MII-Initiative

MII IG Onkologie DE v2026

Bundle Beispiel

Inhalt

Das KRK Bundle Beispiel demonstriert die strukturierte Zusammenstellung aller Kolorektales-Karzinom-spezifischen FHIR-Ressourcen in einem einheitlichen Transaktions-Bundle. Dieses Bundle zeigt die praktische Anwendung der KRK-Profile und deren Verknüpfungen untereinander in einem realistischen klinischen Szenario eines Rektumkarzinoms.

Das Bundle implementiert das Transaction-Pattern und ist server-konsumierbar, wodurch alle enthaltenen Ressourcen als atomare Operation übertragen werden können.

Bundle-Struktur

Das KRK-Bundle umfasst folgende Ressourcen:

Primäre Ressourcen

  • Patient: KRK-Patient (Klaus KolorektalCa)
  • Condition: Primärtumor-Diagnose (C18 - Bösartige Neubildung des Kolons)
  • Encounter: Stationärer Behandlungsfall

KRK-spezifische Observations

  • Abstand zur Anokutanlinie: Tumorsitz 6cm ab Anokutanlinie (KR1)
  • Circumferelle Resektionsebene: Minimaler Abstand 2mm (KR3)
  • Aboraler Resektionsrand: Minimaler Abstand 15mm (KR2)
  • MRT Mesorektale Faszie: Bildgebende Bewertung des Abstands (KR2)
  • Anastomoseninsuffizienz: Postoperative Komplikationsbewertung (KR8)
  • ASA-Klassifikation: Präoperative Risikobewertung ASA II (KR9)

Therapeutische Ressourcen

  • Stoma-Markierung: Präoperative Stomapositionsmarkierung (KR7)
  • KRK-Operation: Operative Resektion mit TME-Qualitätsbewertung (KR4)
  • KRK-Specimen: Operationspräparat mit pathologischer Aufarbeitung

Klinisches Szenario

Das Bundle repräsentiert einen Patienten mit Rektumkarzinom mit kompletter präoperativer Diagnostik und operativer Therapie:

Patientencharakteristika:

  • Diagnose: C18 Kolonkarzinom
  • ASA-Status: ASA II (mäßiges Operationsrisiko)
  • Tumorlokalisation: 6cm ab Anokutanlinie (tiefes Rektum)

Präoperative Diagnostik:

  • MRT-Staging: Bewertung der mesorektalen Faszie
  • Präoperative Vorbereitung: Stomamarkierung durchgeführt

Operative Therapie:

  • Rektumresektion: Mit TME-Technik (Totale mesorektale Exzision)
  • Resektionsränder: R0-Resektion mit ausreichenden Sicherheitsabständen
  • Postoperative Komplikationen: Keine Anastomoseninsuffizienz

Technische Implementation

Bundle-Typ und Struktur

* type = #transaction
  • Transaction Bundle: Atomare Übertragung aller Ressourcen
  • Server-konsumierbar: Alle Entries mit vollständigen Request-Informationen

Entry-Pattern

Jeder Bundle-Entry enthält:

  • fullUrl: Eindeutige Referenz-URL
  • resource: Die eigentliche FHIR-Ressource
  • request.method: HTTP POST für Erstellung
  • request.url: Ziel-Ressourcentyp

Referenz-Integrität

  • Condition: Referenziert Patient über subject
  • Observations: Referenzieren sowohl Patient (subject) als auch Condition (focus)
  • Procedures: Referenzieren Patient (subject) und Condition (reasonReference)
  • Specimen: Referenziert Patient (subject) und Collection-Procedure

Verknüpfungsmuster

Das Bundle demonstriert die konsistente Referenzstruktur zwischen KRK-spezifischen Ressourcen:

Patient ← subject ← Condition (Primärtumor)
                        ↑ focus
                 Observations (Abstände, ASA, Anastomoseninsuffizienz)
                        ↑ reasonReference
                   Procedures (Stoma-Markierung, Operation)
                        ↑ collection.procedure
                    Specimen (Operationspräparat)

oBDS-Zuordnung

Das Bundle demonstriert die vollständige Abbildung der oBDS-Datenfelder für Kolorektales Karzinom:

