Interweave Implementation Guide
0.1.0 - ci-build

Interweave Implementation Guide - Local Development build (v0.1.0). See the Directory of published versions

Resource Profile: InterweaveProcedure

Official URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Interweave-Procedure Version: 0.1.0
Active as of 2024-06-10 Computable Name: InterweaveProcedure

Interweave Procedure resource profile.

  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.

Usage:

  • This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CareConnect-Procedure-1

NameFlagsCard.TypeDescription & Constraintsdoco
.. Procedure 0..*CareConnect-Procedure-1An action that is being or was performed on a patient
... id S0..1idLogical id of this artifact
... meta
.... versionId S0..1idVersion specific identifier
.... lastUpdated S0..1instantMANDATORY except in Contained Resources. When the resource version last changed.
.... profile S0..*uriProfiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
.... security 0..*CodingDISCOURAGED - may not be honoured by Data Consumers
.... Slices for tag 0..*CodingTags applied to this resource
Slice: Unordered, Open by value:system
..... tag:Source S0..1CodingMANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
...... system 1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Source
...... code S1..1codeThe Data Provider Id of the system supplying the data
...... display S1..1stringName of the system supplying the data
..... tag:Provenance S0..1CodingMANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
...... system 1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Provenance
...... code S1..1codeThe ODS Code of the organisation responsible for the data
...... display S1..1stringName of the organisation supplying the data
... implicitRules 0..1uriDISCOURAGED - may not be honoured by Data Consumers
... language 0..1codeEnglish is assumed (not currently a multi-lingual implementation)
... text 0..1NarrativeDISCOURAGED - 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..1Extension-CareConnect-AnaestheticIssues-1DISCOURAGED: May be risky if not consistently used. Consider using AllergyIntolerance or AdverseEvent instead.
... Slices for identifier 0..*IdentifierExternal Identifiers for this procedure
Slice: Unordered, Open by value:system
.... identifier:localIdentifier S0..1IdentifierExternal Identifiers for this procedure
..... system S1..1uriThe namespace for the identifier value
Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
..... value S1..1stringThe 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 S1..1codepreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
... notDone 0..0
... notDoneReason S0..1CodeableConceptReason procedure was not performed
Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
... category S0..1CodeableConceptClassification of the procedure
Binding: Interweave R4 Procedure Category Code (required)
.... coding
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... code S1..1CodeableConceptIdentification of the procedure
Binding: Interweave UkCore Procedure Code (required)
.... coding 1..*CodingCode defined by a terminology system
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
.... coding:snomedCT S1..1CodingCode defined by a terminology system
Binding: Interweave UkCore Procedure Code (required)
... subject S1..1Reference(CareConnectPatient1)Who the procedure was performed on. (A patient, NOT group)
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 1..1stringDescription of the referenced resource
... context S0..1Reference(CareConnect-Encounter-1)Encounter or episode associated with the procedure
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 0..1stringIf relevant, description of the referenced resource
... performed[x] S1..1PeriodDate/Period the procedure was performed
.... start S1..1dateTimeStarting time with inclusive boundary
... performer
.... role 0..1CodeableConceptThe role the actor was in
Binding: Procedure Performer Role Codes (preferred)
... reasonCode 0..*CodeableConceptCoded reason procedure performed
Binding: Procedure Reason Codes (preferred)
... bodySite S0..1CodeableConceptTarget body sites
Binding: SNOMED CT Body Structures (required)
... outcome S0..1CodeableConceptThe result of procedure
Binding: Procedure Outcome Codes (SNOMED CT) (required)
.... coding
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... complication 0..*CodeableConceptComplication following the procedure
Binding: Condition/Problem/Diagnosis Codes (preferred)
.... coding 0..*CodingCode defined by a terminology system
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... followUp 0..*CodeableConceptInstructions for follow up
Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
.... coding
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... note 0..*AnnotationAdditional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
... focalDevice S0..*BackboneElementDevice changed in procedure
.... action 0..1CodeableConceptKind of change to device
Binding: Procedure Device Action Codes (preferred)
..... coding
...... system 1..1uriIdentity of the terminology system
...... code 1..1codeSymbol in syntax defined by the system
...... display 1..1stringRepresentation defined by the system
.... manipulated S1..1Reference(Device)Device that was changed
..... reference 1..1stringReference to a resource (could be Contained)
..... identifier 0..1IdentifierIf relevant could include an id
..... display 0..1stringIf relevant, description of the referenced resource
... usedCode 0..*CodeableConceptCoded items used during the procedure
Binding: FHIR Device Types (preferred)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Procedure.notDoneReasonpreferredProcedure Not Performed Reason (SNOMED-CT)
Procedure.categoryrequiredInterweave R4 Procedure Category Code
Procedure.coderequiredInterweave UkCore Procedure Code
Procedure.code.coding:snomedCTrequiredInterweave UkCore Procedure Code
Procedure.performer.rolepreferredProcedure Performer Role Codes
Procedure.reasonCodepreferredProcedure Reason Codes
Procedure.bodySiterequiredSNOMED CT Body Structures
Procedure.outcomerequiredProcedure Outcome Codes (SNOMED CT)
Procedure.complicationpreferredCondition/Problem/Diagnosis Codes
Procedure.followUppreferredProcedure Follow up Codes (SNOMED CT)
Procedure.focalDevice.actionpreferredProcedure Device Action Codes
Procedure.usedCodepreferredFHIR Device Types
NameFlagsCard.TypeDescription & Constraintsdoco
.. Procedure C0..*CareConnect-Procedure-1An action that is being or was performed on a patient
... id SΣ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... versionId SΣ0..1idVersion specific identifier
.... lastUpdated SΣ0..1instantMANDATORY except in Contained Resources. When the resource version last changed.
.... profile SΣ0..*uriProfiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
.... security Σ0..*CodingDISCOURAGED - 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 Σ0..*CodingTags 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 SΣ0..1CodingMANDATORY 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 Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Source
...... code SΣ1..1codeThe Data Provider Id of the system supplying the data
...... display SΣ1..1stringName of the system supplying the data
..... tag:Provenance SΣ0..1CodingMANDATORY 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 Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Provenance
...... code SΣ1..1codeThe ODS Code of the organisation responsible for the data
...... display SΣ1..1stringName of the organisation supplying the data
... implicitRules ?!Σ0..1uriDISCOURAGED - may not be honoured by Data Consumers
... text 0..1NarrativeDISCOURAGED - 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..1CodeableConcept, 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..*ExtensionExtensions that cannot be ignored
... Slices for identifier Σ0..*IdentifierExternal Identifiers for this procedure
Slice: Unordered, Open by value:system
.... identifier:All Slices Content/Rules for all slices
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
.... identifier:localIdentifier SΣ0..1IdentifierExternal Identifiers for this procedure
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system SΣ1..1uriThe namespace for the identifier value
Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
..... value SΣ1..1stringThe Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
Example General: 123456
... status ?!SΣ1..1codepreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
Binding: EventStatus (required): A code specifying the state of the procedure.

