0.9.0 - Draft

This page is part of the CH CRL (R4) (v0.9.0: STU Draft) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

Change Log

All significant changes to this FHIR implementation guide will be documented on this page.

Note for implementers:
Necessary changes, e.g. due to specification changes or bugs, to existing FHIR artifacts from the previous version that affect existing implementations are highlighted in bold.



  • Download link for NPM package, see here.
  • Separate tabs for the use case and the cancer report (logical model) for simpler navigation in the IG.
  • Set the flag mustSupport=true for case-opening criteria, see here.
  • New use case step with example: Follow-up with a gastroenterologist.
  • Constraints in profiles to enhance validation (e.g. ch-crl-obs-1: Observation must have either value[x] or dataAbsentReason).
  • More NKRS variables with profiles, examples and terminology.
    1. Method of first detection (Variable number: 2.6) (Profile, ValueSet)
    2. Associated in situ tumour (Variable number: 3.6.2) (Profile)
    3. ICCC-3 main group (Variable number: 3.9.1) (Profile, ValueSet)
    4. ICCC-3 code (Variable number: 3.9.2) (Profile, ValueSet)
    5. ICCC-3 extended code (Variable number: 3.9.3) (Profile, ValueSet)
    6. Ann Arbor staging (Variable number: 4.18) (Profile, ValueSet)
    7. COG staging (Variable number: 4.19) (Profile, ValueSet)
    8. COG ALL staging (Variable number: 4.20) (Profile, ValueSet)
    9. FIGO staging (Variable number: 4.21) (Profile, ValueSet)
    10. INRGSS staging (Variable number: 4.22) (Profile, ValueSet)
    11. IRSS staging (Variable number: 4.23) (Profile, ValueSet)
    12. Lugano staging (Variable number: 4.24) (Profile, ValueSet)
    13. PRETEXT staging (Variable number: 4.25) (Profile, ValueSet)
    14. Rai staging (Variable number: 4.26) (Profile, ValueSet)
    15. Binet staging (Variable number: 4.27) (Profile, ValueSet)
    16. Rhabdomyosarcoma site staging (Variable number: 4.28) (Profile, ValueSet)
    17. ISS staging (Variable number: 4.29) (Profile, ValueSet)
    18. DSSplus (Variable number: 4.30) (Profile, ValueSet)
    19. SIOP staging (Variable number: 4.31) (Profile, ValueSet)
    20. St. Jude / Murphy staging (Variable number: 4.32) (Profile, ValueSet)
    21. Toronto Tier II (manual) staging (Variable number: 4.33.2) (Profile, ValueSet)
    22. Creasman grading system (Variable number: 4.34) (Profile, ValueSet)
    23. Elston/Ellis grading system (Variable number: 4.35) (Profile, ValueSet)
    24. SalzerKuntschik grading system (Variable number: 4.36) (Profile, ValueSet)
    25. Shimada grading system (Variable number: 4.37) (Profile, ValueSet)
    26. WHO(CNS) grading system (Variable number: 4.38) (Profile, ValueSet)
    27. Clinical tumour size (Variable number: 4.39) (Profile)
    28. Pathological tumour size (Variable number: 4.40) (Profile)
    29. Metastases at diagnosis indicator (Variable number: 4.41) (Profile)
    30. Topography of metastases at diagnosis (Variable number: 4.42) (Profile, ValueSet)
    31. Oestrogen receptor status (Variable number: 5.1.1) (Profile)
    32. Progesterone receptor status (Variable number: 5.1.2) (Profile)
    33. Her2 receptor status (Variable number: 5.1.3) (Profile, ValueSet)
    34. Tumour proliferation labeling (Variable number: 5.1.4) (Profile)
    35. Pretreatment Prostate Specific Antigen (PSA) (Variable number: 5.2.1) (Profile)
    36. Gleason biopsy most common grade (Variable number: 5.2.2) (Profile)
    37. Gleason biopsy second most common or highest grade (Variable number: 5.2.3) (Profile)
    38. Gleason excision most common grade (Variable number: 5.2.4) (Profile)
    39. Gleason excision second most common or highest grade (Variable number: 5.2.5) (Profile)
    40. Gleason score (Variable number: 5.2.6) (Profile)
    41. WHO grade group (Variable number: 5.2.7) (Profile)
    42. Breslow thickness (Variable number: 5.3.1) (Profile)
    43. Circumferential resection margins (Variable number: 5.4.1) (Profile)
    44. Microsatellite instability (Variable number: 5.4.2) (Profile)
    45. α-fetoprotein (Variable number: 5.5.1) (Profile, ValueSet)
    46. β-hCG (Variable number: 5.5.2) (Profile, ValueSet)
    47. LDH (Variable number: 5.5.3) (Profile, ValueSet)
    48. Serum tumour markers (Variable number: 5.5.4) (Profile, ValueSet)
    49. HPV/p16 (Variable number: 5.6.1) (Profile)
    50. EBV (Variable number: 5.6.2) (Profile)
    51. Residual invasive tumour (Variable number: 6.1) (Profile, ValueSet)
    52. Residual in-situ tumour (Variable number: 6.2) (Profile, ValueSet)
    53. Resection margin invasive tumour (Variable number: 6.3) (Profile)
    54. Resection margin in-situ tumour (Variable number: 6.4) (Profile)
    55. Sentinel lymph node assessment (Variable number: 6.5) (Profile, ValueSet)
    56. Number of examined sentinel lymph nodes (Variable number: 6.6) (Profile)
    57. Number of positive sentinel lymph nodes (Variable number: 6.7) (Profile)
    58. Basis of first treatment complex decision (Variable number: 7.1) (Profile, ValueSet)
    59. Date of first treatment complex decision (Variable number: 7.2.1) (Profile)
    60. First treatment complex goal(s) (Variable number: 7.3) (Profile, ValueSet)
    61. First treatment complex code(s) (Variable number: 7.4) (Profile)
    62. First treatment complex start date(s) (Variable number: 7.5.1) (Profile)
    63. First treatment complex institution(s) (Variable number: 7.6) (Profile)
    64. Type of recurrence(s)/transformation(s) (Variable number: 8.1) (Profile, ValueSet)
    65. Date of recurrence(s)/transformation(s) (Variable number: 8.2.1) (Profile)
    66. Morphology term before change of main diagnosis (Variable number: 8.4) (Profile)
    67. Morphology term after Transformation (Variable number: 8.5) (Profile)
    68. Topography(s) of post-diagnosis metastases (Variable number: 8.6) (Profile, ValueSet)
    69. Diabetes mellitus (Variable number: 10.1) (Profile, ValueSet)
    70. Liver Disease (Variable number: 10.2) (Profile, ValueSet)
    71. HIV/AIDS (Variable number: 10.3) (Profile)
    72. Moderate to Severe Chronic Kidney Disease (Variable number: 10.4) (Profile)
    73. Congestive Heart Failure (Variable number: 10.5) (Profile)
    74. Myocardial infarction (Variable number: 10.6) (Profile)
    75. Chronic Pulmonary Disease (Variable number: 10.7) (Profile)
    76. Peripheral Vascular Disease (Variable number: 10.8) (Profile)
    77. Cerebrovascular Accident or Transient Ischemic Attack (Variable number: 10.9) (Profile)
    78. Dementia (Variable number: 10.10) (Profile)
    79. Hemiplegia / Paraplegia (Variable number: 10.11) (Profile)
    80. Connective Tissue Disease - Rheumatic disease (Variable number: 10.12) (Profile)
    81. Peptic Ulcer Disease (Variable number: 10.13) (Profile)
    82. Charlson Index (Variable number: 10.14) (Profile)

