Diagnosis of cancer originating in the tissues of the breast, and potentially spread to other organs of the body.

The BreastCancerPresenceStatement is a subclass of ConditionPresenceStatement, which is a departure from CIMI. In CIMI, this would be a archetype of ClinicalStatement combining a BreastCancerConditionTopic with the ConditionPresenceContext. This would require definition of BreastCancerConditionTopic in the reference model, follwed by introduction of constraints on Value, Category, Stage, and MorphologyBehavior in the corresponding archetype.

CIMI Alignment (and question for reviewers): The Topic of this statement is 'Neoplasm of the breast', not 'Assertion', with the logic that the topic of the statement is more specific than 'Assertion'. The result (the value) gives the particular type (histologic type) of the condition. Does this make sense?

Representation of a condition, independent of context of being present, absent, risk, expectation etc. 'Condition' is interpreted broadly to include disorder, abnormality, problem, injury, complaint, functionality, concern, illness, disease, ailment, sickness, affliction, upset, difficulty, disorder, symptom, etc.

The value set binding of Value is required to map to US-Core. The value set binding of Category is preferred in US-Core.

CIMI Alignment: In CIMI V0.0.4, this class was called ConditionAssertion, but CIMI has recently changed it to ConditionTopic. ConditionAssertion had properties associated with the presence of the condition, including severity, dueTo, diseasePhase, and more. In the current logical model, properties associated with condition occurrence have been moved to ConditionPresenceContext.

Code representing representation of a condition, independent of context of being present, absent, risk, expectation etc. 'Condition' is interpreted broadly to include disorder, abnormality, problem, injury, complaint, functionality, concern, illness, disease, ailment, sickness, affliction, upset, difficulty, disorder, symptom, etc.

The value set binding of Value is required to map to US-Core. The value set binding of Category is preferred in US-Core.

CIMI Alignment: In CIMI V0.0.4, this class was called ConditionAssertion, but CIMI has recently changed it to ConditionTopic. ConditionAssertion had properties associated with the presence of the condition, including severity, dueTo, diseasePhase, and more. In the current logical model, properties associated with condition occurrence have been moved to ConditionPresenceContext.

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.

CIMI Alignment: TopicCode is the new CIMI name for the attribute formerly called 'key' in CIMI V0.0.4.

Neoplasm of breast (disorder)

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

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.

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.

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

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

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.

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.

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.

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).

Need to refer to a particular code in the system.

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

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

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

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.

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.

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

CIMI Alignment: In CIMI V0.0.4, this attribute was called 'method'. The value set binding reflects CIMI's preference for LOINC codes.

Code representing the technique used to create the finding; for example, the specific imaging technique, lab test code, or assessment vehicle.

CIMI Alignment: In CIMI V0.0.4, this attribute was called 'method'. The value set binding reflects CIMI's preference for LOINC codes.

A clinical interpretation of a finding.

CIMI Alignment: The value set binding has been chosen to align with FHIR. (Note: it is not clear if Interpretation belongs in FindingTopic, rather than a context class, but that is how CIMI has modeled it.)

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

Code representing a class or division of people or things having particular shared characteristics

A body site specific to the breast structure.

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

CIMI Alignment: In CIMI V0.0.4, this class was called AssertionKnownOrSuspectedPresent. The corresponding CIMI class is ungoing a name change to include the word 'StatementContext' and remove the word 'Assertion'. The presence of terminology bindings (necessary to align with FHIR clinicalStatus, severity, and criticality) means that this class cannot be defined entirely within the CIMI reference model. The constraints could only exist in an archetype derived from the reference model class. The logical model here represents both the class structure and the terminology bindings.

An abstract class that represents an encounter class. This class has been stubbed out to limit the scope of this implementation guide to classes relevant to this ballot concerning breast cancer.

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.

This attribute does not have a direct analogy in CIMI V0.0.4 (the closest being ConditionAssertion.diseasePhase), but is included here for consistency with FHIR and because staging is important in the context of breast cancer and cancer in general.

Code representing 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.

This attribute does not have a direct analogy in CIMI V0.0.4 (the closest being ConditionAssertion.diseasePhase), but is included here for consistency with FHIR and because staging is important in the context of breast cancer and cancer in general.

The full staging information

The stage of a breast cancer. Different staging systems use different staging groups, so there are currently no terminology bindings associated with this class.

A description of the morphology and behavioral characteristics of the cancer.

Code representing a description of the morphology and behavioral characteristics of the cancer.