minimal Common Oncology Data Elements (mCODE) Implementation Guide
2.0.0 - STU 2

This page is part of the HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU1 (v2.0.0: STU 2) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: Primary Cancer Condition Profile

Defining URL:http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-primary-cancer-condition
Version:2.0.0
Name:PrimaryCancerCondition
Title:Primary Cancer Condition Profile
Status:Active as of 1/18/22 3:17 AM
Definition:

Records the the primary cancer condition, the original or first tumor in the body (Definition from: NCI Dictionary of Cancer Terms). Cancers that are not clearly secondary (i.e., of uncertain origin or behavior) should be documented as primary.

Publisher:HL7 International Clinical Interoperability Council
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-primary-cancer-condition

Usage

This profile captures the cancer diagnosis. More information on coding the diagnosis can be found on the page Content by Group -> Disease.

In mCODE, staging information MUST be captured in an Observation that conforms to the CancerStageGroup profile. The resulting stage group MAY appear in this profile, in stage.summary and stage.type, but mCODE Data Senders and Receivers MAY ignore it in favor of the CancerStageGroup Observation. If present, cancer staging information summarized in this profile should reflect the most recent staging assessment on the patient, and should be updated if and when there is a new staging assessment. Past staging assessments will be preserved in instances of the CancerStageGroup, which refer back to PrimaryCancerCondition.

For SNOMED CT coding, use a code from the disorder hierarchy under SNOMED CT 363346000 ‘Malignant neoplastic disease (disorder)’ excluding codes descending from SNOMED CT 128462008 ‘Secondary malignant neoplastic disease (disorder)’. If body location is not precoordinated (i.e., implied by the code), the site of the primary tumor should be specified in the body site attribute.

For ICD-10-CM coding, use one of the codes given in this value set representing primary malignant neoplasms and neoplasms of uncertain or unspecified behavior.

Note that ICD-O-3 specifies morphology and topography, not disorder. If ICD-O-3 is used, the primary cancer disorder code must be specifically be SNOMED CT 363346000  ’Malignant neoplastic disease (disorder)’. The ICD-O-3 morphology and topography codes should be entered in the HistologyMorphologyBehavior and body location fields, respectively.

Conformance

Condition resources associated with an in-scope patient with a Condition.code in the value set [PrimaryOrUncertainBehaviorCancerDisorderVS] MUST conform to this profile. Beyond this requirement, a producer of resources SHOULD ensure that any resource instance associated with an in-scope patient that would reasonably be expected to conform to this profile SHOULD be published in this form.

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from USCoreCondition

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition 0..*USCoreConditionDetailed information about conditions, problems or diagnoses
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... condition-assertedDate S0..1dateTimeDate the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... mcode-histology-morphology-behavior S0..1CodeableConceptHistology-Morphology-Behavior Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior
Binding: Histology Morphology Behavior Value Set (extensible)
... bodySite S0..*CodeableConceptAnatomical location, if relevant
Binding: Cancer Body Location Value Set (extensible)
.... mcode-body-location-qualifier S0..*CodeableConceptBody Location Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier
Binding: Body Location Qualifier Value Set (required)
.... mcode-laterality-qualifier S0..1CodeableConceptLaterality Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier
Binding: Laterality Qualifier Value Set (required)
... stage S0..*BackboneElementStage/grade, usually assessed formally
.... summary 0..1CodeableConceptMost recent Stage Group
.... assessment S0..*Reference(Cancer Stage Group Profile)Formal record of assessment
.... type 0..1CodeableConceptStaging system used.
Binding: Staging Type for Stage Group Value Set (required)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition I0..*USCoreConditionDetailed information about conditions, problems or diagnoses
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... condition-assertedDate S0..1dateTimeDate the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... mcode-histology-morphology-behavior S0..1CodeableConceptHistology-Morphology-Behavior Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior
Binding: Histology Morphology Behavior Value Set (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal Ids for this condition
... clinicalStatus ?!SΣI0..1CodeableConceptactive | recurrence | relapse | inactive | remission | resolved
Binding: ConditionClinicalStatusCodes (required)
... verificationStatus ?!SΣI0..1CodeableConceptunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: ConditionVerificationStatus (required)
... category SI1..*CodeableConceptproblem-list-item | encounter-diagnosis | health-concern
Binding: US Core Condition Category Codes (extensible)
... severity 0..1CodeableConceptSubjective severity of condition
Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.

