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 - Detailed Descriptions

Draft as of 2023-04-04

Definitions for the Interweave-Procedure resource profile.

Guidance on how to interpret the contents of this table can be found here.

1. Procedure
2. Procedure.id
Must Supporttrue
3. Procedure.meta
Control0..?
4. Procedure.meta.versionId
Control0..?
Must Supporttrue
5. Procedure.meta.lastUpdated
Control0..?
Must Supporttrue
6. Procedure.meta.profile
Control0..?
Must Supporttrue
7. Procedure.meta.security
Control0..?
8. Procedure.meta.tag
Control0..?
SlicingThis element introduces a set of slices on Procedure.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
9. Procedure.meta.tag:Source
SliceNameSource
Control0..1
Must Supporttrue
10. Procedure.meta.tag:Source.system
Control1..?
Fixed Valuehttps://yhcr.nhs.uk/Source
11. Procedure.meta.tag:Source.code
Control1..?
Must Supporttrue
12. Procedure.meta.tag:Source.display
Control1..?
Must Supporttrue
13. Procedure.meta.tag:Provenance
SliceNameProvenance
Control0..1
Must Supporttrue
14. Procedure.meta.tag:Provenance.system
Control1..?
Fixed Valuehttps://yhcr.nhs.uk/Provenance
15. Procedure.meta.tag:Provenance.code
Control1..?
Must Supporttrue
16. Procedure.meta.tag:Provenance.display
Control1..?
Must Supporttrue
17. Procedure.implicitRules
18. Procedure.language
19. Procedure.text
20. Procedure.extension:anaestheticIssues
SliceNameanaestheticIssues
21. Procedure.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
SlicingThis element introduces a set of slices on Procedure.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
22. Procedure.identifier:localIdentifier
SliceNamelocalIdentifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
Must Supporttrue
23. Procedure.identifier:localIdentifier.system
Control0..?
Must Supporttrue
Fixed Valuehttps://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
24. Procedure.identifier:localIdentifier.value
Control0..?
Must Supporttrue
25. Procedure.identifier:localIdentifier.period
Control0..0
26. Procedure.status
Must Supporttrue
27. Procedure.category
Control10..1
BindingThe codes SHALL be taken from Interweave R4 Procedure Category CodeFor example codes, see Procedure Category Codes (SNOMED CT)
Must Supporttrue
28. Procedure.category.coding
Control0..?
29. Procedure.category.coding.system
Control1..?
30. Procedure.category.coding.code
Control1..?
31. Procedure.category.coding.display
Control1..?
32. Procedure.code
Control10..1
BindingThe codes SHALL be taken from Interweave UkCore Procedure CodeThe codes SHOULD be taken from Procedure Codes (SNOMED CT)
Must Supporttrue
33. Procedure.code.coding
Control10..*
34. Procedure.code.coding.system
Control1..?
35. Procedure.code.coding.code
Control1..?
36. Procedure.code.coding.display
Control1..?
37. Procedure.code.coding:snomedCT
SliceNamesnomedCT
Control10..1
BindingThe codes SHALL be taken from Interweave UkCore Procedure CodeThe codes SHALL be taken from Care Connect Procedure Code; other codes may be used where these codes are not suitable
Must Supporttrue
38. Procedure.subject
TypeReference(CareConnectPatient1|Group)
Must Supporttrue
39. Procedure.subject.reference
Control1..?
40. Procedure.subject.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..?
41. Procedure.subject.display
Control1..?
42. Procedure.context
TypeReference(CareConnect-Encounter-1|EpisodeOfCare)
Must Supporttrue
43. Procedure.context.reference
Control1..?
44. Procedure.context.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..?
45. Procedure.context.display
Control0..?
46. Procedure.performed[x]
Control10..1
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
47. Procedure.outcome
BindingThe codes SHALL be taken from Procedure Outcome Codes (SNOMED CT)For example codes, see Procedure Outcome Codes (SNOMED CT)
Must Supporttrue
48. Procedure.outcome.coding
Control0..?
49. Procedure.outcome.coding.system
Control1..?
50. Procedure.outcome.coding.code
Control1..?
51. Procedure.outcome.coding.display
Control1..?
52. Procedure.followUp
BindingThe codes SHOULD be taken from Procedure Follow up Codes (SNOMED CT)For example codes, see Procedure Follow up Codes (SNOMED CT)
Must Supporttrue
53. Procedure.followUp.coding
Control0..?
54. Procedure.followUp.coding.system
Control1..?
55. Procedure.followUp.coding.code
Control1..?
56. Procedure.followUp.coding.display
Control1..?
57. Procedure.note
58. Procedure.focalDevice
Must Supporttrue
59. Procedure.focalDevice.action
BindingThe codes SHALL be taken from Procedure Device Action CodesThe codes SHOULD be taken from Procedure Device Action Codes
Must Supporttrue
60. Procedure.focalDevice.action.coding
Control0..?
61. Procedure.focalDevice.action.coding.system
Control1..?
62. Procedure.focalDevice.action.coding.code
Control1..?
63. Procedure.focalDevice.action.coding.display
Control1..?
64. Procedure.focalDevice.manipulated
Must Supporttrue
65. Procedure.focalDevice.manipulated.reference
Control1..?
66. Procedure.focalDevice.manipulated.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..?
67. Procedure.focalDevice.manipulated.display
Control0..?
68. Procedure.usedReference
69. Procedure.usedCode

