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  1. FHIR Specification Feedback
  2. FHIR-37575

Consider requiring references to a cancer condition in stage/medication/procedure profiles

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Minimal Common Oncology Data Elements (mCODE) (FHIR)
    • 2.0.0 [deprecated]
    • Clinical Interoperability Council
    • Cancer Stage Group Profile [deprecated]
      Cancer-Related Medication Administration Profile
      Cancer-Related Medication Request Profile
      Cancer-Related Surgical Procedure Profile
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      The request is to require links from the following profiles to the cancer condition.  

      1. PrimaryCancerCondition.stage.assessment – this cannot be required because staging may not be present for all cancer conditions
      2. CancerStageGroup.focus – agree to change this to 1..1 since all staging data relates to a cancer condition
      3.  CancerRelatedMedicationAdministration.reasonReference, CancerRelatedMedicationRequest.reasonReference, and CancerRelatedSurgicalProcedure.reasonReference – There is already an invariant that requires either a reasonCode or reasonReference. One or the other is required to be present. No change is required here. 

      Summary: Agree to change CancerStageGroup.focus to 1..1

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      The request is to require links from the following profiles to the cancer condition.   PrimaryCancerCondition.stage.assessment – this cannot be required because staging may not be present for all cancer conditions CancerStageGroup.focus – agree to change this to 1..1 since all staging data relates to a cancer condition  CancerRelatedMedicationAdministration.reasonReference, CancerRelatedMedicationRequest.reasonReference, and CancerRelatedSurgicalProcedure.reasonReference – There is already an invariant that requires either a reasonCode or reasonReference. One or the other is required to be present. No change is required here.  Summary: Agree to change CancerStageGroup.focus to 1..1
    • Jim McClay/Saul Kravitz :8-0-0
    • Correction
    • Non-compatible
    • Yes

    Description

      Use case:

      • If a patient has e.g., multiple separate melanomas, this would be represented with multiple Conditions conforming to PrimaryCancerCondition to represent these lesions
      • The resource instances representing stage, medication, and surgical procedure should all be linked back to the correct Condition resource. There could be multiple PrimaryCancerConditions in a given patient bundle, so not having this linkage could lead to garbage data.

      This linkage is done via various References

      • Stage *
        • PrimaryCancerCondition.stage.assessment
        • CancerStageGroup.focus
      • Medication
        • CancerRelatedMedicationAdministration.reasonReference
        • CancerRelatedMedicationRequest.reasonReference
      • Procedure
        • CancerRelatedSurgicalProcedure.reasonReference

      These elements are currently MS in mCODE but are not required. This issue proposes making these elements min cardinality 1. Note that it's not clear if the benefits of this additional constraint would outweigh the downsides.

      • Note there is a bi-directional reference for Stage. For this use case, only CancerStageGroup.focus would be 1.. as it’s realistic to have a PrimaryCancerCondition without staging, but not vice versa.

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            Unassigned Unassigned
            masnick Max Masnick
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              Created:
              Updated:
              Resolved: