Implementierungsleitfaden Therapieziele Onkologie
1.0.0-ballot - Ballot Germany

Implementierungsleitfaden Therapieziele Onkologie - Local Development build (v1.0.0-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Empfehlungs- und Behandlungsplan

This page includes translations from the original source language in which the guide was authored. Information on these translations and instructions on how to provide feedback on the translations can be found here.

The therapy intent arises at the recommendation (tumor board). It follows that what is recommended and what is actually delivered are distinct objects.

Two CarePlan roles

  • Recommendation care plan — the tumor board's synthesised list of recommendations (proposed TumorboardServiceRequest/TumorboardMedicationRequest, intent = proposal); carries the overarching goal.
  • Treatment care plan — the episode-specific plan of actually delivered care; carries the respective episode goal.
Recommendation and treatment plan: two roles of CarePlan On the left the coarse-grained recommendation of the tumour board (RecommendationCarePlan, intent proposal) with the overarching goal; on the right the fine-grained treatment plans of autonomous providers (intent order) with episode goals. Linked through basedOn at plan and request level; deliberately no partOf. Recommendation — tumour board Treatment — autonomous providers Tumour board CareTeam RecommendationCarePlan intent: proposal — coarse-grained pursues: overarching goal (curative) Recommendation: platinum-based chemo + checkpoint inhibitor — proposal Recommendation: surgery — proposal TreatmentCarePlan ① neoadjuvant systemic therapy — custodian: Clinic A pursues: goal tumour shrinkage (→ surgery) MedicationRequest — order: Carboplatin AUC5 + Pembrolizumab q3w integration: pharmacy · scheduling TreatmentCarePlan ② surgery — custodian: another organisation (Clinic B) pursues: goal R0 resection · ypCR ServiceRequest: surgery — order basedOn basedOn Request.basedOn no partOf — no central control the treatment plan fulfils the recommendation; decoupled in time and organisation (own custodian per plan) Modelling note: activity.detail vs. standalone Requests The recommendations could in theory sit inline in the plan (CarePlan.activity.detail) — across sectors, profiling as recommendation ServiceRequest / recommendation MedicationRequest is preferable: referenceable, individually fulfillable (Request.basedOn) and exchangeable across organisations. Plan Goal reference Measure / Request Actor / note One recommendation — several treatment plans: implementation at different organisations, linked via basedOn.

Different level of detail, decoupled in time and organisation

The recommendation is coarse-grained ("which strategy, which modalities, which goal"); the treatment plan is fine-grained ("which substance/dose/schedule, which procedure, at which site"). For example, the recommendation may specify a drug class ("platinum-based chemotherapy + checkpoint inhibitor"), while the treatment plan sets the concrete substances and may link to pharmacy/ordering and appointment-booking systems. Recommendation and delivery are decoupled in time and across organisations (each treatment plan has its own custodian).

basedOn, not partOf

The treatment plan fulfils the recommendation via CarePlan.basedOn (not partOf, which would imply central steering that does not exist in German intersectoral care).

Reference to established protocols

A treatment plan often references an established protocol (guideline, study protocol, SOP) via instantiatesCanonical (computable PlanDefinition) or instantiatesUri. Two template levels work together: CPG guidelines as recommendation templates and a protocol catalogue as treatment templates. A normative catalogue for systemic protocols does not yet exist; one is expected from the PHOENIX initiative from Q4 2026 (European Common Cancer Model). It will initially cover systemic chemo-/targeted protocols; non-chemo systemic therapies, surgery, pre-/aftercare and radiotherapy are not yet covered.