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Most cancer drug approvals depend on a handful of facts already in the chart, such as the diagnosis, biomarker and line of therapy; sending those automatically in a standard format would return most decisions before the patient leaves the room.
CMS's 2024 Interoperability and Prior Authorization final rule requires payers to offer electronic prior authorisation through HL7 FHIR interfaces and to decide urgent requests within 72 hours and standard ones within seven days from 2026 and 2027. Oncology criteria are structured (diagnosis, stage, biomarker, prior lines), so the mCODE data standard can carry them. Payers publishing their oncology rules as computable criteria, and electronic records sending mCODE bundles, turns a fax-and-phone process into an automated one with human review only for exceptions.
Shares NCCN Compendium and drug compendia, Not enough oncologists, nurses, pathologists, physicists, Fragmented care and guideline gaps.
Shares mCODE (minimal Common Oncology Data Elements), NCCN Compendium and drug compendia.
Shares Not enough oncologists, nurses, pathologists, physicists, Data silos.
Shares Not enough oncologists, nurses, pathologists, physicists, Fragmented care and guideline gaps.
Shares Not enough oncologists, nurses, pathologists, physicists, Data silos.
Shares Not enough oncologists, nurses, pathologists, physicists, Fragmented care and guideline gaps.