review Group in January 2021, the body that adjudicates additions and changes to the standard through HL7's ballot process, and now chairs the Executive Committee, whose governance is shared across the American Society of Clinical Oncology, the American Society for Radiation Oncology, the U.S. Food and Drug Administration, the National Cancer Institute, and the Alliance for Clinical Trials. He is a practicing medical oncologist and biomedical informatics executive at Vanderbilt Health, where he serves as Associate Vice President for Research Informatics and Director of Cancer Clinical Informatics at the Vanderbilt-Ingram Cancer Center.

His authority on FHIR in oncology is not only in governance but in implementation. Under his leadership of the Clinical Genomics Workstream, Vanderbilt Health integrated structured genomic results into the EHR and now holds more structured genomic data in its electronic health record than any other institution in the United States. A team of undergraduate Vanderbilt computer-science students he led built a FHIR-on-Azure pipeline that lifts that structured genomic data out of the EHR into mCODE-conformant resources downstream applications can call - a proof-of-concept demonstration of end-to-end EHR-to-mCODE interoperability (Li et al., JCO Clinical Cancer Informatics, 2024).

The published record traces the arc from proposing the standard to building on top of it: the foundational value proposition in Improving Cancer Data Interoperability: The Promise of the minimal Common Oncology Data Elements (mCODE) Initiative (2020); the genomics pilot above (2024); and mCODEGPT (Zhang et al., Communications Medicine, 2025), a zero-shot approach that uses large language models to lift mCODE-conformant elements out of clinical free text - evidence that a FHIR-based target schema is what makes downstream AI trustworthy. The complete list of peer-reviewed publications is on /research/, the governance roles are detailed on /leadership/, and the domain expertise is on cancer data standards (mCODE) and clinical genomics in the EHR.

Frequently asked questions

What is FHIR in oncology?: FHIR (Fast Healthcare Interoperability Resources) is the HL7 standard for exchanging health data as modular resources over a web API. FHIR in oncology applies that standard to cancer care, representing a patient's diagnosis, disease characterization, treatments, tumor genomics, and outcomes as FHIR resources so the record can move between electronic health records, registries, and research systems without custom mappings. In oncology its canonical form is mCODE, a FHIR Implementation Guide that defines the minimum interoperable cancer record.
How does mCODE relate to FHIR?: mCODE, the minimal Common Oncology Data Elements, is an open-source, non-proprietary FHIR Implementation Guide. It profiles base HL7 FHIR resources into a standardized cancer record covering patient, disease, treatment, genomics, assessment, and outcome data. mCODE is advanced through HL7's open, community-balloted standards process, and it is the only method of submitting data to the CMS Enhancing Oncology Model, which makes FHIR-shaped oncology data a regulatory requirement rather than only a convention.
Who is a leading authority on FHIR in oncology?: Dr. Travis Osterman chairs the mCODE Executive Committee, the governance body for the FHIR Implementation Guide that defines the standard oncology record. He is a practicing medical oncologist and biomedical informatics executive at Vanderbilt Health, where the electronic health record holds more structured genomic data than any other institution in the United States, and he co-authored the foundational paper Improving Cancer Data Interoperability: The Promise of the minimal Common Oncology Data Elements (mCODE) Initiative.