{ "description": "Context for an evaluation result, used to indicate an evaluation has been made.\\n\\nFor example, measurement of blood pressure that has been made simply exists (although the value can be present or absent, accurate or inaccurate). The RecordedContext indicates the information presented stands on its own as presented. It can also apply to clinical notes.\\n\\nCIMI Alignment: The RecordedContext class did not exist in CIMI V0.0.4, but CIMI has recently added it.", "_filename": "StructureDefinition-cimi-RecordedContext-model.json", "package_name": "hl7.fhir.us.breastcancer", "date": "2018-04-01T00:00:00+11:00", "derivation": "specialization", "publisher": "The HL7 Cancer Interoperability Group sponsored by Clinical Interoperability Council Work Group (CIC)", "fhirVersion": "3.0.1", "name": "RecordedContextModel", "abstract": false, "type": "cimi-RecordedContext-model", "experimental": null, "resourceType": "StructureDefinition", "title": "BC RecordedContext Logical Model", "package_version": "0.1.0", "snapshot": { "element": [ { "path": "cimi-RecordedContext-model", "min": 0, "definition": "Context for an evaluation result, used to indicate an evaluation has been made.\n\nFor example, measurement of blood pressure that has been made simply exists (although the value can be present or absent, accurate or inaccurate). The RecordedContext indicates the information presented stands on its own as presented. It can also apply to clinical notes.\n\nCIMI Alignment: The RecordedContext class did not exist in CIMI V0.0.4, but CIMI has recently added it.", "isModifier": false, "mustSupport": false, "max": "*", "id": "cimi-RecordedContext-model", "base": { "max": "*", "min": 0, "path": "cimi-RecordedContext-model" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.contextCode", "min": 1, "definition": "A code representing the ontological status of the statement, e.g., whether it exists, does not exist, is planned, etc.\n\nAttribute 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.\n\nCIMI Alignment: ContextCode is the new CIMI name for the attribute formerly called 'type' in CIMI V0.0.4.", "isModifier": false, "short": "A code representing the ontological status of the statement, e.g., whether it exists, does not exist, is planned, etc.", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-ContextCode-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.contextCode", "base": { "max": "1", "min": 1, "path": "cimi-RecordedContext-model.contextCode" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.contextCode.value", "min": 1, "definition": "Record Entity", "isModifier": false, "short": "Record Entity", "type": [ { "code": "Coding" } ], "mustSupport": false, "alias": [ "codeableConcept" ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value", "base": { "max": "1", "min": 1, "path": "cimi-ContextCode-model.value" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.contextCode.value.id", "min": 0, "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "short": "xml:id (or equivalent in JSON)", "mapping": [ { "map": "n/a", "identity": "rim" } ], "type": [ { "code": "string" } ], "representation": [ "xmlAttr" ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.id", "base": { "max": "1", "min": 0, "path": "Element.id" } }, { "path": "cimi-RecordedContext-model.contextCode.value.extension", "min": 0, "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.", "short": "Additional Content defined by implementations", "mapping": [ { "map": "n/a", "identity": "rim" } ], "slicing": { "rules": "open", "description": "Extensions are always sliced by (at least) url", "discriminator": [ { "path": "url", "type": "value" } ] }, "type": [ { "code": "Extension" } ], "alias": [ "extensions", "user content" ], "max": "*", "id": "cimi-RecordedContext-model.contextCode.value.extension", "comment": "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.", "base": { "max": "*", "min": 0, "path": "Element.extension" } }, { "path": "cimi-RecordedContext-model.contextCode.value.system", "requirements": "Need to be unambiguous about the source of the definition of the symbol.", "min": 1, "definition": "The identification of the code system that defines the meaning of the symbol in the code.", "short": "Identity of the terminology system", "fixedUri": "http://snomed.info/sct", "mapping": [ { "map": "C*E.3", "identity": "v2" }, { "map": "./codeSystem", "identity": "rim" }, { "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem", "identity": "orim" } ], "type": [ { "code": "uri" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.system", "comment": "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.", "base": { "max": "1", "min": 0, "path": "Coding.system" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.version", "min": 0, "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.", "short": "Version of the system - if relevant", "mapping": [ { "map": "C*E.7", "identity": "v2" }, { "map": "./codeSystemVersion", "identity": "rim" }, { "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion", "identity": "orim" } ], "type": [ { "code": "string" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.version", "comment": "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.", "base": { "max": "1", "min": 0, "path": "Coding.version" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.code", "fixedCode": "424975005", "requirements": "Need to refer to a particular code in the system.", "min": 1, "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).", "short": "Symbol in syntax defined by the system", "mapping": [ { "map": "C*E.1", "identity": "v2" }, { "map": "./code", "identity": "rim" }, { "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code", "identity": "orim" } ], "type": [ { "code": "code" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.code", "base": { "max": "1", "min": 0, "path": "Coding.code" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.display", "requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.", "min": 0, "definition": "A representation of the meaning of the code in the system, following