Guidance on how to interpret the contents of this table can be found here.

1. Procedure
Definition

An action that is or was performed on a patient. This can be a physical intervention like an operation, or less invasive like counseling or hypnotherapy.

Control0..*
InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (: contained.where(('#'+id in %resource.descendants().reference).not()).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
pro-1: Reason not done is only permitted if notDone indicator is true (: notDoneReason.empty() or notDone = true)
2. Procedure.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. Procedure.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Summarytrue
4. Procedure.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

5. Procedure.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

Control0..1
Typeinstant
Must Supporttrue
Summarytrue
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

6. Procedure.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Control0..*
Typeuri
Must Supporttrue
Summarytrue
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

7. Procedure.meta.security
Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Control0..*
BindingThe codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable

Security Labels from the Healthcare Privacy and Security Classification System.

TypeCoding
Summarytrue
Comments

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

8. Procedure.meta.tag
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..*
BindingFor example codes, see Common Tags

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

TypeCoding
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

SlicingThis element introduces a set of slices on Procedure.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
9. Procedure.meta.tag:Source
SliceNameSource
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1*
BindingFor example codes, see Common Tags

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

10. Procedure.meta.tag:Source.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control10..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttps://yhcr.nhs.uk/Source
11. Procedure.meta.tag:Source.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control10..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

12. Procedure.meta.tag:Source.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control10..1
Typestring
Must Supporttrue
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

13. Procedure.meta.tag:Provenance
SliceNameProvenance
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1*
BindingFor example codes, see Common Tags

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

14. Procedure.meta.tag:Provenance.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control10..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttps://yhcr.nhs.uk/Provenance
15. Procedure.meta.tag:Provenance.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control10..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

16. Procedure.meta.tag:Provenance.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control10..1
Typestring
Must Supporttrue
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

17. Procedure.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Summarytrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

18. Procedure.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable

A human language.

Additional BindingsPurpose
All LanguagesMax Binding
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

19. Procedure.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

20. Procedure.extension:anaestheticIssues
SliceNameanaestheticIssues
Definition

Details of any adverse reaction to any anaesthetic agents.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-AnaestheticIssues-1) (Extension Type: Choice of: CodeableConcept, Reference(CareConnect-Condition-1))
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
21. Procedure.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

22. Procedure.identifier
Definition

This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Summarytrue
Requirements

Need to allow connection to a wider workflow.

SlicingThis element introduces a set of slices on Procedure.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
23. Procedure.identifier.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

24. Procedure.identifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control10..1
Typeuri
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example
General:http://www.acme.com/identifiers/patient
25. Procedure.identifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control10..1
Typestring
Summarytrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Example
General:123456
26. Procedure.identifier:localIdentifier
SliceNamelocalIdentifier
Definition

This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1*
TypeIdentifier
Must Supporttrue
Summarytrue
Requirements

Need to allow connection to a wider workflow.

27. Procedure.identifier:localIdentifier.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

28. Procedure.identifier:localIdentifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control10..1
Typeuri
Must Supporttrue
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Fixed Valuehttps://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
Example
General:http://www.acme.com/identifiers/patient
29. Procedure.identifier:localIdentifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control10..1
Typestring
Must Supporttrue
Summarytrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Example
General:123456
30. Procedure.identifier:localIdentifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..01
TypePeriod
Summarytrue
31. Procedure.status
Definition

A code specifying the state of the procedure. Generally this will be in-progress or completed state.

Control1..1
BindingThe codes SHALL be taken from EventStatus

A code specifying the state of the procedure.

Typecode
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

32. Procedure.notDone
Definition

Set this to true if the record is saying that the procedure was NOT performed.

Control0..1
Typeboolean
Is Modifiertrue
Summarytrue
Comments

If true, it means the procedure did not occur as described. Typically it would be accompanied by attributes describing the type of activity. It might also be accompanied by body site information or time information (i.e. no procedure was done to the left arm or no procedure was done in this 2-year period). Specifying additional information such as performer, outcome, etc. is generally inappropriate. For example, it's not that useful to say "There was no appendectomy done at 12:03pm June 6th by Dr. Smith with a successful outcome" as it implies that there could have been an appendectomy done at any other time, by any other clinician or with any other outcome.

This element is labeled as a modifier because it indicates that a procedure didn't happen.

Default Valuefalse
33. Procedure.category
Definition

A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").

Control10..1
BindingThe codes SHALL be taken from Interweave R4 Procedure Category CodeFor example codes, see Procedure Category Codes (SNOMED CT)
TypeCodeableConcept
Must Supporttrue
Summarytrue
34. Procedure.code
Definition

The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").

Control10..1
BindingThe codes SHALL be taken from Interweave UkCore Procedure CodeFor example codes, see Procedure Codes (SNOMED CT)
TypeCodeableConcept
Must Supporttrue
Summarytrue
Requirements

0..1 to account for primarily narrative only resources.

Alternate Namestype
35. Procedure.code.coding
Definition

A reference to a code defined by a terminology system.

Control10..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

SlicingThis element introduces a set of slices on Procedure.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
36. Procedure.code.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control10..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

37. Procedure.code.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control10..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

38. Procedure.code.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control10..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

39. Procedure.code.coding:snomedCT
SliceNamesnomedCT
Definition

A reference to a code defined by a terminology system.

Control10..1*
BindingThe codes SHALL be taken from Interweave UkCore Procedure CodeFor codes, see (unbound)
TypeCoding
Must Supporttrue
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

40. Procedure.code.coding:snomedCT.extension:snomedCTDescriptionID
SliceNamesnomedCTDescriptionID
Definition

The SNOMED CT Description ID for the display.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

TypeExtension(Extension-coding-sctdescid) (Complex Extension)
41. Procedure.code.coding:snomedCT.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control10..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
42. Procedure.code.coding:snomedCT.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control10..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

43. Procedure.code.coding:snomedCT.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control10..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

44. Procedure.subject
Definition

The person, animal or group on which the procedure was performed.

Control1..1
TypeReference(CareConnectPatient1|Patient|Group)
Must Supporttrue
Summarytrue
Alternate Namespatient
45. Procedure.subject.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control10..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

46. Procedure.subject.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

47. Procedure.subject.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control10..1
Typestring
Summarytrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

48. Procedure.context
Definition

The encounter during which the procedure was performed.

Control0..1
TypeReference(CareConnect-Encounter-1|Encounter|EpisodeOfCare)
Must Supporttrue
Summarytrue
Alternate Namesencounter
49. Procedure.context.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control10..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

50. Procedure.context.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

51. Procedure.context.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Summarytrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

52. Procedure.performed[x]
Definition

The date(time)/period over which the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

Control10..1
TypeChoice of: dateTime, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
53. Procedure.outcome
Definition

The outcome of the procedure - did it resolve reasons for the procedure being performed?

