HL7 FHIR Implementation Guide: Breast Cancer Data, Release 1 - US Realm (Draft for Comment 2)
This page is part of the Breast Cancer Data Logical Models and FHIR Profiles (v0.2.0: STU 1 Draft) based on FHIR R3. . For a full list of available versions, see the Directory of published versions 
The official URL for this profile is:
http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-DCISNuclearGrade
An evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade. In breast cancer, nuclear grade is typically evaluated for ductal carcinoma in situ (DCIS) only. There is currently no concept code for DCIS Nuclear Grade in LOINC, SNOMED, or NCI Metathesaurus.
This profile builds on US Core Results Profile.
This profile was published on Fri Aug 17 00:00:00 AEST 2018 as a draft by The HL7 Cancer Interoperability Group sponsored by Clinical Interoperability Council Work Group (CIC).
View the corresponding DCISNuclearGradeModel logical model.
Summary
Mandatory: 0 element (3 nested mandatory elements)
Fixed Value: 3 elements
Prohibited: 5 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
BC Mapping Source
This structure represents the following BC mapping definition:
oncology.DCISNuclearGrade maps to http://hl7.org/fhir/us/core/StructureDefinition/us-core-observationresults: PersonOfRecord maps to subject LaboratoryObservationTopic.TopicCode maps to code LaboratoryObservationTopic.FindingMethod maps to method LaboratoryObservationTopic.Details maps to comment LaboratoryObservationTopic.Category maps to category LaboratoryObservationTopic.AnatomicalLocation maps to bodySite LaboratoryObservationTopic.Device maps to device LaboratoryObservationTopic.Specimen maps to specimen LaboratoryObservationTopic.ReferenceRange maps to referenceRange LaboratoryObservationTopic.ReferenceRange.Range.LowerBound maps to referenceRange.low LaboratoryObservationTopic.ReferenceRange.Range.UpperBound maps to referenceRange.high LaboratoryObservationTopic.ReferenceRange.Type maps to referenceRange.type LaboratoryObservationTopic.ReferenceRange.ApplicableSubpopulation maps to referenceRange.appliesTo LaboratoryObservationTopic.ReferenceRange.ApplicableAgeRange maps to referenceRange.age LaboratoryObservationTopic.EvaluationComponent maps to component (slice on = coding.code; slice strategy = includes) LaboratoryObservationTopic.EvaluationComponent._Concept maps to component.code LaboratoryObservationTopic.EvaluationComponent.Quantity maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.CodeableConcept maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.string maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.Range maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.Ratio maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.Media maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.time maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.dateTime maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.TimePeriod maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.IntegerQuantity maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.ExceptionValue maps to component.dataAbsentReason LaboratoryObservationTopic.EvaluationComponent.Interpretation maps to component.interpretation LaboratoryObservationTopic.EvaluationComponent.ReferenceRange maps to component.referenceRange fix related.type to #has-member LaboratoryObservationTopic.PanelMembers maps to related LaboratoryObservationTopic.PanelMembers.Observation maps to related.target (slice at = related; slice on = target.reference.resolve(); slice on type = profile; slice strategy = includes) ObservationContext.ResultValue maps to value[x] ObservationContext.ExceptionValue maps to dataAbsentReason ObservationContext.Interpretation maps to interpretation ObservationContext.Issued maps to issued ObservationContext.FindingStatus maps to status ObservationContext.RelevantTime maps to effective[x] ObservationContext.DeltaFlag maps to http://hl7.org/fhir/StructureDefinition/observation-delta
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Observation | BC DCISNuclearGrade Profile | |||
  observation-delta | 0..1 | CodeableConcept | Qualitative change or trend in the measurement URL: http://hl7.org/fhir/StructureDefinition/observation-delta | |
| category | ||||
  coding | Slice: Unordered, Open by value:code | |||
  coding | Σ | 1..1 | Coding | |
  system | Fixed Value: http://hl7.org/fhir/observation-category | |||
 code | Fixed Value: laboratory | |||
