[Condition] Morphology of wounds / (open) fractures / ... VS morphology of tumors

[annabel-uzl]

Morphology is defined as an element of bodyStructure (see https://build.fhir.org/bodystructure.html) but, I assume, we don't want to put diagnosis in the bodyStructure element. Therefore we came across some questions:

Case burn injury: seems valid to describe the wound in the bodyStructure and thus add morphology Case tumor: ??? depends on the case - procedure / observation / ... also related to Question about logical model for oncologie: https://github.com/hl7-be/core-clinical/issues/38 Case open or closed fracture: maybe using an extension? Or putting it in the bodyStructure?

The US made an extension: https://build.fhir.org/ig/HL7/fhir-mCODE-ig/StructureDefinition-mcode-histology-morphology-behavior.html that, I think, is only used in their oncology model.

My suggestion would be the following:

• If not related to cancer/tumor: use the morphology field in body structure
• If related to cancer/tumor: do whatever the outcome is of issue https://github.com/hl7-be/core-clinical/issues/38

Something like that? Are there other/better suggestions?

FYI related topics:

• https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Morphologic.20abnormalities.20in.20FHIR
• https://chat.fhir.org/#narrow/stream/179166-implementers/topic/.E2.9C.94.20Tumor.20characteristics.20representation
• https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Representing.20a.20Tumor

[annabel-uzl]

EDIT: bodyStructure is not an element in R4, but bodySite is, so we could argue using a bodyStructure extension to put morphology in it

EDIT2: in context of the datacapabilities project (KWS data to FHIR) this is an urgent question

[annabel-uzl]

I'll bring this topic back to life cuz we need an answer and there is a WG tomorrow ;)

1. I'll suggest making a OncologyProfile to handle cancer diagnoses and tumors. Doing that we can following mCode of the US and make a morphology extension on a higher level (not as part of the bodystructure). I want to propose a LM but I need a place to do this.

2. We need to decide on where to put morphology of wounds, open fractures, ... I would think a wound is not always a condition (e.g. cracked nail). Some options:

   • Extension morphology on Observation and Condition --> or only on Observation and link Observation in Condition BUT we'll also need it in the OncologyProfile which is a profile on resourceType Condition
   • Extension bodyStructure instead of BodySite (although I don't see the bodyStructure as an extension, I do think it exists or should exist :p )
   • ...

[annabel-uzl]

https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Morphology.20of.20wounds.20.2F.20fractures.20.2F.20.2E.2E.2E

[KarlienHL7Belgium]

this will be discussed in the business work group and referred back to WG through @bdc-ehealth