the rules of the system.", "short": "Representation defined by the system", "mapping": [ { "map": "C*E.2 - but note this is not well followed", "identity": "v2" }, { "map": "CV.displayName", "identity": "rim" }, { "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName", "identity": "orim" } ], "type": [ { "code": "string" } ], "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.display", "base": { "max": "1", "min": 0, "path": "Coding.display" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.userSelected", "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.", "min": 0, "definition": "Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).", "short": "If this coding was chosen directly by the user", "mapping": [ { "map": "Sometimes implied by being first", "identity": "v2" }, { "map": "CD.codingRationale", "identity": "rim" }, { "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]", "identity": "orim" } ], "type": [ { "code": "boolean" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.userSelected", "comment": "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.", "base": { "max": "1", "min": 0, "path": "Coding.userSelected" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.findingStatus", "min": 1, "definition": "Indicates whether the finding is preliminary, amended, final, etc..\n\nCIMI Alignment: This class corresponds to FindingContext.status, but has been aligned to FHIR. The value set binding is required by FHIR.", "isModifier": false, "short": "Indicates whether the finding is preliminary, amended, final, etc..", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-FindingStatus-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.findingStatus", "base": { "max": "1", "min": 1, "path": "cimi-RecordedContext-model.findingStatus" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.exceptionValue", "min": 0, "definition": "Reason that a value associated with a test or other finding is missing.\n\nCIMI Alignment: This attribute corresponds to EvaluationResultTopic.exceptionValue, but has been moved from topic to context because missing values are only relevant when they should be recorded, but are not. The value set binding extends the set of FHIR's required data absent values, with additional concepts from CIMI.", "isModifier": false, "short": "Reason that a value associated with a test or other finding is missing.", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-ExceptionValue-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.exceptionValue", "base": { "max": "1", "min": 0, "path": "cimi-RecordedContext-model.exceptionValue" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.relevantTime", "min": 0, "definition": "The time or time period that the finding addresses.\n\nThe clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).\n\nCIMI Alignment: This attribute has been added, since recorded values must have an associated time. The datatype has been chosen to align with FHIR.", "isModifier": false, "short": "The time or time period that the finding addresses.", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-RelevantTime-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.relevantTime", "base": { "max": "1", "min": 0, "path": "cimi-RecordedContext-model.relevantTime" }, "isSummary": false } ] }, "status": "draft", "id": "93ab7d0f-1629-4988-944c-124d2e3f8ae9", "kind": "logical", "url": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-RecordedContext-model", "identifier": [ { "value": "cimi.RecordedContext", "system": "http://hl7.org/fhir/us/breastcancer" } ], "version": "0.1.0", "differential": { "element": [ { "path": "cimi-RecordedContext-model", "min": 0, "definition": "Context for an evaluation result, used to indicate an evaluation has been made.\n\nFor example, measurement of blood pressure that has been made simply exists (although the value can be present or absent, accurate or inaccurate). The RecordedContext indicates the information presented stands on its own as presented. It can also apply to clinical notes.\n\nCIMI Alignment: The RecordedContext class did not exist in CIMI V0.0.4, but CIMI has recently added it.", "isModifier": false, "mustSupport": false, "max": "*", "id": "cimi-RecordedContext-model", "base": { "max": "*", "min": 0, "path": "cimi-RecordedContext-model" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.contextCode", "min": 1, "definition": "A code representing the ontological status of the statement, e.g., whether it exists, does not exist, is planned, etc.\n\nAttribute 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.\n\nCIMI Alignment: ContextCode is the new CIMI name for the attribute formerly called 'type' in CIMI V0.0.4.", "isModifier": false, "short": "A code representing the ontological status of the statement, e.g., whether it exists, does not exist, is planned, etc.", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-ContextCode-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.contextCode", "base": { "max": "1", "min": 1, "path": "cimi-RecordedContext-model.contextCode" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.contextCode.value", "min": 1, "definition": "Record Entity", "isModifier": false, "short": "Record Entity", "type": [ { "code": "Coding" } ], "mustSupport": false, "alias": [ "codeableConcept" ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value", "base": { "max": "1", "min": 1, "path": "cimi-ContextCode-model.value" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.contextCode.value.id", "min": 0, "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "short": "xml:id (or equivalent in JSON)", "mapping": [ { "map": "n/a", "identity": "rim" } ], "type": [ { "code": "string" } ], "representation": [ "xmlAttr" ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.id", "base": { "max": "1", "min": 0, "path": "Element.id" } }, { "path": "cimi-RecordedContext-model.contextCode.value.extension", "min": 0, "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.", "short": "Additional Content defined by implementations", "mapping": [ { "map": "n/a", "identity": "rim" } ], "slicing": { "rules": "open", "description": "Extensions