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Pilot Projects to Assess Newly Released mCODE Proposals for Cancer-Related EHR Standardization

NEW YORK (GenomeWeb) – Point-of-care pilot studies are underway through Intermountain Healthcare, Partners Healthcare, and other cancer centers to evaluate the feasibility a new electronic health record (EHR) standardization scheme.

The new effort, "Minimal Common Oncology Data Elements," or mCODE, was developed through a collaboration between the American Society for Clinical Oncology (ASCO), Mitre Health, and the Alliance for Clinical Trials Oncology Foundation. Those partners, along with Intermountain, ASCO's CancerLinQ non-profit subsidiary, and others, have been working to establish consistent ways of storing and accessing half a dozen core types of information — including information on up to 17 genomic features — in the hopes of making it easier to find eligible clinical trial participants, compare EHR data across patients, and more.

"mCODE is an effort to identify a core set of data elements that should be routinely captured in a standardized format in the electronic health record of every single cancer patient," ASCO President Monica Bertagnolli explained at a press briefing at the American Society for Clinical Oncology annual meeting, which just wrapped up in Chicago.

There are roughly 1,500 EHR systems already in use in the US, Bertagnolliti explained, containing information on almost 15 million Americans with cancer. But it is often difficult to directly compare one person's EHR to the next due to distinct data prioritization, data descriptions, and storage methods from one EHR system to the next.

"Because of the great variety of the data models of EHRs, transferring information from one health IT system to another frequently results in the distortion or loss of information, blocking of critical details, or introduction of erroneous data," according to Mitre Health's website. "This may explain why, even after health IT has been almost universally adopted, clinicians still routinely share information using old-school methods — such as fax machines."

That means the data contained in a person's health record might be slightly different in one health center or EHR system than it is if he or she moves to another, both in terms of the information that is stored and the way it is presented.

"Incompatibility is a significant hindrance to care coordination," Bertagnolliti said. "Patients think it happens seamlessly. Unfortunately, it doesn't."

To push back against that problem, she and her colleagues began by hammering out specific types of data in six main areas that oncologists and researchers may draw from to enhance cancer research and patient care. Those included: patient characteristics and demographics; laboratory test results; information about a patient's tumor type; treatment strategies; outcomes; and genomic data.

"We now live in an era where genomic characterization is defining much of what we know about cancer risk and about how we should be treating cancer patients," Bertagnolliti noted.

Using mCODE elements and standards, Mitre has also developed a related "Fast Healthcare Interoperability Resource" (FHIR) to boost EHR interoperability and start putting these recommendations into practice.

Starting this month, the resulting data element, data language, and data model set was just released in a non-proprietary format. This mCODE "standard element" set is also designed to make it more straightforward to incorporate "the complex genomic data generated by advances in molecular diagnostics," Bertagnolliti explained.

"We have released the initial set of common cancer data standards and the specifications, and published them online," she said, noting that "a physician's clinical query across different EHRs that use mCODE should convey the same information and meaning when they're retrieved in similar cancer patients."

Across the country, cancer centers such as Intermountain Health, Brigham and Women's Hospital, are already kicking the tires on the mCODE approach through point-of-care pilot applications. The strategy will be refined further based on those early-stage results before being rolled out more broadly.

"We want to see how it works with real cancer centers and real docs," explained Robert Miller, medical director at CancerLinQ, in an interview.

The system is not designed to provide treatment- or management-related decision tools to physicians through EHRs. Even so, he noted that it makes the underlying data available in a consistent formats so that  others can build out their own software for tapping into those various kinds of EHR data in the future.

Regarding genomic data, Miller said the current iteration of mCODE is the tip of the iceberg and may expand to include additional genetic or genomic elements as molecularly targeted or informed treatment or management methods become more widespread in the cancer setting.

Members of mCODE have gotten feedback from EHR providers and are encouraging those providers as well as cancer center to adopt mCODE standards and structure.

Through such conversations the mCODE team is also trying to make genomic data more "computable," so that large dumps of genomic data produced digitally do not get missed when physicians receive a written report on paper.

"What often happens for genomic reports, and this is the biggest challenge some of us face right now, is the report doesn't transfer from the lab to the EHR in electronic format," Miller said.

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