... notDoneReason SΣC0..1CodeableConceptReason procedure was not performed
Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
... category SΣ0..1CodeableConceptClassification of the procedure
Binding: Interweave R4 Procedure Category Code (required)
... code SΣ1..1CodeableConceptIdentification of the procedure
Binding: Interweave UkCore Procedure Code (required)
.... Slices for coding Σ1..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
..... coding:snomedCT SΣ1..1CodingCode 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 Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
... subject SΣ1..1Reference(CareConnectPatient1)Who the procedure was performed on. (A patient, NOT group)
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ1..1stringDescription of the referenced resource
... context SΣ0..1Reference(CareConnect-Encounter-1)Encounter or episode associated with the procedure
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ0..1stringIf relevant, description of the referenced resource
... performed[x] SΣ1..1PeriodDate/Period the procedure was performed
.... start SΣC1..1dateTimeStarting time with inclusive boundary
... reasonCode Σ0..*CodeableConceptCoded reason procedure performed
Binding: Procedure Reason Codes (preferred)
... bodySite SΣ0..1CodeableConceptTarget body sites
Binding: SNOMED CT Body Structures (required)
.... Slices for coding Σ0..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:snomedCT Σ0..1CodingCode 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 Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
... outcome SΣ0..1CodeableConceptThe result of procedure
Binding: Procedure Outcome Codes (SNOMED CT) (required)
... complication 0..*CodeableConceptComplication following the procedure
Binding: Condition/Problem/Diagnosis Codes (preferred)
.... Slices for coding Σ0..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
..... coding:snomedCT Σ0..1CodingCode 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 Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
... followUp 0..*CodeableConceptInstructions for follow up
Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
... note 0..*AnnotationAdditional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
.... text 1..1stringThe annotation - text content
... focalDevice S0..*BackboneElementDevice changed in procedure
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... action 0..1CodeableConceptKind of change to device
Binding: Procedure Device Action Codes (preferred)
.... manipulated S1..1Reference(Device)Device that was changed
..... reference ΣC1..1stringReference to a resource (could be Contained)
..... identifier Σ0..1IdentifierIf relevant could include an id
..... display Σ0..1stringIf relevant, description of the referenced resource
... usedCode 0..*CodeableConceptCoded items used during the procedure
Binding: FHIR Device Types (preferred)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Procedure.meta.securityextensibleAll Security Labels
Procedure.meta.tagexampleCommon Tags
Procedure.meta.tag:SourceexampleCommon Tags
Procedure.meta.tag:ProvenanceexampleCommon Tags
Procedure.languageextensibleCommon Languages
Additional Bindings Purpose
AllLanguages Max Binding
Procedure.identifier.userequiredIdentifierUse
Procedure.identifier:localIdentifier.userequiredIdentifierUse
Procedure.statusrequiredEventStatus
Procedure.notDoneReasonpreferredProcedure Not Performed Reason (SNOMED-CT)
Procedure.categoryrequiredInterweave R4 Procedure Category Code
Procedure.coderequiredInterweave UkCore Procedure Code
Procedure.code.coding:snomedCTrequiredInterweave UkCore Procedure Code
Procedure.reasonCodepreferredProcedure Reason Codes
Procedure.bodySiterequiredSNOMED CT Body Structures
Procedure.bodySite.coding:snomedCTextensibleCare Connect Body Site
Procedure.outcomerequiredProcedure Outcome Codes (SNOMED CT)
Procedure.complicationpreferredCondition/Problem/Diagnosis Codes
Procedure.complication.coding:snomedCTrequiredCare Connect Condition Code
Procedure.followUppreferredProcedure Follow up Codes (SNOMED CT)
Procedure.focalDevice.actionpreferredProcedure Device Action Codes
Procedure.usedCodepreferredFHIR Device Types