are always sliced by (at least) url", "discriminator": [ { "path": "url", "type": "value" } ] }, "type": [ { "code": "Extension" } ], "alias": [ "extensions", "user content" ], "max": "*", "id": "cimi-RecordedContext-model.contextCode.value.extension", "comment": "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.", "base": { "max": "*", "min": 0, "path": "Element.extension" } }, { "path": "cimi-RecordedContext-model.contextCode.value.system", "requirements": "Need to be unambiguous about the source of the definition of the symbol.", "min": 1, "definition": "The identification of the code system that defines the meaning of the symbol in the code.", "short": "Identity of the terminology system", "fixedUri": "http://snomed.info/sct", "mapping": [ { "map": "C*E.3", "identity": "v2" }, { "map": "./codeSystem", "identity": "rim" }, { "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem", "identity": "orim" } ], "type": [ { "code": "uri" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.system", "comment": "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.", "base": { "max": "1", "min": 0, "path": "Coding.system" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.version", "min": 0, "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.", "short": "Version of the system - if relevant", "mapping": [ { "map": "C*E.7", "identity": "v2" }, { "map": "./codeSystemVersion", "identity": "rim" }, { "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion", "identity": "orim" } ], "type": [ { "code": "string" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.version", "comment": "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.", "base": { "max": "1", "min": 0, "path": "Coding.version" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.code", "fixedCode": "424975005", "requirements": "Need to refer to a particular code in the system.", "min": 1, "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).", "short": "Symbol in syntax defined by the system", "mapping": [ { "map": "C*E.1", "identity": "v2" }, { "map": "./code", "identity": "rim" }, { "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code", "identity": "orim" } ], "type": [ { "code": "code" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.code", "base": { "max": "1", "min": 0, "path": "Coding.code" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.display", "requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.", "min": 0, "definition": "A representation of the meaning of the code in the system, following the rules of the system.", "short": "Representation defined by the system", "mapping": [ { "map": "C*E.2 - but note this is not well followed", "identity": "v2" }, { "map": "CV.displayName", "identity": "rim" }, { "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName", "identity": "orim" } ], "type": [ { "code": "string" } ], "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.display", "base": { "max": "1", "min": 0, "path": "Coding.display" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.contextCode.value.userSelected", "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.", "min": 0, "definition": "Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).", "short": "If this coding was chosen directly by the user", "mapping": [ { "map": "Sometimes implied by being first", "identity": "v2" }, { "map": "CD.codingRationale", "identity": "rim" }, { "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]", "identity": "orim" } ], "type": [ { "code": "boolean" } ], "max": "1", "id": "cimi-RecordedContext-model.contextCode.value.userSelected", "comment": "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.", "base": { "max": "1", "min": 0, "path": "Coding.userSelected" }, "isSummary": true }, { "path": "cimi-RecordedContext-model.findingStatus", "min": 1, "definition": "Indicates whether the finding is preliminary, amended, final, etc..\n\nCIMI Alignment: This class corresponds to FindingContext.status, but has been aligned to FHIR. The value set binding is required by FHIR.", "isModifier": false, "short": "Indicates whether the finding is preliminary, amended, final, etc..", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-FindingStatus-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.findingStatus", "base": { "max": "1", "min": 1, "path": "cimi-RecordedContext-model.findingStatus" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.exceptionValue", "min": 0, "definition": "Reason that a value associated with a test or other finding is missing.\n\nCIMI Alignment: This attribute corresponds to EvaluationResultTopic.exceptionValue, but has been moved from topic to context because missing values are only relevant when they should be recorded, but are not. The value set binding extends the set of FHIR's required data absent values, with additional concepts from CIMI.", "isModifier": false, "short": "Reason that a value associated with a test or other finding is missing.", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-ExceptionValue-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.exceptionValue", "base": { "max": "1", "min": 0, "path": "cimi-RecordedContext-model.exceptionValue" }, "isSummary": false }, { "path": "cimi-RecordedContext-model.relevantTime", "min": 0, "definition": "The time or time period that the finding addresses.\n\nThe clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).\n\nCIMI Alignment: This attribute has been added, since recorded values must have an associated time. The datatype has been chosen to align with FHIR.", "isModifier": false, "short": "The time or time period that the finding addresses.", "type": [ { "code": "http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-RelevantTime-model" } ], "mustSupport": false, "max": "1", "id": "cimi-RecordedContext-model.relevantTime", "base": { "max": "1", "min": 0, "path": "cimi-RecordedContext-model.relevantTime" }, "isSummary": false } ] }, "contact": [ { "telecom": [ { "value": "http://standardhealthrecord.org", "system": "url" } ] } ], "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Element" }