... code SΣ1..1CodeableConceptIdentification of the condition, problem or diagnosis
Binding: Primary Cancer Disorder Value Set (extensible)
... bodySite SΣ0..*CodeableConceptAnatomical location, if relevant
Binding: Cancer Body Location Value Set (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... mcode-body-location-qualifier S0..*CodeableConceptBody Location Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier
Binding: Body Location Qualifier Value Set (required)
.... mcode-laterality-qualifier S0..1CodeableConceptLaterality Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier
Binding: Laterality Qualifier Value Set (required)
.... coding Σ0..*CodingCode defined by a terminology system
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(US Core Patient Profile)Who has the condition?
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... onset[x] Σ0..1Estimated or actual date, date-time, or age
.... onsetDateTimedateTime
.... onsetAgeAge
.... onsetPeriodPeriod
.... onsetRangeRange
.... onsetStringstring
... abatement[x] I0..1When in resolution/remission
.... abatementDateTimedateTime
.... abatementAgeAge
.... abatementPeriodPeriod
.... abatementRangeRange
.... abatementStringstring
... recordedDate Σ0..1dateTimeDate record was first recorded
... recorder Σ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)Who recorded the condition
... asserter Σ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)Person who asserts this condition
... stage SI0..*BackboneElementStage/grade, usually assessed formally
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... summary I0..1CodeableConceptMost recent Stage Group
Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).

.... assessment SI0..*Reference(Cancer Stage Group Profile)Formal record of assessment
.... type 0..1CodeableConceptStaging system used.
Binding: Staging Type for Stage Group Value Set (required)
... evidence I0..*BackboneElementSupporting evidence
con-2: evidence SHALL have code or details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code ΣI0..*CodeableConceptManifestation/symptom
Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.


.... detail ΣI0..*Reference(Resource)Supporting information found elsewhere
... note 0..*AnnotationAdditional information about the Condition

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition I0..*USCoreConditionDetailed information about conditions, problems or diagnoses
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... condition-assertedDate 0..1dateTimeDate the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... mcode-histology-morphology-behavior 0..1CodeableConceptHistology-Morphology-Behavior Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior
Binding: Histology Morphology Behavior Value Set (extensible)
... verificationStatus ?!ΣI0..1CodeableConceptunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: ConditionVerificationStatus (required)
... category I1..*CodeableConceptproblem-list-item | encounter-diagnosis | health-concern
Binding: US Core Condition Category Codes (extensible)
... code Σ1..1CodeableConceptIdentification of the condition, problem or diagnosis
Binding: Primary Cancer Disorder Value Set (extensible)
... bodySite Σ0..*CodeableConceptAnatomical location, if relevant
Binding: Cancer Body Location Value Set (extensible)
.... mcode-body-location-qualifier 0..*CodeableConceptBody Location Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier
Binding: Body Location Qualifier Value Set (required)
.... mcode-laterality-qualifier 0..1CodeableConceptLaterality Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier
Binding: Laterality Qualifier Value Set (required)
... subject Σ1..1Reference(US Core Patient Profile)Who has the condition?
... stage I0..*BackboneElementStage/grade, usually assessed formally
.... assessment I0..*Reference(Cancer Stage Group Profile)Formal record of assessment