Tumor-Lokalisation

  • KR1: Abstand Anokutanlinie → Observation/mii-exa-onko-krk-abstand-tumor-anokutanlinie

Pathologische Bewertung

  • KR2: Abstand Resektionsrand aboral → Observation/mii-exa-onko-krk-abstand-resektionsrand-aboral
  • KR3: Abstand circumferelle Resektionsebene → Observation/mii-exa-onko-krk-abstand-circumferelle-resektionsebene
  • KR4: TME-Qualität → Specimen/mii-exa-onko-krk-specimen

Bildgebende Verfahren

  • KR5: MRT/CT Mesorektale Faszie → Observation/mii-exa-onko-krk-abstand-mesorektale-fascie

Operative Daten

  • KR7: Stomamarkierung → Procedure/mii-exa-onko-krk-stoma-markierung
  • KR8: Anastomoseninsuffizienz → Observation/mii-exa-onko-krk-anastomoseninsuffizienz
  • KR9: ASA-Klassifikation → Observation/mii-exa-onko-krk-asa-klassifikation

ValueSet-Verwendung

Das Bundle zeigt die praktische Anwendung verschiedener Terminologien:

LOINC

  • Abstand Anokutanlinie: 33748-5 "Distance from anal verge"
  • ASA-Klassifikation: 97816-3 "American Society of Anesthesiologists physical status score"

SNOMED CT

  • Anastomoseninsuffizienz: 235919008 "Anastomotic leak"
  • Operative Eingriffe: Verschiedene SNOMED CT Codes für kolorektale Operationen

ICD-10-GM

  • Diagnose: C18 "Bösartige Neubildung des Kolons"

oBDS CodeSystems

  • ASA-Klassifikation: mii-cs-onko-krk-asa-obds#2 "ASA II"
  • Stomamarkierung: mii-cs-onko-krk-stoma-anzeichnung#durchgefuehrt "Durchgeführt"
  • TME-Qualität: mii-cs-onko-krk-tme-qualitaet#komplett "Komplett"

