FHIR R4 for the Survivorship Hand-off: What Actually Crosses the Wire
A field-by-field walk-through of the FHIR R4 bundle Life Spark generates for a survivorship hand-off — Condition, MedicationStatement, Observation, CarePlan — and how it lands in a modern EHR.
For the technical clinician or informatics lead evaluating Life Spark: here is the exact FHIR R4 bundle shape a survivor hands you at the point of transition, and how it lands cleanly in a modern EHR without becoming another interface project.
Resource inventory
The bundle is a transaction Bundle containing: Patient (self-reported demographics, opt-in), Condition (diagnosis + stage, with SNOMED CT + ICD-10 coding), MedicationStatement (chemotherapeutic history with RxNorm codes and cumulative-dose extensions where applicable), Procedure (radiation with anatomic site + total dose), Observation (survivor-reported symptom trends and validated screens, LOINC-coded), CarePlan (surveillance schedule aligned to primary guidance), and Consent (the patient's scoped share).
Coding that actually round-trips
LOINC on Observations (distress thermometer 71969-4, PROMIS panels where applicable), SNOMED CT + ICD-10 on Conditions, RxNorm on MedicationStatements, and CVX on Immunizations. This is the code set most US-Core-conformant EHRs will accept without translation.
Cumulative-dose extension for anthracyclines
The most consequential number for cardio-oncology surveillance — cumulative anthracycline dose in doxorubicin-equivalent mg/m² — is carried on a dosage extension on the MedicationStatement, with the equivalence math already applied. Your echo interval logic can read it directly.
How the hand-off actually happens
The patient generates the bundle and hands you either a downloaded file or a one-time signed link. Nothing is auto-pushed into your EHR. Your intake reviews it, imports what you want, and discards the rest — the toolkit is not a parallel record system, and Life Spark does not become a HIPAA business associate of your clinic by virtue of a hand-off.