doco Documentation for this format

Differential View

This structure is derived from USCoreCondition

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition 0..*USCoreConditionDetailed information about conditions, problems or diagnoses
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... condition-assertedDate S0..1dateTimeDate the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... mcode-histology-morphology-behavior S0..1CodeableConceptHistology-Morphology-Behavior Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior
Binding: Histology Morphology Behavior Value Set (extensible)
... bodySite S0..*CodeableConceptAnatomical location, if relevant
Binding: Cancer Body Location Value Set (extensible)
.... mcode-body-location-qualifier S0..*CodeableConceptBody Location Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier
Binding: Body Location Qualifier Value Set (required)
.... mcode-laterality-qualifier S0..1CodeableConceptLaterality Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier
Binding: Laterality Qualifier Value Set (required)
... stage S0..*BackboneElementStage/grade, usually assessed formally
.... summary 0..1CodeableConceptMost recent Stage Group
.... assessment S0..*Reference(Cancer Stage Group Profile)Formal record of assessment
.... type 0..1CodeableConceptStaging system used.
Binding: Staging Type for Stage Group Value Set (required)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition I0..*USCoreConditionDetailed information about conditions, problems or diagnoses
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension S0..*ExtensionExtension
Slice: Unordered, Open by value:url
... condition-assertedDate S0..1dateTimeDate the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... mcode-histology-morphology-behavior S0..1CodeableConceptHistology-Morphology-Behavior Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior
Binding: Histology Morphology Behavior Value Set (extensible)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal Ids for this condition
... clinicalStatus ?!SΣI0..1CodeableConceptactive | recurrence | relapse | inactive | remission | resolved
Binding: ConditionClinicalStatusCodes (required)
... verificationStatus ?!SΣI0..1CodeableConceptunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: ConditionVerificationStatus (required)
... category SI1..*CodeableConceptproblem-list-item | encounter-diagnosis | health-concern
Binding: US Core Condition Category Codes (extensible)
... severity 0..1CodeableConceptSubjective severity of condition
Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.

... code SΣ1..1CodeableConceptIdentification of the condition, problem or diagnosis
Binding: Primary Cancer Disorder Value Set (extensible)
... bodySite SΣ0..*CodeableConceptAnatomical location, if relevant
Binding: Cancer Body Location Value Set (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... mcode-body-location-qualifier S0..*CodeableConceptBody Location Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier
Binding: Body Location Qualifier Value Set (required)
.... mcode-laterality-qualifier S0..1CodeableConceptLaterality Qualifier Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier
Binding: Laterality Qualifier Value Set (required)
.... coding Σ0..*CodingCode defined by a terminology system
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(US Core Patient Profile)Who has the condition?
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... onset[x] Σ0..1Estimated or actual date, date-time, or age
.... onsetDateTimedateTime
.... onsetAgeAge
.... onsetPeriodPeriod
.... onsetRangeRange
.... onsetStringstring
... abatement[x] I0..1When in resolution/remission
.... abatementDateTimedateTime
.... abatementAgeAge
.... abatementPeriodPeriod
.... abatementRangeRange
.... abatementStringstring
... recordedDate Σ0..1dateTimeDate record was first recorded
... recorder Σ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)Who recorded the condition
... asserter Σ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)Person who asserts this condition
... stage SI0..*BackboneElementStage/grade, usually assessed formally
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... summary I0..1CodeableConceptMost recent Stage Group
Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).

.... assessment SI0..*Reference(Cancer Stage Group Profile)Formal record of assessment
.... type 0..1CodeableConceptStaging system used.
Binding: Staging Type for Stage Group Value Set (required)
... evidence I0..*BackboneElementSupporting evidence
con-2: evidence SHALL have code or details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code ΣI0..*CodeableConceptManifestation/symptom
Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.


.... detail ΣI0..*Reference(Resource)Supporting information found elsewhere
... note 0..*AnnotationAdditional information about the Condition

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Condition.languagepreferredCommonLanguages
Max Binding: AllLanguages
Condition.clinicalStatusrequiredConditionClinicalStatusCodes
Condition.verificationStatusrequiredConditionVerificationStatus
Condition.categoryextensibleUSCoreConditionCategoryCodes
Condition.severitypreferredCondition/DiagnosisSeverity
Condition.codeextensiblePrimaryCancerDisorderVS
Condition.bodySiteextensibleCancerBodyLocationVS
Condition.stage.summaryexampleConditionStage
Condition.stage.typerequiredObservationCodesStageGroupVS
Condition.evidence.codeexampleManifestationAndSymptomCodes

Constraints

IdGradePathDetailsRequirements
con-2errorCondition.evidenceevidence SHALL have code or details
: code.exists() or detail.exists()