Bundle-Beispiel

{
"resourceType": "Bundle",
"id": "mii-exa-onko-krk-bundle",
"meta": {
"profile": [
"http://hl7.org/fhir/StructureDefinition/Bundle"
]
},
"identifier": {
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko",
"value": "krk-example-bundle-2024-001"
},
"type": "transaction",
"timestamp": "2024-03-25T10:00:00+01:00",
"entry": [
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Patient/mii-exa-onko-krk-bundle-patient",
"resource": {
"resourceType": "Patient",
"id": "mii-exa-onko-krk-bundle-patient",
"name": [
{
"given": [
"Klaus"
],
"family": "KolorektalCa"
}
]
},
"request": {
"method": "POST",
"url": "Patient"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Condition/mii-exa-onko-krk-diagnose",
"resource": {
"resourceType": "Condition",
"id": "mii-exa-onko-krk-diagnose",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-diagnose-primaertumor"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/condition-assertedDate",
"valueDateTime": "2020-03-07"
}
],
"clinicalStatus": {
"coding": [
{
"code": "active",
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical"
}
]
},
"verificationStatus": {
"coding": [
{
"code": "confirmed",
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
}
]
},
"code": {
"coding": [
{
"code": "C18",
"system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
"display": "Bösartige Neubildung des Kolons",
"version": "2024"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"recordedDate": "2024-01-02"
},
"request": {
"method": "POST",
"url": "Condition"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Encounter/mii-exa-onko-krk-bundle-encounter",
"resource": {
"resourceType": "Encounter",
"id": "mii-exa-onko-krk-bundle-encounter",
"status": "finished",
"class": {
"code": "IMP",
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"display": "inpatient encounter"
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
}
},
"request": {
"method": "POST",
"url": "Encounter"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-tumor-anokutanlinie",
"resource": {
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-tumor-anokutanlinie",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-abstand-anokutan"
]
},
"code": {
"coding": [
{
"code": "33748-5",
"system": "http://loinc.org",
"display": "Distance from anal verge"
}
]
},
"valueQuantity": {
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm",
"value": 8.5
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-10T14:30:00+01:00"
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-circumferelle-resektionsebene",
"resource": {
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-circumferelle-resektionsebene",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-abstand-circumferelle-resektionsebene"
]
},
"valueQuantity": {
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm",
"value": 2.5
},
"status": "final",
"code": {
"coding": [
{
"code": "81176-0",
"system": "http://loinc.org",
"display": "Distance of tumor from circumferential resection margin [Length] in Specimen by Macroscopy"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-20T10:15:00+01:00"
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-resektionsrand-aboral",
"resource": {
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-resektionsrand-aboral",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-abstand-aboral"
]
},
"valueQuantity": {
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm",
"value": 15
},
"status": "final",
"code": {
"coding": [
{
"code": "81175-2",
"system": "http://loinc.org",
"display": "Distance of tumor from closest margin [Length] in Specimen by Macroscopy"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-20T10:15:00+01:00"
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-abstand-mesorektale-fascie",
"resource": {
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-mesorektale-fascie",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-mrt-mesorektale-faszie"
]
},
"code": {
"coding": [
{
"code": "RDE96",
"system": "http://radlex.org",
"display": "Distance to MRF"
}
]
},
"valueQuantity": {
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm",
"value": 3.2
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-12T16:00:00+01:00"
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-anastomoseninsuffizienz",
"resource": {
"resourceType": "Observation",
"id": "mii-exa-onko-krk-anastomoseninsuffizienz",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-anastomoseninsuffizienz"
]
},
"code": {
"coding": [
{
"code": "236091002",
"system": "http://snomed.info/sct",
"display": "Large intestine anastomotic leak (disorder)"
}
]
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Procedure/mii-exa-onko-krk-operation"
}
],
"effectiveDateTime": "2024-03-25T08:00:00+01:00",
"valueCodeableConcept": {
"coding": [
{
"code": "B",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-krk-anastomoseninsuffizienz",
"display": "Anastomoseninsuffizienz Grad B"
}
]
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Observation/mii-exa-onko-krk-asa-klassifikation",
"resource": {
"resourceType": "Observation",
"id": "mii-exa-onko-krk-asa-klassifikation",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-asa-klassifikation"
]
},
"code": {
"coding": [
{
"code": "97816-3",
"system": "http://loinc.org",
"display": "American society of anesthesiologists morbidity state"
}
]
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-15T08:30:00+01:00",
"valueCodeableConcept": {
"coding": [
{
"code": "2",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-krk-asa-obds",
"display": "ASA II"
}
]
}
},
"request": {
"method": "POST",
"url": "Observation"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Procedure/mii-exa-onko-krk-stoma-markierung",
"resource": {
"resourceType": "Procedure",
"id": "mii-exa-onko-krk-stoma-markierung",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-stoma-markierung"
]
},
"category": {
"coding": [
{
"code": "387713003",
"system": "http://snomed.info/sct",
"display": "Surgical procedure"
}
]
},
"code": {
"coding": [
{
"code": "225134005",
"system": "http://snomed.info/sct",
"display": "Marking position of planned stoma site (procedure)"
}
]
},
"status": "completed",
"statusReason": {
"coding": [
{
"code": "262008008",
"system": "http://snomed.info/sct",
"display": "Not performed (qualifier value)"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"reasonReference": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"performedDateTime": "2024-03-15T09:30:00+01:00",
"note": [
{
"text": "Präoperative Markierung der geplanten Stoma-Position im rechten Hemiabdomen nach Rücksprache mit dem Patienten"
}
]
},
"request": {
"method": "POST",
"url": "Procedure"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Procedure/mii-exa-onko-krk-operation",
"resource": {
"resourceType": "Procedure",
"id": "mii-exa-onko-krk-operation",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-operation"
]
},
"extension": [
{
"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-operation-intention",
"valueCodeableConcept": {
"coding": [
{
"code": "K",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-intention",
"display": "kurativ"
}
]
}
}
],
"code": {
"coding": [
{
"system": "http://fhir.de/CodeSystem/bfarm/ops",
"code": "5-484.55",
"display": "Tiefe anteriore Resektion : Laparoskopisch mit Anastomose",
"version": "2024"
}
]
},
"status": "completed",
"category": {
"coding": [
{
"code": "387713003",
"system": "http://snomed.info/sct",
"display": "Surgical procedure"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"reasonReference": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"performedDateTime": "2024-03-22T08:00:00+01:00",
"note": [
{
"text": "Laparoskopische Resektion beim kolorektalen Karzinom"
}
]
},
"request": {
"method": "POST",
"url": "Procedure"
}
},
{
"fullUrl": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/Specimen/mii-exa-onko-krk-specimen",
"resource": {
"resourceType": "Specimen",
"id": "mii-exa-onko-krk-specimen",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-specimen"
]
},
"status": "available",
"type": {
"coding": [
{
"code": "122652004",
"system": "http://snomed.info/sct",
"display": "Specimen from colon obtained by rectal/rectosigmoid (low anterior) resection (specimen)"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"collection": {
"collectedDateTime": "2024-03-22T08:30:00+01:00"
},
"accessionIdentifier": {
"value": "KRK-2024-001234"
},
"condition": [
{
"coding": [
{
"code": "1",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-krk-tme-qualitaet",
"display": "Grad 1 (gut)"
}
]
}
],
"note": [
{
"text": "Sigmaresekat mit Primärtumor und regionären Lymphknoten"
}
]
},
"request": {
"method": "POST",
"url": "Specimen"
}
}
]
}