Constraints

IdGradePath(s)DetailsRequirements
dom-1errorProcedureIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.empty()
dom-2errorProcedureIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorProcedureIf 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-4errorProcedureIf 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-1errorProcedure.extension:anaestheticIssues, Procedure.focalDeviceAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1errorProcedure.extension:anaestheticIssuesMust have either extensions or value[x], not both
: extension.exists() != value.exists()
pro-1errorProcedureReason not done is only permitted if notDone indicator is true
: notDoneReason.empty() or notDone = true
NameFlagsCard.TypeDescription & Constraintsdoco
.. Procedure C0..*CareConnect-Procedure-1An action that is being or was performed on a patient
... id SΣ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... versionId SΣ0..1idVersion specific identifier
.... lastUpdated SΣ0..1instantMANDATORY except in Contained Resources. When the resource version last changed.
.... profile SΣ0..*uriProfiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
.... security Σ0..*CodingDISCOURAGED - 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 Σ0..*CodingTags 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 SΣ0..1CodingMANDATORY 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..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Source
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeThe Data Provider Id of the system supplying the data
...... display SΣ1..1stringName of the system supplying the data
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... tag:Provenance SΣ0..1CodingMANDATORY 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..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Provenance
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeThe ODS Code of the organisation responsible for the data
...... display SΣ1..1stringName of the organisation supplying the data
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
... implicitRules ?!Σ0..1uriDISCOURAGED - may not be honoured by Data Consumers
... language 0..1codeEnglish is assumed (not currently a multi-lingual implementation)
Binding: Common Languages (extensible): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeDISCOURAGED - 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..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... anaestheticIssues 0..1CodeableConcept, 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..*ExtensionExtensions that cannot be ignored
... Slices for identifier Σ0..*IdentifierExternal Identifiers for this procedure
Slice: Unordered, Open by value:system
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription 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 Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(CareConnect-Organization-1)Organization that issued id (may be just text)
.... identifier:localIdentifier SΣ0..1IdentifierExternal Identifiers for this procedure
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription 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 SΣ1..1uriThe namespace for the identifier value
Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
..... value SΣ1..1stringThe Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
Example General: 123456
..... assigner Σ0..1Reference(CareConnect-Organization-1)Organization that issued id (may be just text)
... status ?!SΣ1..1codepreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
Binding: EventStatus (required): A code specifying the state of the procedure.

