Status: Draft - Work In Progress

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. 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. 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

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

5. Performed - when the Procedure was performed. A DateTime is easier to deal with and thus prefered, however Period may also be valid for some types of procedure.

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. 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

3. 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”)

4. 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.

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

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:

• Definition - A detailed definition of the procedure – eg protocol.

• Based On - Useful to describe the Care Plan, Referral or ProcedureRequest that led to this Procedure

• Part Of - Could be useful to describe if the procedure is part of a wider overall procedure, or involved in an observation or medication administration

• Not Done / Not Done Reason - 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”)

• 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 – 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

• Body Site - Useful to populate if known, and if not already obvious from the “code”

• 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

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

Discouraged or Removed fields

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

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

• Text Summary
• Differential Table
• Snapshot Table
• Snapshot Table (Must Support)
• 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
status	S	1..1	code	preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
category	S	1..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(CareConnect-Patient-1)	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	dateTime, Period	Date/Period the procedure was performed
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
followUp	S	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	S	0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (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
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
usedReference		0..*	Reference(Device | Substance | CareConnect-Medication-1)	DISCOURAGED: relevant to stock control within an organisation, but less so for a regional record
usedCode		0..*	CodeableConcept	DISCOURAGED: relevant to stock control within an organisation, but less so for a regional record
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Procedure	I	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 All Languages 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
Extension-CareConnect-AnaestheticIssues-1		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)
definition	Σ	0..*	Reference(PlanDefinition | ActivityDefinition | HealthcareService)	Instantiates protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ProcedureRequest | ReferralRequest)	A request for this procedure
partOf	Σ	0..*	Reference(MedicationAdministration | CareConnect-Procedure-1 | CareConnect-Observation-1)	Part of referenced event
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.
notDone	?!Σ	0..1	boolean	True if procedure was not performed as scheduled
notDoneReason	ΣI	0..1	CodeableConcept	Reason procedure was not performed Binding: Procedure Not Performed Reason (SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	SΣ	1..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
Extension-coding-sctdescid		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(CareConnect-Patient-1)	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	ΣI	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	ΣI	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
performed[x]	SΣ	1..1		Date/Period the procedure was performed
performedDateTime			dateTime
performedPeriod			Period
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 (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(RelatedPerson | Device | CareConnect-Organization-1 | CareConnect-Patient-1 | 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 (example): A code that identifies the reason a procedure is required.
reasonReference	Σ	0..*	Reference(CareConnect-Observation-1 | CareConnect-Condition-1)	Condition that is the reason the procedure performed
bodySite	Σ	0..*	CodeableConcept	Target body sites Binding: SNOMED CT Body Structures (example): Codes describing anatomical locations. May include laterality.
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
Extension-coding-sctdescid		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 (example): Codes describing complications that resulted from a 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
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 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
Extension-coding-sctdescid		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	S	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 | CareConnect-Patient-1 | 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	S	0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (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
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	ΣI	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)	DISCOURAGED: relevant to stock control within an organisation, but less so for a regional record
usedCode		0..*	CodeableConcept	DISCOURAGED: relevant to stock control within an organisation, but less so for a regional record Binding: FHIR Device Types (example): Codes describing items used during a procedure
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Procedure	I	0..*	CareConnect-Procedure-1	An action that is being or was performed on a patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	Σ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
tag:Source	Σ	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"
code	Σ	1..1	code	The Data Provider Id of the system supplying the data
display	Σ	1..1	string	Name of the system supplying the data
tag:Provenance	Σ	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"
code	Σ	1..1	code	The ODS Code of the organisation responsible for the data
display	Σ	1..1	string	Name of the organisation supplying the data
identifier:localIdentifier	Σ	0..1	Identifier	External Identifiers for this procedure
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
value	Σ	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
status	?!Σ	1..1	code	preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure.
category	Σ	1..1	CodeableConcept	Classification of the procedure Binding: Interweave R4 Procedure Category Code (required)
code	Σ	1..1	CodeableConcept	Identification of the procedure Binding: Interweave UkCore Procedure Code (required)
coding:snomedCT	Σ	1..1	Coding	Code defined by a terminology system Binding: Interweave UkCore Procedure Code (required)
subject	Σ	1..1	Reference(CareConnect-Patient-1)	Who the procedure was performed on. (A patient, NOT group)
context	Σ	0..1	Reference(CareConnect-Encounter-1)	Encounter or episode associated with the procedure
performed[x]	Σ	1..1		Date/Period the procedure was performed
performedDateTime			dateTime
performedPeriod			Period
outcome	Σ	0..1	CodeableConcept	The result of procedure Binding: Procedure Outcome Codes (SNOMED CT) (required)
followUp		0..*	CodeableConcept	Instructions for follow up Binding: Procedure Follow up Codes (SNOMED CT) (preferred)
focalDevice		0..*	BackboneElement	Device changed in procedure
action		0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (required)
manipulated		1..1	Reference(Device)	Device that was changed
Documentation for this format

This structure is derived from CareConnect-Procedure-1

Summary

Mandatory: 10 elements (20 nested mandatory elements)
Must-Support: 25 elements
Fixed Value: 3 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• CareConnect-Patient-1 (https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Patient-1)
• CareConnect-Encounter-1 (https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1)

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

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
status	S	1..1	code	preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
category	S	1..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(CareConnect-Patient-1)	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	dateTime, Period	Date/Period the procedure was performed
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
followUp	S	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	S	0..1	CodeableConcept	Kind of change to device Binding: Procedure Device Action Codes (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
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
usedReference		0..*	Reference(Device | Substance | CareConnect-Medication-1)	DISCOURAGED: relevant to stock control within an organisation, but less so for a regional record
usedCode		0..*	CodeableConcept	DISCOURAGED: relevant to stock control within an organisation, but less so for a regional record
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Procedure	I	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 All Languages 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
Extension-CareConnect-AnaestheticIssues-1		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)
definition	Σ	0..*	Reference(PlanDefinition | ActivityDefinition | HealthcareService)	Instantiates protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ProcedureRequest | ReferralRequest)	A request for this procedure
partOf	Σ	0..*	Reference(MedicationAdministration | CareConnect-Procedure-1 | CareConnect-Observation-1)	Part of referenced event
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.
notDone	?!Σ	0..1	boolean	True if procedure was not performed as scheduled
notDoneReason	ΣI	0..1	CodeableConcept	Reason procedure was not performed Binding: Procedure Not Performed Reason (SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	SΣ	1..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
Extension-coding-sctdescid		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(CareConnect-Patient-1)	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	ΣI	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	ΣI	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display