HL7 FHIR Implementation Guide: Breast Cancer Data, Release 1 - US Realm (Draft for Comment 2)

BreastTumorModel

Definitions for oncology-BreastTumor-model.

1. oncology-BreastTumor-model
Definition

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm. (source: NCI)

Control0..*
2. oncology-BreastTumor-model.personOfRecord
Definition

The person this entry belongs to.

Control1..1
TypeReference(PersonOfRecordModel)
3. oncology-BreastTumor-model.findingSiteConditionTopic
Definition

Presence (or absence) of a distinct anatomical or pathological morphological feature or organizational pattern, acquired or innate. Examples include tissue types, tumors, and wounds. The FindingSiteCondition topic provides not only the AnatomicalLocation (as in CIMI FindingSiteAssertionTopic), tbut also the type of structure found at that location, such as a wound or tumor.

Control1..1
TypeBackboneElement
4. oncology-BreastTumor-model.findingSiteConditionTopic.topicCode
Definition

The concept representing the finding or action that is the topic of the statement.

For action topics, the TopicCode represents the action being described. For findings, the TopicCode represents the 'question' or property being investigated. For evaluation result findings, the TopicCode contains a concept for an observable entity, such as systolic blood pressure. For assertion findings, the TopicCode contains a code representing the condition, allergy, or other item being asserted. In all cases, the TopicCode describes the topic independent of the context of the action or the finding.

Control1..1
BindingThe codes SHALL be taken from Problem Value Set; other codes may be used where these codes are not suitable
TypeCoding
5. oncology-BreastTumor-model.findingSiteConditionTopic.findingMethod
Definition

The technique used to create the finding, for example, the specific imaging technical, lab test code, or assessment vehicle.

Control0..1
BindingThe codes SHOULD be taken from BC BreastCancerDetectionVS ValueSet
TypeCoding
6. oncology-BreastTumor-model.findingSiteConditionTopic.details
Definition

A text note containing additional details, explanation, description, comment, or summarization. Details can discuss, support, explain changes to, or dispute information.

Control0..1
Typestring
7. oncology-BreastTumor-model.findingSiteConditionTopic.media
Definition

A file that contains audio, video, image, or similar content.

Control0..*
Typehttp://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-Media-model
8. oncology-BreastTumor-model.findingSiteConditionTopic.category
Definition

A class or division of people or things having particular shared characteristics

Control1..*
BindingThe codes SHOULD be taken from US Core Condition Category Codes
TypeCoding
9. oncology-BreastTumor-model.findingSiteConditionTopic.breastSite
Definition

A body site specific to the breast structure.

Control1..*
Typehttp://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastSite-model
10. oncology-BreastTumor-model.findingSiteConditionTopic.conditionCause
Definition

The cause of the condition. This includes such causes as disease vectors and endogenous states (e.g., macular degeneration due to diabetes), substances, medications, micro-organisms, and forces associated with the occurrence of a Condition from temporal or causative perspectives

Control0..*
TypeChoice of: Coding, Reference(EntityModel | ClinicalStatementModel)
11. oncology-BreastTumor-model.findingSiteConditionTopic.alleviatingFactor
Definition

Activities that reduce the severity of the pathology

Control0..0
TypeCoding
12. oncology-BreastTumor-model.findingSiteConditionTopic.exacerbatingFactor
Definition

Activities that increase the severity of the pathology

Control0..0
TypeCoding
13. oncology-BreastTumor-model.findingSiteConditionTopic.tumorIdentifier
Definition

A human-readable identifier for the lesion; e.g., a letter or integer.

Control0..1
Typestring
14. oncology-BreastTumor-model.conditionPresenceContext
Definition

The context for a condition that is known, suspected, or possibly present.

Control1..1
Typehttp://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-context-ConditionPresenceContext-model
15. oncology-BreastTumor-model.conditionPresenceContext.contextCode
Definition

A code representing the ontological status of the statement, e.g., whether it exists, does not exist, is planned, etc. Attribute aligns with the SNOMED CT Situation with Explicit Context (SWEC) Concept Model context attributes: 'Finding context (attribute)' (SCTID: 408729009) and 'Procedure context (attribute)' (SCTID: 408730004). The range allowed for this attribute shall be consistent with the SNOMED CT concept model specification for SWEC.