... notDoneReason SΣC0..1CodeableConceptReason procedure was not performed
Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
... category SΣ0..1CodeableConceptClassification of the procedure
Binding: Interweave R4 Procedure Category Code (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*CodingCode defined by a terminology system
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ1..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... code SΣ1..1CodeableConceptIdentification of the procedure
Binding: Interweave UkCore Procedure Code (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ1..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... coding:snomedCT SΣ1..1CodingCode defined by a terminology system
Binding: Interweave UkCore Procedure Code (required)
...... id 0..1stringxml:id (or equivalent in JSON)
...... Slices for extension 0..*ExtensionExtension
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 Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(CareConnectPatient1)Who the procedure was performed on. (A patient, NOT group)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ1..1stringDescription of the referenced resource
... context SΣ0..1Reference(CareConnect-Encounter-1)Encounter or episode associated with the procedure
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ0..1stringIf relevant, description of the referenced resource
... performed[x] SΣ1..1PeriodDate/Period the procedure was performed
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC1..1dateTimeStarting time with inclusive boundary
.... end ΣC0..1dateTimeEnd time with inclusive boundary, if not ongoing
... performer Σ0..*BackboneElementThe people who performed the procedure
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... role Σ0..1CodeableConceptThe role the actor was in
Binding: Procedure Performer Role Codes (preferred)
.... actor Σ1..1Reference(RelatedPerson | Device | CareConnect-Organization-1 | CareConnectPatient1 | CareConnect-Practitioner-1)The reference to the practitioner
.... onBehalfOf 0..1Reference(CareConnect-Organization-1)Organization the device or practitioner was acting for
... location Σ0..1Reference(CareConnect-Location-1)Where the procedure happened
... reasonCode Σ0..*CodeableConceptCoded reason procedure performed
Binding: Procedure Reason Codes (preferred)
... reasonReference Σ0..*Reference(CareConnect-Observation-1 | CareConnect-Condition-1)Condition that is the reason the procedure performed
... bodySite SΣ0..1CodeableConceptTarget body sites
Binding: SNOMED CT Body Structures (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ0..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:snomedCT Σ0..1CodingCode defined by a terminology system
Binding: Care Connect Body Site (extensible): A code from the SNOMED Clinical Terminology UK.


...... id 0..1stringxml:id (or equivalent in JSON)
...... Slices for extension 0..*ExtensionExtension
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 Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... outcome SΣ0..1CodeableConceptThe result of procedure
Binding: Procedure Outcome Codes (SNOMED CT) (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*CodingCode defined by a terminology system
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ1..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... report 0..*Reference(DiagnosticReport)Any report resulting from the procedure
... complication 0..*CodeableConceptComplication following the procedure
Binding: Condition/Problem/Diagnosis Codes (preferred)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ0..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... coding:snomedCT Σ0..1CodingCode defined by a terminology system
Binding: Care Connect Condition Code (required): A code from the SNOMED Clinical Terminology UK.


