Notice
- Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
- This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from the NHS England Genomics Unit.
StructureDefinition UKCore-Procedure
Used for detailing information on procedures the patient has had performed, to aid interpretation of Genomic test results.
Assertion of an absence of a procedure being performed SHOULD be recorded using an Observation resource, as described in Profile-UKCore-Observation
At a minimum, Procedure resources are expected to contain the status, code, subject and performedDateTime, though additional information conforming to the FHIR profile below MAY be included if relevant.
Genomic Study and Genomic Study Analysis profiles on Procedure may also be used as part of structured reporting. Mandated usage of these profiles is pending data standard discovery work to identify the items required within Genomic Test Reporting. As such, elements called out, and guidance suggested on this page, may be subject to change.
| Profile url | FHIR Module | Normative Status |
|---|---|---|
| https://fhir.hl7.org.uk/StructureDefinition/UKCore-Procedure | UKCore | trial-use |
| UKCoreProcedure (Procedure) | C | Procedure | There are no (further) constraints on this element Element idProcedureShort description An action that is being or was performed on a patient DefinitionAn action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idProcedure.idShort description Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idProcedure.metaShort description Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idProcedure.implicitRulesShort description A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idProcedure.languageShort description Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idProcedure.textShort description Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idProcedure.containedShort description Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idProcedure.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. 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 can 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idProcedure.modifierExtensionShort description Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idProcedure.identifierShort description External Identifiers for this procedure DefinitionBusiness identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server. Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | There are no (further) constraints on this element Element idProcedure.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure. canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element idProcedure.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| basedOn | Σ C | 0..* | Reference(CarePlan | ServiceRequest) | There are no (further) constraints on this element Element idProcedure.basedOnShort description A request for this procedure Alternate namesfulfills DefinitionA reference to a resource that contains details of the request for this procedure. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(CarePlan | ServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| partOf | Σ C | 0..* | Reference(MedicationAdministration | Observation | Procedure) | There are no (further) constraints on this element Element idProcedure.partOfShort description Part of referenced event Alternate namescontainer DefinitionA larger event of which this particular procedure is a component or step. The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration). Reference(MedicationAdministration | Observation | Procedure) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | S Σ ?! | 1..1 | codeBinding | Element idProcedure.statusShort description A code specifying the state of the procedure. DefinitionA code specifying the state of the procedure. Generally, this will be the in-progress or completed state. The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A code specifying the state of the procedure. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| statusReason | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idProcedure.statusReasonShort description Reason for current status Alternate namesSuspended Reason, Cancelled Reason DefinitionCaptures the reason for the current state of the procedure. This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here. A code that identifies the reason a procedure was not performed. ProcedureNotPerformedReason(SNOMED-CT) (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| category | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idProcedure.categoryShort description Classification of the procedure DefinitionA code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure"). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A code that classifies a procedure for searching, sorting and display purposes. ProcedureCategoryCodes(SNOMEDCT) (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| code | S Σ | 0..1 | CodeableConceptBinding | Element idProcedure.codeShort description A code identifying the procedure performed. Alternate namestype DefinitionThe specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy"). 0..1 to account for primarily narrative only resources. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A code from the SNOMED Clinical Terminology UK. UKCoreProcedureCode (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| subject | S Σ C | 1..1 | Reference(Group | Patient) | Element idProcedure.subjectShort description Who the procedure was performed on. Alternate namespatient DefinitionThe person, animal or group on which the procedure was performed. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| encounter | Σ C | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idProcedure.encounterShort description Encounter created as part of DefinitionThe Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performed[x] | S Σ | 0..1 | Element idProcedure.performed[x]Short description When the procedure was performed. DefinitionEstimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured. Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performedAge | Age | There are no (further) constraints on this element Data type | ||||