Control0..1
BindingThe codes SHALL be taken from Procedure Outcome Codes (SNOMED CT)For example codes, see Procedure Outcome Codes (SNOMED CT)
TypeCodeableConcept
Must Supporttrue
Summarytrue
Comments

If outcome contains narrative text only, it can be captured using the CodeableConcept.text.

54. Procedure.followUp
Definition

If the procedure required specific follow up - e.g. removal of sutures. The followup may be represented as a simple note, or could potentially be more complex in which case the CarePlan resource can be used.

Control0..*
BindingThe codes SHOULD be taken from Procedure Follow up Codes (SNOMED CT)For example codes, see Procedure Follow up Codes (SNOMED CT)
TypeCodeableConcept
Must Supporttrue
55. Procedure.note
Definition

Any other notes about the procedure. E.g. the operative notes.

Control0..*
TypeAnnotation
56. Procedure.note.text
Definition

The text of the annotation.

Control1..1
Typestring
57. Procedure.focalDevice
Definition

A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.

Control0..*
TypeBackboneElement
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
58. Procedure.focalDevice.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

59. Procedure.focalDevice.action
Definition

The kind of change that happened to the device during the procedure.

Control0..1
BindingThe codes SHALL be taken from Procedure Device Action CodesThe codes SHOULD be taken from Procedure Device Action Codes
TypeCodeableConcept
Must Supporttrue
60. Procedure.focalDevice.manipulated
Definition

The device that was manipulated (changed) during the procedure.

Control1..1
TypeReference(Device)
Must Supporttrue
61. Procedure.focalDevice.manipulated.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control10..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

62. Procedure.focalDevice.manipulated.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

63. Procedure.focalDevice.manipulated.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Summarytrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

64. Procedure.usedReference
Definition

Identifies medications, devices and any other substance used as part of the procedure.

Control0..*
TypeReference(Device|Substance|CareConnect-Medication-1|Medication)
Requirements

Used for tracking contamination, etc.

Comments

For devices actually implanted or removed, use Procedure.device.

65. Procedure.usedCode
Definition

Identifies coded items that were used as part of the procedure.

Control0..*
BindingFor example codes, see FHIR Device Types

Codes describing items used during a procedure

TypeCodeableConcept
Comments

For devices actually implanted or removed, use Procedure.device.

Guidance on how to interpret the contents of this table can be found here.

1. Procedure
Definition

An action that is or was performed on a patient. This can be a physical intervention like an operation, or less invasive like counseling or hypnotherapy.

Control0..*
2. Procedure.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. Procedure.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Summarytrue
4. Procedure.meta.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
5. Procedure.meta.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.meta.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
6. Procedure.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.

Control0..1
Typeid
Must Supporttrue
Summarytrue
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

7. Procedure.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

Control0..1
Typeinstant
Must Supporttrue
Summarytrue
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

8. Procedure.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Control0..*
Typeuri
Must Supporttrue
Summarytrue
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

9. Procedure.meta.security
Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Control0..*
BindingThe codes SHALL be taken from All Security Labels; other codes may be used where these codes are not suitable Security Labels from the Healthcare Privacy and Security Classification System
TypeCoding
Summarytrue
Comments

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

10. Procedure.meta.tag
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..*
BindingFor example codes, see Common Tags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones
TypeCoding
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

SlicingThis element introduces a set of slices on Procedure.meta.tag. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
11. Procedure.meta.tag:Source
SliceNameSource
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1
BindingFor example codes, see Common Tags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones
TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

12. Procedure.meta.tag:Source.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
13. Procedure.meta.tag:Source.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.meta.tag.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
14. Procedure.meta.tag:Source.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttps://yhcr.nhs.uk/Source
15. Procedure.meta.tag:Source.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

16. Procedure.meta.tag:Source.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

17. Procedure.meta.tag:Source.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Must Supporttrue
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

