Status: Active: Approved (STU)

Introduction

This profile sets minimum expectations for the Procedure resource.

As described further in the FHIR documentation, a Procedure should be used to describe something that is actually done to a Patient. There are other FHIR Resources which are more appropriate for observations, assessments, opinions etc.

It is also noted that a pragmatic approach is needed to specifying mandatory fields for this resource. The reality is that it may often be populated from a “clinical coding” system - that does not necessarily have access to the full contextual richness that might ideally be hoped for.

Mandatory fields

The following mandatory fields are defined in order to properly describe a Procedure:

1. Status - This is most likely to be “completed” to provide a historical list of procedures performed. However other codes about future or aborted procedures MAY be used where relevant – as long as they are kept up-to-date.
   • “unknown” should be avoided if at all possible

2. Subject - every Procedure must be linked to a Patient (not a Group)

3. Code - Essential to describe what the procedure actually is. Based on SNOMED codes eg “Excision of lesion of artery”. We pre-adopt the list from UkCore which aligns with PRSB standards and extends FHIR with extra codes for social care

Must Support fields

In addition the following fields are “Must Support” - ie they must be populated if relevant and known:

1. Identifier - a Local Id should be provided, such that could be quoted if manually getting in touch to find out more

2. Category - A simple and short list of SNOMED codes to describe the overall category of procedure eg “Surgical Procedure”, “Diagnostic Procedure”. We pre-adopt the R4 list which adds one extra code for “Social Service Procedure”.

3. Context - A reference to the Encounter where the procedure was performed. This is likely to be very useful and should be provided if at all possible. (Noting however the introductory comments that this may be impossible if the linkage is lost within a clinical coding system). Should link to the lowest level possible in any hierarchy, thus providing maximum detail about where the condition was noted

   Note: Do not link to an Episode of Care, as this is deprecated in FHIR R4

4. Performed - when the Procedure was performed. We have removed the DateTime data type from this field as Period.start would provide identical data, and it reduced the complexity of processing multiple data types for the data consumer.

5. Body Site - Useful to populate if known.

6. Outcome - A short and simple list of “successful”, “unsuccessful”, “partially successful”. Must be populated when relevant and known. (Accepting that for some types of procedure then this may be impossible if there is no simple definition of “success”)

7. Focal Device - This is useful to provide if relevant (ie if a device has been implanted, changed or removed). May inform community teams with follow up care.

8. notDoneReason - relevent with status codes such as “suspended” or “aborted” to provide reason for suspension / aborting the procedure. In R4, this field has been renamed to StatusReason.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. For a Procedure there are many of these optional fields. This reflects the view expressed in the introduction that there is considerable richness which could be added, but which it is not necessarily realistic to insist on. Points of note include:

• Performer - Useful to provide if known, although it may be more relevant in some scenarios than others. For example some procedures are quite transactional and the person in overall charge of the care may be more useful as a contact.
  • Note: The “OnBehalfOf” reference is not essential and is removed – as this will also be covered by the Provenance tags

• Location - Generally speaking the exact location where the procedure was performed seems unlikely to be vital for a regional care record. The organisation involved (from the Provenance tags) is often likely to be sufficient, and further details can also be provided by the Context linking to an Encounter.

• Reason Code and Reason Reference - Could be useful to provide a code and/or a link to a Condition or Observation to explain the reason for the Procedure

• Report - Could be useful if relevant to provide additional background information

• Complication and Complication Detail - can be populated with a code and/or Condition reference for any complications if relevant and known

• Used Code and Used Reference - Relevant to stock control within an organisation, but less so for a regional record

• Note - Only to be used with caution. Any notes may be shared widely across the region, including being viewed by the patient themselves

• Follow Up - This is very useful to populate in a regional care record as, for example, it allows community teams to see that follow up care is needed. FHIR provides an “example” list which does not cover a great range of scenarios, and we are not aware of any better alternative list. Therefore categorised only as a “preferred” list for now - please get in touch if you intend to use and have further insights.

Discouraged or Removed fields

• Anaesthetic Issues (Care Connect Extension) - May be risky if not consistently used. Consider using AllergyIntolerance or AdverseEvent instead.

• Definition – Removed.

• Based On – Removed.

• Part Of – Removed.