| performedDateTime | dateTime | There are no (further) constraints on this element Data type | ||||
| performedPeriod | Period | There are no (further) constraints on this element Data type | ||||
| performedRange | Range | There are no (further) constraints on this element Data type | ||||
| performedString | string | There are no (further) constraints on this element Data type | ||||
| recorder | Σ C | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idProcedure.recorderShort description Who recorded the procedure DefinitionIndividual who recorded the record and takes responsibility for its content. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| asserter | Σ C | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idProcedure.asserterShort description Person who asserts this procedure DefinitionIndividual who is making the procedure statement. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performer | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idProcedure.performerShort description The people who performed the procedure DefinitionLimited to "real" people rather than equipment. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idProcedure.performer.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idProcedure.performer.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idProcedure.performer.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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 cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| function | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idProcedure.performer.functionShort description Type of performance DefinitionDistinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist. Allows disambiguation of the types of involvement of different performers. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A code that identifies the role of a performer of the procedure. ProcedurePerformerRoleCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| actor | Σ C | 1..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idProcedure.performer.actorShort description The reference to the practitioner DefinitionThe practitioner who was involved in the procedure. A reference to Device supports use cases, such as pacemakers. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| onBehalfOf | C | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idProcedure.performer.onBehalfOfShort description Organization the device or practitioner was acting for DefinitionThe organization the device or practitioner was acting on behalf of. Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| location | Σ C | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idProcedure.locationShort description Where the procedure happened DefinitionThe location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant. Ties a procedure to where the records are likely kept. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonCode | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idProcedure.reasonCodeShort description Coded reason procedure performed DefinitionThe coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text. Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure. A code that identifies the reason a procedure is required. ProcedureReasonCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonReference | Σ C | 0..* | Reference(Condition | DiagnosticReport | DocumentReference | Observation | Procedure) | There are no (further) constraints on this element Element idProcedure.reasonReferenceShort description The justification that the procedure was performed DefinitionThe justification of why the procedure was performed. It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure. Reference(Condition | DiagnosticReport | DocumentReference | Observation | Procedure) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| bodySite | Σ | 0..* | CodeableConceptBinding | Element idProcedure.bodySiteShort description Target body sites DefinitionDetailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure. Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcome | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idProcedure.outcomeShort description The result of procedure DefinitionThe outcome of the procedure - did it resolve the reasons for the procedure being performed? If outcome contains narrative text only, it can be captured using the CodeableConcept.text. An outcome of a procedure - whether it was resolved or otherwise. ProcedureOutcomeCodes(SNOMEDCT) (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| report | C | 0..* | Reference(Composition | DiagnosticReport | DocumentReference) | There are no (further) constraints on this element Element idProcedure.reportShort description Any report resulting from the procedure DefinitionThis could be a histology result, pathology report, surgical report, etc. There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports. Reference(Composition | DiagnosticReport | DocumentReference) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| complication | 0..* | CodeableConceptBinding | Element idProcedure.complicationShort description Complication following the procedure DefinitionAny complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues. If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text. A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|). UKCoreConditionCode (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| complicationDetail | C | 0..* | Reference(Condition) | There are no (further) constraints on this element Element idProcedure.complicationDetailShort description A condition that is a result of the procedure DefinitionAny complications that occurred during the procedure, or in the immediate post-performance period. This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| followUp | 0..* | CodeableConcept | There are no (further) constraints on this element Element idProcedure.followUpShort description Instructions for follow up DefinitionIf the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Specific follow up required for a procedure e.g. removal of sutures. ProcedureFollowUpCodes(SNOMEDCT) (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idProcedure.noteShort description Additional information about the procedure DefinitionAny other notes and comments about the procedure. For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| focalDevice | 0..