Oncology
Oncology Care Pathway on FHIR
Oncology programs run on protocols. The protocol drives the treatment cycle, the cycle drives the activities, and the activities feed back into ongoing decisions about the patient's plan. Fire Arrow models the protocol as PlanDefinition, the patient instance as CarePlan, and the daily work as Task, Communication, and Observation.
What you can build
- Protocol structure as PlanDefinition
Standardized protocols (NCCN-aligned, institutional) load as PlanDefinitions. Each patient's plan instantiates one or more protocols.
- Cycle scheduling as Tasks
Treatment cycles materialize as Tasks on schedule. Modifications (dose reductions, delays) are Task amendments rather than custom state changes.
- Tumor board coordination through shared worklists
Cases for review are Tasks scoped to the tumor board CareTeam. Decisions are recorded as Communication or as updates to the CarePlan.
What you get out of the box
Who this is for
Oncology informatics leads, cancer center IT teams, and product teams building digital oncology platforms (treatment summaries, side-effect tracking, survivorship).
Clinical applicability
A breast cancer treatment program uses a NCCN-aligned protocol. Each patient's CarePlan instantiates the protocol; cycle Tasks drive infusion scheduling; ePRO collection captures side effects; the tumor board reviews progress through a shared worklist.
Protocols and their patient instances
An oncology protocol describes a structured course of treatment: cycles, activities per cycle, decision points, and the criteria for moving on. PlanDefinition captures the structure; ActivityDefinition captures the repeatable activities.
Each patient's plan is a CarePlan that references the PlanDefinition. The patient's plan can deviate from the protocol (dose reductions, treatment changes) without losing the link to the source. Protocol updates can roll forward to new patient plans while existing plans continue against the version they started on.
Cycle scheduling and modifications
Cycles materialize as Tasks on the schedule the protocol defines. Each Task carries the activity reference, the scheduled date, the responsible CareTeam, and a status field.
Modifications (delay by a week, reduce dose) update the Task. The audit log captures the modification, the reason (recorded as a note or a link to the relevant Observation), and the responsible identity. The history of the cycle is reconstructable from the Task's version history.
ePRO and side-effect surveillance
Patients submit weekly PRO-CTCAE responses through the patient app. Severe responses trigger Subscriptions that create a Task for the care team to follow up. The clinical workflow does not require a separate symptom-tracking system.
Trends across cycles are visible through Observation searches: the patient's hemoglobin trajectory, weight change, performance status. The same data feeds the tumor board review.
Related docs
FAQ
Can I import a NCCN protocol?
NCCN protocols are typically encoded by the institution into PlanDefinition resources. The encoding is a one-time effort per protocol; the patient instances flow from there.
How do tumor board decisions get recorded?
As Communication resources or as updates to the CarePlan, depending on the institutional preference. Either approach keeps the decision tied to the patient and timestamped.
What about clinical trial enrollment?
ResearchSubject and ResearchStudy resources capture trial enrollment. The trial protocol can sit alongside the standard care protocol in the patient's CarePlan stack.
How does this support survivorship care plans?
A survivorship CarePlan replaces (or runs alongside) the active treatment CarePlan once the patient transitions. The data model is the same; the activities differ.