18. Procedure.meta.tag:Source.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

19. Procedure.meta.tag:Provenance
SliceNameProvenance
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Control0..1
BindingFor example codes, see Common Tags Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones
TypeCoding
Must Supporttrue
Summarytrue
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

20. Procedure.meta.tag:Provenance.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
21. Procedure.meta.tag:Provenance.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.meta.tag.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
22. Procedure.meta.tag:Provenance.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttps://yhcr.nhs.uk/Provenance
23. Procedure.meta.tag:Provenance.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

24. Procedure.meta.tag:Provenance.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Must Supporttrue
Summarytrue
Requirements

Need to refer to a particular code in the system.

25. Procedure.meta.tag:Provenance.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Must Supporttrue
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

26. Procedure.meta.tag:Provenance.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

27. Procedure.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Summarytrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

28. Procedure.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable A human language
Additional BindingsPurpose
All LanguagesMax Binding
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

29. Procedure.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

30. Procedure.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

31. Procedure.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
32. Procedure.extension:anaestheticIssues
SliceNameanaestheticIssues
Definition

Details of any adverse reaction to any anaesthetic agents.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-CareConnect-AnaestheticIssues-1) (Extension Type: Choice of: CodeableConcept, Reference(CareConnect-Condition-1))
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
33. Procedure.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

34. Procedure.identifier
Definition

This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Summarytrue
Requirements

Need to allow connection to a wider workflow.

SlicingThis element introduces a set of slices on Procedure.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
35. Procedure.identifier.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
36. Procedure.identifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
37. Procedure.identifier.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known
Typecode
Is Modifiertrue
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

38. Procedure.identifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingThe codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose
TypeCodeableConcept
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.

Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

39. Procedure.identifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control1..1
Typeuri
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example
General:http://www.acme.com/identifiers/patient
40. Procedure.identifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Summarytrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Example
General:123456
41. Procedure.identifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
Summarytrue
42. Procedure.identifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(CareConnect-Organization-1)
Summarytrue
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

43. Procedure.identifier:localIdentifier
SliceNamelocalIdentifier
Definition

This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Must Supporttrue
Summarytrue
Requirements

Need to allow connection to a wider workflow.

44. Procedure.identifier:localIdentifier.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
45. Procedure.identifier:localIdentifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
46. Procedure.identifier:localIdentifier.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known
Typecode
Is Modifiertrue
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

47. Procedure.identifier:localIdentifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingThe codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose
TypeCodeableConcept
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.

Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

48. Procedure.identifier:localIdentifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control1..1
Typeuri
Must Supporttrue
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Fixed Valuehttps://fhir.yhcr.nhs.uk/Id/local-procedure-identifier
Example
General:http://www.acme.com/identifiers/patient
49. Procedure.identifier:localIdentifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Must Supporttrue
Summarytrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Example
General:123456
50. Procedure.identifier:localIdentifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..0
TypePeriod
Summarytrue
51. Procedure.identifier:localIdentifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(CareConnect-Organization-1)
Summarytrue
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

52. Procedure.definition
Definition

A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this procedure.

Control0..*
TypeReference(PlanDefinition|ActivityDefinition|HealthcareService)
Summarytrue
53. Procedure.basedOn
Definition

A reference to a resource that contains details of the request for this procedure.

Control0..*
TypeReference(CarePlan|ProcedureRequest|ReferralRequest)
Summarytrue
Alternate Namesfulfills
54. Procedure.partOf
Definition

A larger event of which this particular procedure is a component or step.

Control0..*
TypeReference(MedicationAdministration|CareConnect-Procedure-1|CareConnect-Observation-1)
Summarytrue
Alternate Namescontainer
Comments

The MedicationAdministration has a partOf reference to Procedure, but this is not a circular reference. For a surgical procedure, the anesthesia related medicationAdministration is part of the procedure. For an IV medication administration, the procedure to insert the IV port is part of the medication administration.

55. Procedure.status
Definition

A code specifying the state of the procedure. Generally this will be in-progress or completed state.