Einzelne Ressourcen-Beispiele

Patient

{
"resourceType": "Patient",
"id": "mii-exa-onko-krk-bundle-patient",
"name": [
{
"given": [
"Klaus"
],
"family": "KolorektalCa"
}
]
}

Primärtumor-Condition

{
"resourceType": "Condition",
"id": "mii-exa-onko-krk-diagnose",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-diagnose-primaertumor"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/condition-assertedDate",
"valueDateTime": "2020-03-07"
}
],
"clinicalStatus": {
"coding": [
{
"code": "active",
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical"
}
]
},
"verificationStatus": {
"coding": [
{
"code": "confirmed",
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
}
]
},
"code": {
"coding": [
{
"code": "C18",
"system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
"display": "Bösartige Neubildung des Kolons",
"version": "2024"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"recordedDate": "2024-01-02"
}

Abstand Anokutanlinie

{
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-tumor-anokutanlinie",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-abstand-anokutan"
]
},
"code": {
"coding": [
{
"code": "33748-5",
"system": "http://loinc.org",
"display": "Distance from anal verge"
}
]
},
"valueQuantity": {
"unit": "cm",
"system": "http://unitsofmeasure.org",
"code": "cm",
"value": 8.5
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-10T14:30:00+01:00"
}

Circumferelle Resektionsebene

{
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-circumferelle-resektionsebene",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-abstand-circumferelle-resektionsebene"
]
},
"valueQuantity": {
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm",
"value": 2.5
},
"status": "final",
"code": {
"coding": [
{
"code": "81176-0",
"system": "http://loinc.org",
"display": "Distance of tumor from circumferential resection margin [Length] in Specimen by Macroscopy"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-20T10:15:00+01:00"
}

Aboraler Resektionsrand

{
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-resektionsrand-aboral",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-abstand-aboral"
]
},
"valueQuantity": {
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm",
"value": 15
},
"status": "final",
"code": {
"coding": [
{
"code": "81175-2",
"system": "http://loinc.org",
"display": "Distance of tumor from closest margin [Length] in Specimen by Macroscopy"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-20T10:15:00+01:00"
}

MRT Mesorektale Faszie

{
"resourceType": "Observation",
"id": "mii-exa-onko-krk-abstand-mesorektale-fascie",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-mrt-mesorektale-faszie"
]
},
"code": {
"coding": [
{
"code": "RDE96",
"system": "http://radlex.org",
"display": "Distance to MRF"
}
]
},
"valueQuantity": {
"unit": "mm",
"system": "http://unitsofmeasure.org",
"code": "mm",
"value": 3.2
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-12T16:00:00+01:00"
}