| valueCodeableConcept | CodeableConcept | Binding: BC DCISNuclearGradeVS ValueSet (required) | ||
| dataAbsentReason | Binding: DataAbsentReason (extensible) | |||
| bodySite | 0..0 | |||
| method | Binding: http://loinc.org/vs (preferred) | |||
 specimen | 1..1 | Reference(BC BreastSpecimen Profile) | ||
| device | 0..0 | |||
| referenceRange | 0..0 | |||
| related | 0..0 | |||
| component | 0..0 | |||
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Observation | I | 0..* | BC DCISNuclearGrade Profile us-core-2: If there is no component or related element then either a value[x] or a data absent reason must be present | |
 id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: Common Languages (extensible) | |
| text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
 contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |
| observation-delta | 0..1 | CodeableConcept | Qualitative change or trend in the measurement URL: http://hl7.org/fhir/StructureDefinition/observation-delta | |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..* | Identifier | Business Identifier for observation |
| basedOn | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest) | Fulfills plan, proposal or order |
| status | ?!SΣ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required) |
| category | SI | 1..* | CodeableConcept | Classification of type of observation Binding: Observation Category Codes (preferred) us-core-5: Must have a category of 'laboratory' and a code system 'http://hl7.org/fhir/observation-category' |
| id | 0..1 | string | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |
| coding | Σ | Coding | Code defined by a terminology system Slice: Unordered, Open by value:code | |
| coding | Σ | 1..1 | Coding | |
| id | 0..1 | string | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |
| system | Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category |
| version | Σ | 0..1 | string | Version of the system - if relevant |
| code | Σ | 0..1 | code | Symbol in syntax defined by the system Fixed Value: laboratory |
| display | Σ | 0..1 | string | Representation defined by the system |
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user |
| text | Σ | 0..1 | string | Plain text representation of the concept |
| code | SΣ | 1..1 | CodeableConcept | Laboratory Test Name Binding: LOINC Codes (extensible) |
| subject | SΣ | 1..1 | Reference(US Core Patient Profile) | Who and/or what this is about |
| context | 0..1 | Reference(Encounter | EpisodeOfCare) | Healthcare event during which this observation is made | |
 effective[x] | SΣI | 0..1 | dateTime, Period | Clinically relevant time/time-period for observation us-core-1: Datetime must be at least to day. |
| issued | Σ | 0..1 | instant | Date/Time this was made available |
| performer | Σ | 0..* | Reference(Practitioner | Organization | Patient | RelatedPerson) | Who is responsible for the observation |
| valueCodeableConcept | Σ | 0..1 | CodeableConcept | Result Value Binding: BC DCISNuclearGradeVS ValueSet (required) |
| dataAbsentReason | SI | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible) |
| interpretation | 0..1 | CodeableConcept | High, low, normal, etc. Binding: Observation Interpretation Codes (extensible) | |
| comment | 0..1 | string | Comments about result | |
| method | 0..1 | CodeableConcept | How it was done Binding: http://loinc.org/vs (preferred) | |
| specimen | 1..1 | Reference(BC BreastSpecimen Profile) | Specimen used for this observation | |
| Documentation for this format | ||||
Summary
Mandatory: 0 element (3 nested mandatory elements)
Fixed Value: 3 elements
Prohibited: 5 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
BC Mapping Source
This structure represents the following BC mapping definition:
oncology.DCISNuclearGrade maps to http://hl7.org/fhir/us/core/StructureDefinition/us-core-observationresults: PersonOfRecord maps to subject LaboratoryObservationTopic.TopicCode maps to code LaboratoryObservationTopic.FindingMethod maps to method LaboratoryObservationTopic.Details maps to comment LaboratoryObservationTopic.Category maps to category LaboratoryObservationTopic.AnatomicalLocation maps to bodySite LaboratoryObservationTopic.Device maps to device LaboratoryObservationTopic.Specimen maps to specimen LaboratoryObservationTopic.ReferenceRange maps to referenceRange LaboratoryObservationTopic.ReferenceRange.Range.LowerBound maps to referenceRange.low LaboratoryObservationTopic.ReferenceRange.Range.UpperBound maps to referenceRange.high LaboratoryObservationTopic.ReferenceRange.Type