• Not Done - Somewhat overlaps with status codes such as “suspended” or “aborted”, but provides the possibility of adding additional coding to explain why. (Note: FHIR R4 concurs, and remodels this into a single field called “Status Reason”). Inline with R4, we have added StatusReason field.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from CareConnect-Procedure-1

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	CareConnect-Procedure-1	An action that is being or was performed on a patient
id	S	0..1	id	Logical id of this artifact
meta
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
extension:anaestheticIssues		0..1	Extension-CareConnect-AnaestheticIssues-1	DISCOURAGED: May be risky if not consistently used. Consider using AllergyIntolerance or AdverseEvent instead.
Slices for identifier		0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:localIdentifier	S	0..1	Identifier	External Identifiers for this procedure
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
value	S	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
definition		0..0
basedOn		0..0
partOf		0..0
status	S	1..1	code	preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
notDone		0..0
notDoneReason	S	0..1	CodeableConcept	Reason procedure was not performed Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
category	S	0..1	CodeableConcept	Classification of the procedure Binding: Interweave R4 Procedure Category Code (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
code	S	1..1	CodeableConcept	Identification of the procedure Binding: Interweave UkCore Procedure Code (required)
coding		1..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:snomedCT	S	1..1	Coding	Code defined by a terminology system Binding: Interweave UkCore Procedure Code (required)
subject	S	1..1	Reference(CareConnectPatient1)	Who the procedure was performed on. (A patient, NOT group)
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or episode associated with the procedure
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
performed[x]	S	1..1	Period	Date/Period the procedure was performed Slice: Unordered, Open by type:$this
performedPeriod		1..1	Period	Date/Period the procedure was performed
start	S	1..1	dateTime	Starting time with inclusive boundary
performer
role		0..1	CodeableConcept	The role the actor was in Binding: Procedure Performer Role Codes (preferred)
reasonCode		0..*	CodeableConcept	Coded reason procedure performed Binding: Procedure Reason Codes (preferred)
bodySite	S	0..1	CodeableConcept	Target body sites Binding: SNOMED CT Body Structures (required)
outcome	S	0..1	CodeableConcept	The result of procedure Binding: Procedure Outcome Codes (SNOMED CT) (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/Diagnosis Codes (preferred)
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
followUp		0..*	CodeableConcept	Instructions for follow up Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
focalDevice	S	0..*	BackboneElement	Device changed in procedure
action		0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (preferred)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
manipulated	S	1..1	Reference(Device)	Device that was changed
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIR Device Types (preferred)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Procedure.notDoneReason	preferred	Procedure Not Performed Reason (SNOMED-CT)
Procedure.category	required	Interweave R4 Procedure Category Code
Procedure.code	required	Interweave UkCore Procedure Code
Procedure.code.coding:snomedCT	required	Interweave UkCore Procedure Code
Procedure.performer.role	preferred	Procedure Performer Role Codes
Procedure.reasonCode	preferred	Procedure Reason Codes
Procedure.bodySite	required	SNOMED CT Body Structures
Procedure.outcome	required	Procedure Outcome Codes (SNOMED CT)
Procedure.complication	preferred	Condition/Problem/Diagnosis Codes
Procedure.followUp	preferred	Procedure Follow up Codes (SNOMED CT)
Procedure.focalDevice.action	preferred	Procedure Device Action Codes
Procedure.usedCode	preferred	FHIR Device Types