Changed / Updated

  • Switch to the new IG template and adaptations to its new requiremenst. This adaptation only slightly changes the appearance of the IG.
  • Transformation of the raw source (IG input) into FHIR Shorthand files (.fsh). This change has no impact on the IG published as a web page, it just makes it easier to author the FHIR artifacts for the IG.
  • Updating the dependency on CH Core IG from current to the currently published version 2.0.0.
  • Structure of the cancer report document, based on the registration application. Implementers need to insert sections (with codings and titles) in the Composition to group the references.
  • There have been changes to the NKRS code lists V1.1. Implementers have to adapt the following codes systems, which were already integrated in the FHIR Implementation Guide:
    • NKRS - Diagnostic Methods Used
      • Additional code 23 “Biopsy locoregional or of metastasis”
      • The numerical code of the following elements increases accordingly by 1
    • NKRS - TNM Stage Group
      • Additional code IIID “Stage IIID”
      • Removed codes A “Stage A”, AP “Stage AP”, B “Stage B”, BP “Stage BP”, C “Stage C”, CP “Stage CP”
  • Enable local codes to be reported as an option (if not otherwise possible):
  • Add the Extension ‘data-absent-reason’ to the Procedure for the diagnostic method(s), to support the representation of the value ‘unknown’. Implementers should now be able to support ‘unknown’ for this Procedure.
  • Mapping CH CRL to mCODE adapted to both new versions.



Final version 0.2.1 of use case 1b.


Draft version 0.2.0 of use case 1b for public comment.


  • FHIR artifacts for use case 1b (report as structured data).


Final version 0.1.1 of use case 1a.


Draft version 0.1.0 of use case 1a for public comment.


  • FHIR artifacts for use case 1a (report as PDF).