maps to referenceRange.type LaboratoryObservationTopic.ReferenceRange.ApplicableSubpopulation maps to referenceRange.appliesTo LaboratoryObservationTopic.ReferenceRange.ApplicableAgeRange maps to referenceRange.age LaboratoryObservationTopic.EvaluationComponent maps to component (slice on = coding.code; slice strategy = includes) LaboratoryObservationTopic.EvaluationComponent._Concept maps to component.code LaboratoryObservationTopic.EvaluationComponent.Quantity maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.CodeableConcept maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.string maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.Range maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.Ratio maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.Media maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.time maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.dateTime maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.TimePeriod maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.IntegerQuantity maps to component.value[x] LaboratoryObservationTopic.EvaluationComponent.ExceptionValue maps to component.dataAbsentReason LaboratoryObservationTopic.EvaluationComponent.Interpretation maps to component.interpretation LaboratoryObservationTopic.EvaluationComponent.ReferenceRange maps to component.referenceRange fix related.type to #has-member LaboratoryObservationTopic.PanelMembers maps to related LaboratoryObservationTopic.PanelMembers.Observation maps to related.target (slice at = related; slice on = target.reference.resolve(); slice on type = profile; slice strategy = includes) ObservationContext.ResultValue maps to value[x] ObservationContext.ExceptionValue maps to dataAbsentReason ObservationContext.Interpretation maps to interpretation ObservationContext.Issued maps to issued ObservationContext.FindingStatus maps to status ObservationContext.RelevantTime maps to effective[x] ObservationContext.DeltaFlag maps to http://hl7.org/fhir/StructureDefinition/observation-delta
Differential View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Observation | BC DCISNuclearGrade Profile | |||
| observation-delta | 0..1 | CodeableConcept | Qualitative change or trend in the measurement URL: http://hl7.org/fhir/StructureDefinition/observation-delta | |
| category | ||||
| coding | Slice: Unordered, Open by value:code | |||
| coding | Σ | 1..1 | Coding | |
| system | Fixed Value: http://hl7.org/fhir/observation-category | |||
| code | Fixed Value: laboratory | |||
| valueCodeableConcept | CodeableConcept | Binding: BC DCISNuclearGradeVS ValueSet (required) | ||
| dataAbsentReason | Binding: DataAbsentReason (extensible) | |||
| bodySite | 0..0 | |||
| method | Binding: http://loinc.org/vs (preferred) | |||
| specimen | 1..1 | Reference(BC BreastSpecimen Profile) | ||
| device | 0..0 | |||
| referenceRange | 0..0 | |||
| related | 0..0 | |||
| component | 0..0 | |||
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Observation | I | 0..* | BC DCISNuclearGrade Profile us-core-2: If there is no component or related element then either a value[x] or a data absent reason must be present | |
| id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: Common Languages (extensible) | |
| text | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |
| observation-delta | 0..1 | CodeableConcept | Qualitative change or trend in the measurement URL: http://hl7.org/fhir/StructureDefinition/observation-delta | |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..* | Identifier | Business Identifier for observation |
| basedOn | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest) | Fulfills plan, proposal or order |
| status | ?!SΣ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required) |
| category | SI | 1..* | CodeableConcept | Classification of type of observation Binding: Observation Category Codes (preferred) us-core-5: Must have a category of 'laboratory' and a code system 'http://hl7.org/fhir/observation-category' |
| id | 0..1 | string | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |
| coding | Σ | Coding | Code defined by a terminology system Slice: Unordered, Open by value:code | |
| coding | Σ | 1..1 | Coding | |
| id | 0..1 | string | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Additional Content defined by implementations Slice: Unordered, Open by value:url | |
| system | Σ | 0..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category |
| version | Σ | 0..1 | string | Version of the system - if relevant |
