Cancer data standards (mCODE)

Cancer data is generated everywhere - at the bedside, in pathology, in molecular labs, in radiology, in survivorship clinics - and historically almost none of it could travel from one institution to another without manual remapping. Dr. Osterman's work in cancer data standards is the patient infrastructure project that makes the rest of cancer informatics tractable: standardize the data model, get clinicians and vendors and regulators to agree on it, and the downstream applications - quality reporting, trial matching, real-world evidence, AI - all become possible. The arc below traces that work from early decision-support tooling to chairing the standard that now anchors a CMS value-based care program.

Early roots (2014-2017). Before mCODE existed, Dr. Osterman served as the non-small-cell-lung- cancer section editor for HemOnc.org, the open-access oncology regimen and drug-interaction reference under Dr. Jeremy L. Warner. The work was a public exercise in curating cancer information into a shared, machine-readable form. The collaboration produced a 2015 ASCO educational session and accompanying chapter (Rioth, Osterman & Warner, ASCO Educational Book, 2015) on website-based information resources for clinical practice. That work established Dr. Osterman early on as part of the small national community thinking carefully about structured oncology information - the community that, a few years later, would propose mCODE.

2018-2019: proposing the standard. Dr. Osterman joined the original 2018 mCODE working group convened to design a minimum interoperable cancer record on top of HL7 FHIR. The standard was released publicly at the 2019 ASCO Annual Meeting. Dr. Osterman was selected to present it in the meeting's educational session on big data and cancer care - the work was captured in the ed book chapter The Impact of Big Data Research on Practice, Policy, and Cancer Care (Chambers et al., ASCO Educational Book, 2019). The initial release coincided with then-ASCO-President Dr. Monica Bertagnolli's presidential address. The published version of the standard's value proposition followed the next year (Osterman, Terry & Miller, JCO Clinical Cancer Informatics, 2020 - "The Promise of mCODE").

2021-present: governance and consensus. Dr. Osterman was appointed Chair of the mCODE Technology Review Group in January 2021 - the body that adjudicates additions and changes to the standard and ushers them through HL7's community ballot process. The TRG has shepherded more than two hundred community comments through HL7's open consensus mechanism, which is what makes mCODE durable rather than just one consortium's preferred shape. The community-facing side of that work has shown up in regular ecosystem updates: the 3-year Update talk at the AMIA Annual Symposium (Washington DC, November 2022) and Interoperability in Action: Progress in Implementing the mCODE Oncology Data Standard at the ASCO Annual Meeting (Chicago, June 2023). He now serves as Chair of the mCODE Executive Committee, with governance 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.

Regulatory uptake and international reach. The executive-committee chairship's stated goal is to embed mCODE more deeply into the broader standards community. The clearest concrete outcome is CMS' Enhancing Oncology Model: every practice participating in EOM must submit data via mCODE, and only via mCODE. That regulatory hook converted mCODE from a promising consortium standard into infrastructure that anchors a federal value-based care program. Internationally, Dr. Osterman presented at the 2026 HL7 International Working Group Meeting in Rotterdam - opening discussions about mCODE as a true international cancer data standard, building on existing implementations in Taiwan, Brazil, and Canada. The fuller history is in the mCODE case study.

Implementation demonstrations. Standards are easier to defend in committee meetings than to deploy in production. Dr. Osterman led a team of undergraduate Vanderbilt computer-science students through the first mCODE Genomics Pilot Project at Vanderbilt University Medical Center (Li et al., JCO Clinical Cancer Informatics, 2024) - a working FHIR-on-Azure pipeline that lifts structured genomic data out of the EHR and into mCODE-conformant resources downstream applications can consume. The project doubled as a teaching exercise: undergraduates learning cloud development, FHIR, and oncology data shaping while building something the standard's other implementers could reuse. The mCODEGPT zero-shot extraction work (Zhang et al., Communications Medicine, 2025) extends the same idea to unstructured text: when an LLM has a real schema to aim at, the outputs become trustworthy. Both papers exist because the standard exists first.

Dr. Osterman's standards work also runs through several related communities - the NCCN Digital Oncology Forum, the Epic Adult Oncology Steering Committee, and the Epic Beacon Community Operations Group (which he founded as a multi-institution governance body for the dominant U.S. oncology EHR module). The framing he returns to in talks: a standard is a force multiplier. One good cancer-data standard, adopted broadly, replaces hundreds of one-off institutional mappings, lowers the cost of every downstream AI/research/quality project, and is the only sustainable answer to cancer's data fragmentation problem. See also clinical genomics in the EHR for the implementation side and AI in oncology for what becomes possible once the standard is in place.