ASA-Klassifikation

{
"resourceType": "Observation",
"id": "mii-exa-onko-krk-asa-klassifikation",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-asa-klassifikation"
]
},
"code": {
"coding": [
{
"code": "97816-3",
"system": "http://loinc.org",
"display": "American society of anesthesiologists morbidity state"
}
]
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"focus": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"effectiveDateTime": "2024-03-15T08:30:00+01:00",
"valueCodeableConcept": {
"coding": [
{
"code": "2",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-krk-asa-obds",
"display": "ASA II"
}
]
}
}

Anastomoseninsuffizienz

{
"resourceType": "Observation",
"id": "mii-exa-onko-krk-anastomoseninsuffizienz",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-anastomoseninsuffizienz"
]
},
"code": {
"coding": [
{
"code": "236091002",
"system": "http://snomed.info/sct",
"display": "Large intestine anastomotic leak (disorder)"
}
]
},
"status": "final",
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"focus": [
{
"reference": "Procedure/mii-exa-onko-krk-operation"
}
],
"effectiveDateTime": "2024-03-25T08:00:00+01:00",
"valueCodeableConcept": {
"coding": [
{
"code": "B",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-krk-anastomoseninsuffizienz",
"display": "Anastomoseninsuffizienz Grad B"
}
]
}
}

Stoma-Markierung

{
"resourceType": "Procedure",
"id": "mii-exa-onko-krk-stoma-markierung",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-stoma-markierung"
]
},
"category": {
"coding": [
{
"code": "387713003",
"system": "http://snomed.info/sct",
"display": "Surgical procedure"
}
]
},
"code": {
"coding": [
{
"code": "225134005",
"system": "http://snomed.info/sct",
"display": "Marking position of planned stoma site (procedure)"
}
]
},
"status": "completed",
"statusReason": {
"coding": [
{
"code": "262008008",
"system": "http://snomed.info/sct",
"display": "Not performed (qualifier value)"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"reasonReference": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"performedDateTime": "2024-03-15T09:30:00+01:00",
"note": [
{
"text": "Präoperative Markierung der geplanten Stoma-Position im rechten Hemiabdomen nach Rücksprache mit dem Patienten"
}
]
}

KRK-Operation

{
"resourceType": "Procedure",
"id": "mii-exa-onko-krk-operation",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-operation"
]
},
"extension": [
{
"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-operation-intention",
"valueCodeableConcept": {
"coding": [
{
"code": "K",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-intention",
"display": "kurativ"
}
]
}
}
],
"code": {
"coding": [
{
"system": "http://fhir.de/CodeSystem/bfarm/ops",
"code": "5-484.55",
"display": "Tiefe anteriore Resektion : Laparoskopisch mit Anastomose",
"version": "2024"
}
]
},
"status": "completed",
"category": {
"coding": [
{
"code": "387713003",
"system": "http://snomed.info/sct",
"display": "Surgical procedure"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"encounter": {
"reference": "Encounter/mii-exa-onko-krk-bundle-encounter"
},
"reasonReference": [
{
"reference": "Condition/mii-exa-onko-krk-diagnose"
}
],
"performedDateTime": "2024-03-22T08:00:00+01:00",
"note": [
{
"text": "Laparoskopische Resektion beim kolorektalen Karzinom"
}
]
}

KRK-Specimen

{
"resourceType": "Specimen",
"id": "mii-exa-onko-krk-specimen",
"meta": {
"profile": [
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-krk-specimen"
]
},
"status": "available",
"type": {
"coding": [
{
"code": "122652004",
"system": "http://snomed.info/sct",
"display": "Specimen from colon obtained by rectal/rectosigmoid (low anterior) resection (specimen)"
}
]
},
"subject": {
"reference": "Patient/mii-exa-onko-krk-bundle-patient"
},
"collection": {
"collectedDateTime": "2024-03-22T08:30:00+01:00"
},
"accessionIdentifier": {
"value": "KRK-2024-001234"
},
"condition": [
{
"coding": [
{
"code": "1",
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-krk-tme-qualitaet",
"display": "Grad 1 (gut)"
}
]
}
],
"note": [
{
"text": "Sigmaresekat mit Primärtumor und regionären Lymphknoten"
}
]
}

Powered by SIMPLIFIER.NET

HL7® and FHIR® are the registered trademarks of Health Level Seven International