* | BackboneElement | There are no (further) constraints on this element Element idProcedure.focalDeviceShort description Manipulated, implanted, or removed device DefinitionA device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idProcedure.focalDevice.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idProcedure.focalDevice.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idProcedure.focalDevice.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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 cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| action | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idProcedure.focalDevice.actionShort description Kind of change to device DefinitionThe kind of change that happened to the device during the procedure. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A kind of change that happened to the device during the procedure. ProcedureDeviceActionCodes (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| manipulated | C | 1..1 | Reference(Device) | There are no (further) constraints on this element Element idProcedure.focalDevice.manipulatedShort description Device that was changed DefinitionThe device that was manipulated (changed) during the procedure. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| usedReference | C | 0..* | Reference(Device | Medication | Substance) | There are no (further) constraints on this element Element idProcedure.usedReferenceShort description Items used during procedure DefinitionIdentifies medications, devices and any other substance used as part of the procedure. Used for tracking contamination, etc. For devices actually implanted or removed, use Procedure.device. Reference(Device | Medication | Substance) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| usedCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idProcedure.usedCodeShort description Coded items used during the procedure DefinitionIdentifies coded items that were used as part of the procedure. For devices actually implanted or removed, use Procedure.device. Codes describing items used during a procedure. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
|
| FHIR | MDS | HL7v2 |
|---|---|---|
| Procedure | Patient - Had transplant, Patient - Had transfusion, Is patient on TKI therapy, Insulin treated within 6 months of diagnosis, Is on Ig replacement | Presence of OBR segment with OBR-44 code for transplant/transfusion etc. |
| Procedure.performedDateTime | Patient - Fetal gestation (to determine termination date), Patient - Transplant date, Patient - Transfusion date | OBR-7 |
| Procedure.code | Patient - Pregnancy type, Patient - Type of transplant, Patient - Type of transfusion, Neonatal hypoglycemia treatment details, Current exocrine pancreatic treatment | OBR segments with appropriate codes, OBR-44, OBR/RXA segments |
| Procedure.performedPeriod.start | Neonatal hypoglycemia treatment start date, Exocrine pancreatic treatment start date | OBR-7, RXA-3 |
| Procedure.performedPeriod.end | Neonatal hypoglycemia treatment end date | OBR-8 |
Additional Guidance
extension:genomic-study-analysis
From the Genomic Reporting IG Genomic Study profile. Reference to the Genomic Study Analysis resource, detailing the analyses performed as part of genomic test.
"extension" : [ { "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-ext", "valueReference" : { "reference" : "Procedure/PGXGenomicStudyAnalysis" } } ],
Genomic Study Analysis extensions
From the Genomic Reporting IG Genomic Study Analysis profile. Various extensions covering the metadata related to a genomic test, e.g. regions studied, change types tested for etc. For the full list of extensions, please see the linked profile page.
Specifically the extension:device element SHOULD be used to record the software/device that generated an observation, where applicable.
Use of the profile and its extensions is pending further discovery of the data standards required for Genomic Reporting in the UK.
"extension" : [ { "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-genome-build", "valueCodeableConcept" : { "coding" : [ { "system" : "http://loinc.org", "code" : "LA26806-2", "display" : "GRCh38" } ] } }, { "extension" : [ { "url" : "sequencing-coverage", "valueQuantity" : { "value" : 100 } } ], "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-metrics" }, { "extension" : [ { "url" : "description", "valueString" : "protein-coding and exon-splicing regions" }, { "url" : "studied", "valueCodeableConcept" : { "coding" : [ { "system" : "http://www.genenames.org", "code" : "HGNC:2621", "display" : "CYP2C19" } ] } }, { "url" : "studied", "valueCodeableConcept" : { "coding" : [ { "system" : "http://www.genenames.org", "code" : "HGNC:2623", "display" : "CYP2C9" } ] } }, { "url" : "studied", "valueCodeableConcept" : { "coding" : [ { "system" : "http://www.genenames.org", "code" : "HGNC:23663", "display" : "VKORC1" } ] } } ], "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-regions" } ],
status
Status SHALL use the codes recommended in the base Procedure resource, appropriately tagging procedures as having been completed or in-progress etc. depending on the actual status of the procedure.
"status": "completed",
code
SHALL be present. SNOMED CT coding is preferred, though alternative codings MAY be provided subject to review of the Coding system by the NHS England Genomics Unit.
For the Genomic Study profile, expected to be from the Genomic Study Type ValueSet
"code": { "coding": [ { "system": "http://snomed.info/sct", "code": "23719005", "display": "Transplantation of bone marrow" } ] },
subject
SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS.
"subject": { "reference": "Patient/Patient-MeirLieberman-Example", "identifier": { "system": "https://fhir.nhs.uk/Id/nhs-number", "value": "9449307873" } },
performed[x]
performed SHOULD be provided wherever possible, using the appropriate data type, to aid in interpretation of Genomic test results.
"performedDateTime": "2020-01-19"