...... id 0..1stringxml:id (or equivalent in JSON)
...... Slices for extension 0..*ExtensionExtension
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 Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... complicationDetail 0..*Reference(CareConnect-Condition-1)A condition that is a result of the procedure
... followUp 0..*CodeableConceptInstructions for follow up
Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*CodingCode defined by a terminology system
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ1..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... note 0..*AnnotationAdditional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... author[x] Σ0..1Individual responsible for the annotation
..... authorReferenceReference(RelatedPerson | CareConnectPatient1 | CareConnect-Practitioner-1)
..... authorStringstring
.... time Σ0..1dateTimeWhen the annotation was made
.... text 1..1stringThe annotation - text content
... focalDevice S0..*BackboneElementDevice changed in procedure
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... action 0..1CodeableConceptKind of change to device
Binding: Procedure Device Action Codes (preferred)
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ0..*CodingCode defined by a terminology system
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
.... manipulated S1..1Reference(Device)Device that was changed
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... reference ΣC1..1stringReference to a resource (could be Contained)
..... identifier Σ0..1IdentifierIf relevant could include an id
..... display Σ0..1stringIf relevant, description of the referenced resource
... usedReference 0..*Reference(Device | Substance | CareConnect-Medication-1)Items used during procedure
... usedCode 0..*CodeableConceptCoded items used during the procedure
Binding: FHIR Device Types (preferred)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Procedure.meta.securityextensibleAll Security Labels
Procedure.meta.tagexampleCommon Tags
Procedure.meta.tag:SourceexampleCommon Tags
Procedure.meta.tag:ProvenanceexampleCommon Tags
Procedure.languageextensibleCommon Languages
Additional Bindings Purpose
AllLanguages Max Binding
Procedure.identifier.userequiredIdentifierUse
Procedure.identifier.typeextensibleIdentifier Type Codes
Procedure.identifier:localIdentifier.userequiredIdentifierUse
Procedure.identifier:localIdentifier.typeextensibleIdentifier Type Codes
Procedure.statusrequiredEventStatus
Procedure.notDoneReasonpreferredProcedure Not Performed Reason (SNOMED-CT)
Procedure.categoryrequiredInterweave R4 Procedure Category Code
Procedure.coderequiredInterweave UkCore Procedure Code
Procedure.code.coding:snomedCTrequiredInterweave UkCore Procedure Code
Procedure.performer.rolepreferredProcedure Performer Role Codes
Procedure.reasonCodepreferredProcedure Reason Codes
Procedure.bodySiterequiredSNOMED CT Body Structures
Procedure.bodySite.coding:snomedCTextensibleCare Connect Body Site
Procedure.outcomerequiredProcedure Outcome Codes (SNOMED CT)
Procedure.complicationpreferredCondition/Problem/Diagnosis Codes
Procedure.complication.coding:snomedCTrequiredCare Connect Condition Code
Procedure.followUppreferredProcedure Follow up Codes (SNOMED CT)
Procedure.focalDevice.actionpreferredProcedure Device Action Codes
Procedure.usedCodepreferredFHIR Device Types

Constraints

IdGradePath(s)DetailsRequirements
ele-1errorProcedure.extension:anaestheticIssues, Procedure.performer, Procedure.focalDeviceAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1errorProcedure.extension:anaestheticIssuesMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from CareConnect-Procedure-1

Summary

Mandatory: 10 elements (23 nested mandatory elements)
Must-Support: 26 elements
Fixed Value: 3 elements
Prohibited: 5 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Procedure.meta.tag is sliced based on the value of value:system
  • The element Procedure.identifier is sliced based on the value of value:system

