Dieses Profil beschreibt den allgemeinen Leistungszustand eines Patienten in der Onkologie.
Die Erfassung des allgemeine Leistungszustand wird im oBDS vorgeschrieben. Dabei wird die eigentliche Meldung als ECOG kodiert und übertragen, wobei die Antwortmöglichkeiten ein Mapping vom Karnofsky-Score ermöglichen.
Im bisherigen oBDS und in den vorliegenden FHIR-Profilen ist sowohl eine Dokumentation des ECOG mit den Antwortmöglichkeiten 0-4 als auch des Karnofsky-Scores mit 10%, 20% etc. gestattet. Der aktuelle Umsetzungsleitfaden enthält jedoch einen Hinweis, dass in Zukunft ausschließlich der ECOG gemeldet werden soll. https://plattform65c.atlassian.net/wiki/spaces/UMK/pages/15532323/Allgemeiner+Leistungszustand+Typ
Für den Fall, dass in den Befunden nur Bezug auf den Allgemeinzustand genommen wird, ohne dabei in ECOG oder Karnofsky zu kodieren, empfiehlt der Dokumentationsleitfaden der Plattform §65c die Entwicklung hausinterner Richtlinien zur besseren Reproduzierbarkeit. https://plattform65c.atlassian.net/wiki/spaces/Dokumentat/pages/86310992/Allgemeiner+Leistungszustand
Daher enthält das vorliegende Profil nur Kodierungen für die Angabe des ECOG-Leistungszustandes.
Name | Status | Version | Canonical | Basis |
---|---|---|---|---|
MII_PR_Onko_Allgemeiner_Leistungszustand | active | 2025.0.0 | https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand | http://hl7.org/fhir/StructureDefinition/Observation |
MII_PR_Onko_Allgemeiner_Leistungszustand (Observation) | I | Observation | |
id | Σ | 0..1 | string |
meta | Σ | 0..1 | Meta |
id | 0..1 | string | |
extension | I | 0..* | Extension |
versionId | Σ | 0..1 | id |
lastUpdated | Σ | 0..1 | instant |
source | Σ | 0..1 | uri |
profile | S Σ | 0..* | canonical(StructureDefinition) |
security | Σ | 0..* | CodingBinding |
tag | Σ | 0..* | Coding |
implicitRules | Σ ?! | 0..1 | uri |
language | 0..1 | codeBinding | |
text | 0..1 | Narrative | |
contained | 0..* | Resource | |
extension | I | 0..* | Extension |
modifierExtension | ?! I | 0..* | Extension |
identifier | Σ | 0..* | Identifier |
basedOn | Σ I | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) |
partOf | Σ I | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) |
status | Σ ?! | 1..1 | codeBinding |
category | 0..* | CodeableConceptBinding | |
code | S Σ | 1..1 | CodeableConcept |
id | 0..1 | string | |
extension | I | 0..* | Extension |
coding | S Σ | 1..* | CodingPattern |
id | 0..1 | string | |
extension | I | 0..* | Extension |
system | Σ | 1..1 | uriPattern |
version | Σ | 0..1 | string |
code | Σ | 1..1 | codePattern |
display | Σ | 0..1 | string |
userSelected | Σ | 0..1 | boolean |
text | Σ | 0..1 | string |
subject | S Σ I | 1..1 | Reference(Patient) |
focus | Σ I | 0..* | Reference(Resource) |
encounter | S Σ I | 0..1 | Reference(Encounter) |
effective[x] | Σ | 0..1 | |
effectiveDateTime | dateTime | ||
effectivePeriod | Period | ||
effectiveTiming | Timing | ||
effectiveInstant | instant | ||
issued | Σ | 0..1 | instant |
performer | Σ I | 0..* | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) |
value[x] | Σ I | 0..1 | |
(All Slices) | |||
valueQuantity | Quantity | ||
valueString | string | ||
valueBoolean | boolean | ||
valueInteger | integer | ||
valueRange | Range | ||
valueRatio | Ratio | ||
valueSampledData | SampledData | ||
valueTime | time | ||
valueDateTime | dateTime | ||
valuePeriod | Period | ||
valueCodeableConcept | Σ I | 0..1 | CodeableConcept |
id | 0..1 | string | |
extension | I | 0..* | Extension |
coding | Σ | 0..* | Coding |
id | 0..1 | string | |
extension | I | 0..* | Extension |
system | Σ | 0..1 | uri |
version | Σ | 0..1 | string |
code | Σ | 0..1 | code |
display | Σ | 0..1 | string |
userSelected | Σ | 0..1 | boolean |
text | Σ | 0..1 | string |
dataAbsentReason | I | 0..1 | CodeableConceptBinding |
interpretation | 0..* | CodeableConceptBinding | |
note | 0..* | Annotation | |
bodySite | 0..1 | CodeableConcept | |
method | 0..1 | CodeableConcept | |
specimen | I | 0..1 | Reference(Specimen) |
device | I | 0..1 | Reference(Device | DeviceMetric) |
referenceRange | I | 0..* | BackboneElement |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
low | I | 0..1 | SimpleQuantity |
high | I | 0..1 | SimpleQuantity |