Control1..1
BindingThe codes SHALL be taken from BC PresenceContextVS ValueSet
TypeCoding
16. oncology-BreastTumor-model.conditionPresenceContext.encounter
Definition

A description of an interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.

Control0..1
Typehttp://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-encounter-Encounter-model
17. oncology-BreastTumor-model.conditionPresenceContext.verificationStatus
Definition

Whether an assessment has been confirmed by testing or observation. CIMI Alignment: This attribute corresponds to FindingContext.status, but has been defined to align with FHIR. In AllergyIntolerance, the type is code.

Control1..1
TypeCoding
18. oncology-BreastTumor-model.conditionPresenceContext.onset
Definition

The beginning or first appearance of a mental or physical disorder.

Control0..1
TypeChoice of: dateTime, http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-Age-model, http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-TimePeriod-model, http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-Range-model, string
19. oncology-BreastTumor-model.conditionPresenceContext.abatement
Definition

The end, remission or resolution.

Control0..1
TypeChoice of: dateTime, http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-Age-model, boolean, http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-TimePeriod-model, http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-Range-model, string
20. oncology-BreastTumor-model.conditionPresenceContext.certainty
Definition

The degree of confidence in a conclusion or assertion.

Control0..1
TypeCoding
21. oncology-BreastTumor-model.conditionPresenceContext.clinicalStatus
Definition

A flag indicating whether the condition is active or inactive, recurring, in remission, or resolved (as of the last update of the Condition).

Control1..1
BindingThe codes SHALL be taken from Condition Clinical Status Codes
Typecode
22. oncology-BreastTumor-model.conditionPresenceContext.whenClinicallyRecognized
Definition

The time at which a condition or condition was first identified in a healthcare context.

Control0..1
Typedate
23. oncology-BreastTumor-model.conditionPresenceContext.presentOnAdmission
Definition

If the problem or condition existed before the current episode of care.

Control0..1
BindingThe codes SHALL be taken from BC YesNoUnknownVS ValueSet
TypeCoding
24. oncology-BreastTumor-model.conditionPresenceContext.severity
Definition

Degree of harshness or extent of a symptom, disorder, or condition.

Control0..0
BindingThe codes SHALL be taken from Condition/Diagnosis Severity
TypeCoding
25. oncology-BreastTumor-model.conditionPresenceContext.stage
Definition

The relative advancement in the course of a disease. The value is the summary stage or stage group. StageDetail optionally contains the full staging information.

Control0..0
Typehttp://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-context-Stage-model
26. oncology-BreastTumor-model.topicCode
Definition

The concept representing the finding or action that is the topic of the statement.

For action topics, the TopicCode represents the action being described. For findings, the TopicCode represents the 'question' or property being investigated. For evaluation result findings, the TopicCode contains a concept for an observable entity, such as systolic blood pressure. For assertion findings, the TopicCode contains a code representing the condition, allergy, or other item being asserted. In all cases, the TopicCode describes the topic independent of the context of the action or the finding.

Control1..1
TypeCoding
27. oncology-BreastTumor-model.topicCode.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
28. oncology-BreastTumor-model.topicCode.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

29. oncology-BreastTumor-model.topicCode.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
30. oncology-BreastTumor-model.topicCode.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

31. oncology-BreastTumor-model.topicCode.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Requirements

Need to refer to a particular code in the system.

Fixed Value395557000
32. oncology-BreastTumor-model.topicCode.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

33. oncology-BreastTumor-model.topicCode.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

34. oncology-BreastTumor-model.category
Definition

A class or division of people or things having particular shared characteristics

Control1..1
TypeCoding
35. oncology-BreastTumor-model.category.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
36. oncology-BreastTumor-model.category.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

37. oncology-BreastTumor-model.category.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://hl7.org/fhir/observation-category
38. oncology-BreastTumor-model.category.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

39. oncology-BreastTumor-model.category.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Requirements

Need to refer to a particular code in the system.

Fixed Valueexam
40. oncology-BreastTumor-model.category.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

41. oncology-BreastTumor-model.category.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.