Differential View

This structure is derived from CareConnect-Procedure-1

NameFlagsCard.TypeDescription & Constraintsdoco
.. Procedure 0..*CareConnect-Procedure-1An action that is being or was performed on a patient
... id S0..1idLogical id of this artifact
... meta
.... versionId S0..1idVersion specific identifier
.... lastUpdated S0..1instantMANDATORY except in Contained Resources. When the resource version last changed.
.... profile S0..*uriProfiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
.... security 0..*CodingDISCOURAGED - may not be honoured by Data Consumers
.... Slices for tag 0..*CodingTags applied to this resource
Slice: Unordered, Open by value:system
..... tag:Source S0..1CodingMANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
...... system 1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Source
...... code S1..1codeThe Data Provider Id of the system supplying the data
...... display S1..1stringName of the system supplying the data
..... tag:Provenance S0..1CodingMANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
...... system 1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Provenance
...... code S1..1codeThe ODS Code of the organisation responsible for the data
...... display S1..1stringName of the organisation supplying the data
... implicitRules 0..1uriDISCOURAGED - may not be honoured by Data Consumers
... language 0..1codeEnglish is assumed (not currently a multi-lingual implementation)
... text 0..1NarrativeDISCOURAGED - 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..1Extension-CareConnect-AnaestheticIssues-1DISCOURAGED: May be risky if not consistently used. Consider using AllergyIntolerance or AdverseEvent instead.
... Slices for identifier 0..*IdentifierExternal Identifiers for this procedure
Slice: Unordered, Open by value:system
.... identifier:localIdentifier S0..1IdentifierExternal Identifiers for this procedure
..... system S1..1uriThe namespace for the identifier value
Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
..... value S1..1stringThe 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 S1..1codepreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
... notDone 0..0
... notDoneReason S0..1CodeableConceptReason procedure was not performed
Binding: Procedure Not Performed Reason (SNOMED-CT) (preferred)
... category S0..1CodeableConceptClassification of the procedure
Binding: Interweave R4 Procedure Category Code (required)
.... coding
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... code S1..1CodeableConceptIdentification of the procedure
Binding: Interweave UkCore Procedure Code (required)
.... coding 1..*CodingCode defined by a terminology system
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
.... coding:snomedCT S1..1CodingCode defined by a terminology system
Binding: Interweave UkCore Procedure Code (required)
... subject S1..1Reference(CareConnectPatient1)Who the procedure was performed on. (A patient, NOT group)
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 1..1stringDescription of the referenced resource
... context S0..1Reference(CareConnect-Encounter-1)Encounter or episode associated with the procedure
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 0..1stringIf relevant, description of the referenced resource
... performed[x] S1..1PeriodDate/Period the procedure was performed
.... start S1..1dateTimeStarting time with inclusive boundary
... performer
.... role 0..1CodeableConceptThe role the actor was in
Binding: Procedure Performer Role Codes (preferred)
... reasonCode 0..*CodeableConceptCoded reason procedure performed
Binding: Procedure Reason Codes (preferred)
... bodySite S0..1CodeableConceptTarget body sites
Binding: SNOMED CT Body Structures (required)
... outcome S0..1CodeableConceptThe result of procedure
Binding: Procedure Outcome Codes (SNOMED CT) (required)
.... coding
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... complication 0..*CodeableConceptComplication following the procedure
Binding: Condition/Problem/Diagnosis Codes (preferred)
.... coding 0..*CodingCode defined by a terminology system
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... followUp 0..*CodeableConceptInstructions for follow up
Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
.... coding
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... note 0..*AnnotationAdditional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
... focalDevice S0..*BackboneElementDevice changed in procedure
.... action 0..1CodeableConceptKind of change to device
Binding: Procedure Device Action Codes (preferred)
..... coding
...... system 1..1uriIdentity of the terminology system
...... code 1..1codeSymbol in syntax defined by the system
...... display 1..1stringRepresentation defined by the system
.... manipulated S1..1Reference(Device)Device that was changed
..... reference 1..1stringReference to a resource (could be Contained)
..... identifier 0..1IdentifierIf relevant could include an id
..... display 0..1stringIf relevant, description of the referenced resource
... usedCode 0..*CodeableConceptCoded items used during the procedure
Binding: FHIR Device Types (preferred)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Procedure.notDoneReasonpreferredProcedure Not Performed Reason (SNOMED-CT)
Procedure.categoryrequiredInterweave R4 Procedure Category Code
Procedure.coderequiredInterweave UkCore Procedure Code
Procedure.code.coding:snomedCTrequiredInterweave UkCore Procedure Code
Procedure.performer.rolepreferred