| code | Σ | 0..1 | code | Symbol in syntax defined by the system Fixed Value: laboratory |
| display | Σ | 0..1 | string | Representation defined by the system |
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user |
| text | Σ | 0..1 | string | Plain text representation of the concept |
| code | SΣ | 1..1 | CodeableConcept | Laboratory Test Name Binding: LOINC Codes (extensible) |
| subject | SΣ | 1..1 | Reference(US Core Patient Profile) | Who and/or what this is about |
| context | 0..1 | Reference(Encounter | EpisodeOfCare) | Healthcare event during which this observation is made | |
| effective[x] | SΣI | 0..1 | dateTime, Period | Clinically relevant time/time-period for observation us-core-1: Datetime must be at least to day. |
| issued | Σ | 0..1 | instant | Date/Time this was made available |
| performer | Σ | 0..* | Reference(Practitioner | Organization | Patient | RelatedPerson) | Who is responsible for the observation |
| valueCodeableConcept | Σ | 0..1 | CodeableConcept | Result Value Binding: BC DCISNuclearGradeVS ValueSet (required) |
| dataAbsentReason | SI | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible) |
| interpretation | 0..1 | CodeableConcept | High, low, normal, etc. Binding: Observation Interpretation Codes (extensible) | |
| comment | 0..1 | string | Comments about result | |
| method | 0..1 | CodeableConcept | How it was done Binding: http://loinc.org/vs (preferred) | |
| specimen | 1..1 | Reference(BC BreastSpecimen Profile) | Specimen used for this observation | |
| Documentation for this format | ||||
Downloads: StructureDefinition: (XML, JSON, TTL), Schema: XML Schematron
| Path | Name | Conformance | ValueSet |
| Observation.language | Common Languages | extensible | Common Languages |
| Observation.status | ObservationStatus | required | ObservationStatus |
| Observation.category | Observation Category Codes | preferred | Observation Category Codes |
| Observation.code | LOINC Codes | extensible | LOINC Codes |
| Observation.valueCodeableConcept | BC DCISNuclearGradeVS ValueSet | required | DCISNuclearGradeVS |
| Observation.dataAbsentReason | DataAbsentReason | extensible | DataAbsentReason |
| Observation.interpretation | Observation Interpretation Codes | extensible | Observation Interpretation Codes |
| Observation.method | ?ext | preferred | http://loinc.org/vs |
| Observation.referenceRange.type | Observation Reference Range Meaning Codes | extensible | Observation Reference Range Meaning Codes |
| Observation.referenceRange.appliesTo | Observation Reference Range Applies To Codes | extensible | Observation Reference Range Applies To Codes |
| Observation.related.type | ObservationRelationshipType | required | ObservationRelationshipType |
| Observation.component.code | LOINC Codes | example | LOINC Codes |
| Observation.component.dataAbsentReason | DataAbsentReason | extensible | DataAbsentReason |
| Observation.component.interpretation | Observation Interpretation Codes | extensible | Observation Interpretation Codes |
| Observation.component.referenceRange.type | Observation Reference Range Meaning Codes | extensible | Observation Reference Range Meaning Codes |
| Observation.component.referenceRange.appliesTo | Observation Reference Range Applies To Codes | example | Observation Reference Range Applies To Codes |
| Id | Path | Details | Requirements |
| dom-2 | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-1 | Observation | If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty() | |
| dom-4 | Observation | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-3 | Observation | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty() | |
| obs-7 | Observation | If code is the same as a component code then the value element associated with the code SHALL NOT be present : value.empty() or code!=component.code | |
| obs-6 | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty() | |
| us-core-2 | Observation | If there is no component or related element then either a value[x] or a data absent reason must be present : (component.empty() and related.empty()) implies (dataAbsentReason or value) | |
| us-core-5 | Observation.category | Must have a category of 'laboratory' and a code system 'http://hl7.org/fhir/observation-category' : where(coding.system='http://hl7.org/fhir/observation-category' and coding.code='laboratory').exists() | |
| us-core-1 | Observation.effective[x] | Datetime must be at least to day. : ($this as dateTime).toString().length() >= 8 |