type | 0..1 | CodeableConceptBinding | |
appliesTo | 0..* | CodeableConcept | |
age | I | 0..1 | Range |
text | 0..1 | string | |
hasMember | Σ I | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) |
derivedFrom | Σ I | 0..* | Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) |
component | S Σ | 1..* | BackboneElement |
(All Slices) | |||
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
code | Σ | 1..1 | CodeableConcept |
value[x] | Σ | 0..1 | |
valueQuantity | Quantity | ||
valueCodeableConcept | CodeableConcept | ||
valueString | string | ||
valueBoolean | boolean | ||
valueInteger | integer | ||
valueRange | Range | ||
valueRatio | Ratio | ||
valueSampledData | SampledData | ||
valueTime | time | ||
valueDateTime | dateTime | ||
valuePeriod | Period | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding |
interpretation | 0..* | CodeableConceptBinding | |
referenceRange | 0..* | see (referenceRange) | |
ecog | Σ | 0..1 | BackboneElement |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
code | S Σ | 1..1 | CodeableConcept |
id | 0..1 | string | |
extension | I | 0..* | Extension |
coding | S Σ | 1..1 | CodingPattern |
text | Σ | 0..1 | string |
value[x] | S Σ | 1..1 | Binding |
valueCodeableConcept | CodeableConcept | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding |
interpretation | 0..* | CodeableConceptBinding | |
referenceRange | 0..* | see (referenceRange) | |
karnofsky | S Σ | 1..1 | BackboneElement |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
code | S Σ | 1..1 | CodeableConcept |
id | 0..1 | string | |
extension | I | 0..* | Extension |
coding | S Σ | 1..1 | CodingPattern |
text | Σ | 0..1 | string |
value[x] | S Σ | 1..1 | Binding |
valueCodeableConcept | CodeableConcept | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding |
interpretation | 0..* | CodeableConceptBinding | |
referenceRange | 0..* | see (referenceRange) |
OBDS Beschreibung des allgemeines Leistungszustandes |
Feldname |
---|
Observation.meta.profile |
Observation.code |
Observation.code.coding |
Observation.subject |
Observation.encounter |
Observation.component |
Observation.component:ecog.code |
Observation.component:ecog.code.coding |
Observation.component:ecog.value[x] |
Observation.component:karnofsky |
Observation.component:karnofsky.code |
Observation.component:karnofsky.code.coding |
Observation.component:karnofsky.value[x] |
<StructureDefinition xmlns="http://hl7.org/fhir"> <id value="mii-pr-onko-allgemeiner-leistungszustand" /> <url value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand" /> <version value="2025.0.0" /> <name value="MII_PR_Onko_Allgemeiner_Leistungszustand" /> <title value="MII PR Onkologie Allgemeiner Leistungszustand" /> <status value="active" /> <publisher value="Medizininformatik Initiative" /> <contact> <telecom> <system value="url" /> <value value="https://www.medizininformatik-initiative.de" /> </telecom> </contact> <description value="OBDS Beschreibung des allgemeines Leistungszustandes" /> <fhirVersion value="4.0.1" /> <mapping> <identity value="oBDS" /> <name value="Mapping FHIR zu oBDS" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="Observation" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" /> <derivation value="constraint" /> <differential> <element id="Observation"> <path value="Observation" /> <mapping> <identity value="oBDS" /> <map value="12" /> <comment value="Allgemeiner Leistungszustand" /> </mapping> </element> <element id="Observation.meta.profile"> <path value="Observation.meta.profile" /> <mustSupport value="true" /> </element> <element id="Observation.code"> <path value="Observation.code" /> <mustSupport value="true" /> </element> <element id="Observation.code.coding"> <path value="Observation.code.coding" /> <min value="1" /> <patternCoding> <system value="http://snomed.info/sct" /> <code value="423690003" /> </patternCoding> <mustSupport value="true" /> </element> <element id="Observation.code.coding.system"> <path value="Observation.code.coding.system" /> <min value="1" /> </element> <element id="Observation.code.coding.code"> <path value="Observation.code.coding.code" /> <min value="1" /> </element> <element id="Observation.subject"> <path value="Observation.subject" /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" /> </type> <mustSupport