No mCODE, no payment: tie oncology reimbursement to a minimal structured record
Hospitals would only be paid for cancer treatment if they record a small, standard set of facts (diagnosis, stage, biomarkers, treatment, outcome) in a shared format that any computer can read.
mCODE (minimal Common Oncology Data Elements) is an HL7 FHIR implementation guide of roughly 90 elements covering the cancer patient, disease, genomics, treatment and outcomes. Adoption is voluntary and patchy. The proposal is for Medicare, the NHS and national insurers to make conformant mCODE capture a condition of payment for systemic anticancer therapy, phased over three years, mirroring how Meaningful Use forced EHR adoption in the US and how the NHS Systemic Anti-Cancer Therapy (SACT) dataset made chemotherapy reporting near-universal in England.
- Data silos · Records, scans, genomes and outcomes sit in separate systems that cannot talk. Every patient's experience is lost to the next.
- Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.