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	CareConnect-Procedure-1	An action that is being or was performed on a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
anaestheticIssues		0..1	CodeableConcept, Reference(CareConnect-Condition-1)	DISCOURAGED: May be risky if not consistently used. Consider using AllergyIntolerance or AdverseEvent instead. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-AnaestheticIssues-1 Binding: Care Connect Condition Code (required): A code from the SNOMED Clinical Terminology UK
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
identifier:localIdentifier	SΣ	0..1	Identifier	External Identifiers for this procedure
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
value	SΣ	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure.
notDoneReason	SΣC	0..1	CodeableConcept	Reason procedure was not performed Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
category	SΣ	0..1	CodeableConcept	Classification of the procedure Binding: Interweave R4 Procedure Category Code (required)
code	SΣ	1..1	CodeableConcept	Identification of the procedure Binding: Interweave UkCore Procedure Code (required)
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	SΣ	1..1	Coding	Code defined by a terminology system Binding: Interweave UkCore Procedure Code (required)
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who the procedure was performed on. (A patient, NOT group)
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	SΣ	0..1	Reference(CareConnect-Encounter-1)	Encounter or episode associated with the procedure
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
Slices for performed[x]	SΣ	1..1	Period	Date/Period the procedure was performed Slice: Unordered, Closed by type:$this
performed[x]:performedPeriod	Σ	1..1	Period	Date/Period the procedure was performed
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: Procedure Reason Codes (preferred)
bodySite	SΣ	0..1	CodeableConcept	Target body sites Binding: SNOMED CT Body Structures (required)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Body Site (extensible): A code from the SNOMED Clinical Terminology UK.
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: Procedure Outcome Codes (SNOMED CT) (required)
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/Diagnosis Codes (preferred)
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Condition Code (required): A code from the SNOMED Clinical Terminology UK.
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
followUp		0..*	CodeableConcept	Instructions for follow up Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
text		1..1	string	The annotation - text content
focalDevice	S	0..*	BackboneElement	Device changed in procedure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
action		0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (preferred)
manipulated	S	1..1	Reference(Device)	Device that was changed
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIR Device Types (preferred)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Procedure.meta.security	extensible	All Security Labels
Procedure.meta.tag	example	Common Tags
Procedure.meta.tag:Source	example	Common Tags
Procedure.meta.tag:Provenance	example	Common Tags
Procedure.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Procedure.identifier.use	required	IdentifierUse
Procedure.identifier:localIdentifier.use	required	IdentifierUse
Procedure.status	required	EventStatus
Procedure.notDoneReason	preferred	Procedure Not Performed Reason (SNOMED-CT)
Procedure.category	required	Interweave R4 Procedure Category Code
Procedure.code	required	Interweave UkCore Procedure Code
Procedure.code.coding:snomedCT	required	Interweave UkCore Procedure Code
Procedure.reasonCode	preferred	Procedure Reason Codes
Procedure.bodySite	required	SNOMED CT Body Structures
Procedure.bodySite.coding:snomedCT	extensible	Care Connect Body Site
Procedure.outcome	required	Procedure Outcome Codes (SNOMED CT)
Procedure.complication	preferred	Condition/Problem/Diagnosis Codes
Procedure.complication.coding:snomedCT	required	Care Connect Condition Code
Procedure.followUp	preferred	Procedure Follow up Codes (SNOMED CT)
Procedure.focalDevice.action	preferred	Procedure Device Action Codes
Procedure.usedCode	preferred	FHIR Device Types

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
ele-1	error	Procedure.extension:anaestheticIssues, Procedure.focalDevice	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	Procedure.extension:anaestheticIssues	Must have either extensions or value[x], not both : extension.exists() != value.exists()
pro-1	error	Procedure	Reason not done is only permitted if notDone indicator is true : notDoneReason.empty() or notDone = true

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	CareConnect-Procedure-1	An action that is being or was performed on a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
anaestheticIssues		0..1	CodeableConcept, Reference(CareConnect-Condition-1)	DISCOURAGED: May be risky if not consistently used. Consider using AllergyIntolerance or AdverseEvent instead. URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-AnaestheticIssues-1 Binding: Care Connect Condition Code (required): A code from the SNOMED Clinical Terminology UK
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	External Identifiers for this procedure
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
value	SΣ	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure.
notDoneReason	SΣC	0..1	CodeableConcept	Reason procedure was not performed Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
category	SΣ	0..1	CodeableConcept	Classification of the procedure Binding: Interweave R4 Procedure Category Code (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣ	1..1	CodeableConcept	Identification of the procedure Binding: Interweave UkCore Procedure Code (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	SΣ	1..1	Coding	Code defined by a terminology system Binding: Interweave UkCore Procedure Code (required)
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(CareConnectPatient1)	Who the procedure was performed on. (A patient, NOT group)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context	SΣ	0..1	Reference(CareConnect-Encounter-1)	Encounter or episode associated with the procedure
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
Slices for performed[x]	SΣ	1..1	Period	Date/Period the procedure was performed Slice: Unordered, Closed by type:$this
performed[x]:performedPeriod	Σ	1..1	Period	Date/Period the procedure was performed
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performer	Σ	0..*	BackboneElement	The people who performed the procedure
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
role	Σ	0..1	CodeableConcept	The role the actor was in Binding: Procedure Performer Role Codes (preferred)
actor	Σ	1..1	Reference(RelatedPerson | Device | CareConnect-Organization-1 | CareConnectPatient1 | CareConnect-Practitioner-1)	The reference to the practitioner
onBehalfOf		0..1	Reference(CareConnect-Organization-1)	Organization the device or practitioner was acting for
location	Σ	0..1	Reference(CareConnect-Location-1)	Where the procedure happened
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: Procedure Reason Codes (preferred)
reasonReference	Σ	0..*	Reference(CareConnect-Observation-1 | CareConnect-Condition-1)	Condition that is the reason the procedure performed
bodySite	SΣ	0..1	CodeableConcept	Target body sites Binding: SNOMED CT Body Structures (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Body Site (extensible): A code from the SNOMED Clinical Terminology UK.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: Procedure Outcome Codes (SNOMED CT) (required)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
report		0..*	Reference(DiagnosticReport)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/Diagnosis Codes (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Condition Code (required): A code from the SNOMED Clinical Terminology UK.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
complicationDetail		0..*	Reference(CareConnect-Condition-1)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(RelatedPerson | CareConnectPatient1 | CareConnect-Practitioner-1)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text		1..1	string	The annotation - text content
focalDevice	S	0..*	BackboneElement	Device changed in procedure
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
action		0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
manipulated	S	1..1	Reference(Device)	Device that was changed
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
usedReference		0..*	Reference(Device | Substance | CareConnect-Medication-1)	Items used during procedure
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIR Device Types (preferred)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Procedure.meta.security	extensible	All Security Labels
Procedure.meta.tag	example	Common Tags
Procedure.meta.tag:Source	example	Common Tags
Procedure.meta.tag:Provenance	example	Common Tags
Procedure.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Procedure.identifier.use	required	IdentifierUse
Procedure.identifier.type	extensible	Identifier Type Codes
Procedure.identifier:localIdentifier.use	required	IdentifierUse
Procedure.identifier:localIdentifier.type	extensible	Identifier Type Codes
Procedure.status	required	EventStatus
Procedure.notDoneReason	preferred	Procedure Not Performed Reason (SNOMED-CT)
Procedure.category	required	Interweave R4 Procedure Category Code
Procedure.code	required	Interweave UkCore Procedure Code
Procedure.code.coding:snomedCT	required	Interweave UkCore Procedure Code
Procedure.performer.role	preferred	Procedure Performer Role Codes
Procedure.reasonCode	preferred	Procedure Reason Codes
Procedure.bodySite	required	SNOMED CT Body Structures
Procedure.bodySite.coding:snomedCT	extensible	Care Connect Body Site
Procedure.outcome	required	Procedure Outcome Codes (SNOMED CT)
Procedure.complication	preferred	Condition/Problem/Diagnosis Codes
Procedure.complication.coding:snomedCT	required	Care Connect Condition Code
Procedure.followUp	preferred	Procedure Follow up Codes (SNOMED CT)
Procedure.focalDevice.action	preferred	Procedure Device Action Codes
Procedure.usedCode	preferred	FHIR Device Types