value="true" /> </element> <element id="Observation.encounter"> <path value="Observation.encounter" /> <mustSupport value="true" /> </element> <element id="Observation.value[x]"> <path value="Observation.value[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> <ordered value="false" /> <rules value="open" /> </slicing> </element> <element id="Observation.value[x]:valueCodeableConcept"> <path value="Observation.value[x]" /> <sliceName value="valueCodeableConcept" /> <min value="0" /> <max value="1" /> <type> <code value="CodeableConcept" /> </type> </element> <element id="Observation.value[x]:valueCodeableConcept.coding.code"> <path value="Observation.value[x].coding.code" /> <mapping> <identity value="oBDS" /> <map value="12.1" /> <comment value="Allgemeiner Leistungszustand" /> </mapping> </element> <element id="Observation.component"> <path value="Observation.component" /> <slicing> <discriminator> <type value="pattern" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> <min value="1" /> <mustSupport value="true" /> </element> <element id="Observation.component:ecog"> <path value="Observation.component" /> <sliceName value="ecog" /> <min value="0" /> <max value="1" /> </element> <element id="Observation.component:ecog.code"> <path value="Observation.component.code" /> <mustSupport value="true" /> </element> <element id="Observation.component:ecog.code.coding"> <path value="Observation.component.code.coding" /> <min value="1" /> <max value="1" /> <patternCoding> <system value="http://snomed.info/sct" /> <code value="423740007" /> </patternCoding> <mustSupport value="true" /> </element> <element id="Observation.component:ecog.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-allgemeiner-leistungszustand-ecog" /> </binding> </element> <element id="Observation.component:karnofsky"> <path value="Observation.component" /> <sliceName value="karnofsky" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Observation.component:karnofsky.code"> <path value="Observation.component.code" /> <mustSupport value="true" /> </element> <element id="Observation.component:karnofsky.code.coding"> <path value="Observation.component.code.coding" /> <min value="1" /> <max value="1" /> <patternCoding> <system value="http://snomed.info/sct" /> <code value="761869008" /> </patternCoding> <mustSupport value="true" /> </element> <element id="Observation.component:karnofsky.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-allgemeiner-leistungszustand-karnofsky" /> </binding> </element> </differential> </StructureDefinition>
{ "resourceType": "StructureDefinition", "id": "mii-pr-onko-allgemeiner-leistungszustand", "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand", "version": "2025.0.0", "name": "MII_PR_Onko_Allgemeiner_Leistungszustand", "title": "MII PR Onkologie Allgemeiner Leistungszustand", "status": "active", "publisher": "Medizininformatik Initiative", "contact": [ { "telecom": [ { "system": "url", "value": "https://www.medizininformatik-initiative.de" } ] } ], "description": "OBDS Beschreibung des allgemeines Leistungszustandes", "fhirVersion": "4.0.1", "mapping": [ { "identity": "oBDS", "name": "Mapping FHIR zu oBDS" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation", "path": "Observation", "mapping": [ { "identity": "oBDS", "map": "12", "comment": "Allgemeiner Leistungszustand" } ] }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "min": 1, "patternCoding": { "code": "423690003", "system": "http://snomed.info/sct" }, "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "min": 1 }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "min": 1 }, { "id": "Observation.subject", "path": "Observation.subject", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ] } ], "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "slicing": { "discriminator": [ { "type": "type", "path": "$this" } ], "ordered": false, "rules": "open" } }, { "id": "Observation.value[x]:valueCodeableConcept", "path": "Observation.value[x]", "sliceName": "valueCodeableConcept", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ] }, { "id": "Observation.value[x]:valueCodeableConcept.coding.code", "path": "Observation.value[x].coding.code", "mapping": [ { "identity": "oBDS", "map": "12.1", "comment": "Allgemeiner Leistungszustand " } ] }, { "id": "Observation.component", "path": "Observation.component", "slicing": { "discriminator": [ { "type": "pattern", "path": "$this" } ], "rules": "open" }, "min": 1, "mustSupport": true }, { "id": "Observation.component:ecog", "path": "Observation.component", "sliceName": "ecog", "min": 0, "max": "1" }, { "id": "Observation.component:ecog.code", "path": "Observation.component.code", "mustSupport": true }, { "id": "Observation.component:ecog.code.coding", "path": "Observation.component.code.coding", "min": 1, "max": "1", "patternCoding": { "code": "423740007", "system": "http://snomed.info/sct" }, "mustSupport": true }, { "id": "Observation.component:ecog.value[x]", "path": "Observation.component.value[x]", "min": 1, "type": [ { "code": "CodeableConcept" } ], "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-allgemeiner-leistungszustand-ecog" } }, { "id": "Observation.component:karnofsky", "path": "Observation.component", "sliceName": "karnofsky", "min": 1, "max": "1", "mustSupport": true }, { "id": "Observation.component:karnofsky.code", "path": "Observation.component.code", "mustSupport": true }, { "id": "Observation.component:karnofsky.code.coding", "path": "Observation.component.code.coding", "min": 1, "max": "1", "patternCoding": { "code": "761869008", "system": "http://snomed.info/sct" }, "mustSupport": true }, { "id": "Observation.component:karnofsky.value[x]", "path": "Observation.component.value[x]", "min": 1, "type": [ { "code": "CodeableConcept" } ], "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-allgemeiner-leistungszustand-karnofsky" } } ] } }
Mapping Datensatz zu FHIR
Datensatz | Erklaerung | FHIR |
---|---|---|
Allgemeiner Leistungszustand | Allgemeiner Leistungszustand | |
ECOG oder Karnofsky | ECOG oder Karnofsky | Observation.value[x] |
Mapping Einheitlicher onkologischer Basisdatensatz (oBDS) zu FHIR
oBDS | Definition | FHIR |
---|---|---|
12 | Allgemeiner Leistungszustand | Observation |
12.1 | Allgemeiner Leistungszustand | Observation.value[x].coding.code |
Suchparameter
Folgende Suchparameter sind für das Modul Onkologie relevant, auch in Kombination:
Der Suchparameter _id
MUSS unterstützt werden:
Beispiele:
GET [base]/Observation?_id=1234
Anwendungshinweise: Weitere Informationen zur Suche nach "_id" finden sich in der FHIR-Basisspezifikation - Abschnitt "Parameters for all resources".
Der Suchparameter "_profile" MUSS unterstützt werden:
Beispiele:
GET [base]/Observation?_profile=https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand
Anwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der FHIR-Basisspezifikation - Abschnitt "token".
Der Suchparameter "code" MUSS unterstützt werden:
Beispiele:
GET [base]/Observation?code=http://fhir.de/CodeSystem/sct|184305005
Anwendungshinweise: Weitere Informationen zur Suche nach "code" finden sich in der FHIR-Basisspezifikation - Abschnitt "token".
Der Suchparameter "subject" MUSS unterstützt werden:
Beispiele:
GET [base]/Observation?subject=Patient/example
Anwendungshinweise: Weitere Informationen zur Suche nach "subject" finden sich in der FHIR-Basisspezifikation - Abschnitt "reference".
Der Suchparameter "encounter" MUSS unterstützt werden:
Beispiele:
GET [base]/Observation?encounter=Encounter/example
Anwendungshinweise: Weitere Informationen zur Suche nach "encounter" finden sich in der FHIR-Basisspezifikation - Abschnitt "reference".
Beispiele
{ "resourceType": "Observation", "id": "mii-exa-onko-allgemeiner-leistungszustand-1", "meta": { "profile": [ "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand" ] }, "code": { "coding": [ { "code": "423690003", "system": "http://snomed.info/sct" } ] }, "component": [ { "code": { "coding": [ { "code": "761869008", "system": "http://snomed.info/sct" } ] }, "valueCodeableConcept": { "coding": [ { "code": "30%", "display": "30%" } ] } }, { "code": { "coding": [ { "code": "423740007", "system": "http://snomed.info/sct" } ] }, "valueCodeableConcept": { "coding": [ { "code": "3", "display": "Nur begrenzte Selbstversorgung möglich; ist 50 % oder mehr der Wachzeit an Bett oder Stuhl gebunden (30 - 40 % nach Karnofsky)" } ] } } ], "status": "final", "subject": { "reference": "Patient/example" } }