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	Procedure.extension:anaestheticIssues, Procedure.performer, Procedure.focalDevice	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	Procedure.extension:anaestheticIssues	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from CareConnect-Procedure-1

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	CareConnect-Procedure-1	An action that is being or was performed on a patient
id	S	0..1	id	Logical id of this artifact
meta
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
system		1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
extension:anaestheticIssues		0..1	Extension-CareConnect-AnaestheticIssues-1	DISCOURAGED: May be risky if not consistently used. Consider using AllergyIntolerance or AdverseEvent instead.
Slices for identifier		0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:localIdentifier	S	0..1	Identifier	External Identifiers for this procedure
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
value	S	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
definition		0..0
basedOn		0..0
partOf		0..0
status	S	1..1	code	preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
notDone		0..0
notDoneReason	S	0..1	CodeableConcept	Reason procedure was not performed Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
category	S	0..1	CodeableConcept	Classification of the procedure Binding: Interweave R4 Procedure Category Code (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
code	S	1..1	CodeableConcept	Identification of the procedure Binding: Interweave UkCore Procedure Code (required)
coding		1..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:snomedCT	S	1..1	Coding	Code defined by a terminology system Binding: Interweave UkCore Procedure Code (required)
subject	S	1..1	Reference(CareConnectPatient1)	Who the procedure was performed on. (A patient, NOT group)
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
context	S	0..1	Reference(CareConnect-Encounter-1)	Encounter or episode associated with the procedure
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
performed[x]	S	1..1	Period	Date/Period the procedure was performed Slice: Unordered, Open by type:$this
performedPeriod		1..1	Period	Date/Period the procedure was performed
start	S	1..1	dateTime	Starting time with inclusive boundary
performer
role		0..1	CodeableConcept	The role the actor was in Binding: Procedure Performer Role Codes (preferred)
reasonCode		0..*	CodeableConcept	Coded reason procedure performed Binding: Procedure Reason Codes (preferred)
bodySite	S	0..1	CodeableConcept	Target body sites Binding: SNOMED CT Body Structures (required)
outcome	S	0..1	CodeableConcept	The result of procedure Binding: Procedure Outcome Codes (SNOMED CT) (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/Diagnosis Codes (preferred)
coding		0..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
followUp		0..*	CodeableConcept	Instructions for follow up Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
focalDevice	S	0..*	BackboneElement	Device changed in procedure
action		0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (preferred)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
manipulated