Control1..1
BindingThe codes SHALL be taken from EventStatus A code specifying the state of the procedure
Typecode
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

56. Procedure.notDone
Definition

Set this to true if the record is saying that the procedure was NOT performed.

Control0..1
Typeboolean
Is Modifiertrue
Summarytrue
Comments

If true, it means the procedure did not occur as described. Typically it would be accompanied by attributes describing the type of activity. It might also be accompanied by body site information or time information (i.e. no procedure was done to the left arm or no procedure was done in this 2-year period). Specifying additional information such as performer, outcome, etc. is generally inappropriate. For example, it's not that useful to say "There was no appendectomy done at 12:03pm June 6th by Dr. Smith with a successful outcome" as it implies that there could have been an appendectomy done at any other time, by any other clinician or with any other outcome.

This element is labeled as a modifier because it indicates that a procedure didn't happen.

Default Valuefalse
57. Procedure.notDoneReason
Definition

A code indicating why the procedure was not performed.

Control0..1 This element is affected by the following invariants: pro-1
BindingFor example codes, see Procedure Not Performed Reason (SNOMED-CT) A code that identifies the reason a procedure was not performed
TypeCodeableConcept
Summarytrue
58. Procedure.category
Definition

A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").

Control1..1
BindingThe codes SHALL be taken from Interweave R4 Procedure Category Code
TypeCodeableConcept
Must Supporttrue
Summarytrue
59. Procedure.category.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
60. Procedure.category.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.category.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
61. Procedure.category.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

62. Procedure.category.coding.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
63. Procedure.category.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.category.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
64. Procedure.category.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

65. Procedure.category.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

66. Procedure.category.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

67. Procedure.category.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

68. Procedure.category.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

69. Procedure.category.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

70. Procedure.code
Definition

The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").

Control1..1
BindingThe codes SHALL be taken from Interweave UkCore Procedure Code
TypeCodeableConcept
Must Supporttrue
Summarytrue
Requirements

0..1 to account for primarily narrative only resources.

Alternate Namestype
71. Procedure.code.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
72. Procedure.code.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
73. Procedure.code.coding
Definition

A reference to a code defined by a terminology system.

Control1..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

SlicingThis element introduces a set of slices on Procedure.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
74. Procedure.code.coding.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
75. Procedure.code.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
76. Procedure.code.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

77. Procedure.code.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

78. Procedure.code.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

79. Procedure.code.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

80. Procedure.code.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

81. Procedure.code.coding:snomedCT
SliceNamesnomedCT
Definition

A reference to a code defined by a terminology system.

Control1..1
BindingThe codes SHALL be taken from Interweave UkCore Procedure Code
TypeCoding
Must Supporttrue
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

82. Procedure.code.coding:snomedCT.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
83. Procedure.code.coding:snomedCT.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Procedure.code.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
84. Procedure.code.coding:snomedCT.extension:snomedCTDescriptionID
SliceNamesnomedCTDescriptionID
Definition

The SNOMED CT Description ID for the display.

Control0..*
TypeExtension(Extension-coding-sctdescid) (Complex Extension)
85. Procedure.code.coding:snomedCT.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
86. Procedure.code.coding:snomedCT.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

87. Procedure.code.coding:snomedCT.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

88. Procedure.code.coding:snomedCT.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

89. Procedure.code.coding:snomedCT.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

90. Procedure.code.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

91. Procedure.subject
Definition

The person, animal or group on which the procedure was performed.

Control1..1
TypeReference(CareConnectPatient1)
Must Supporttrue
Summarytrue
Alternate Namespatient
92. Procedure.subject.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
93. Procedure.subject.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.subject.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
94. Procedure.subject.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control1..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

95. Procedure.subject.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

96. Procedure.subject.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control1..1
Typestring
Summarytrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

97. Procedure.context
Definition

The encounter during which the procedure was performed.

Control0..1
TypeReference(CareConnect-Encounter-1)
Must Supporttrue
Summarytrue
Alternate Namesencounter
98. Procedure.context.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
99. Procedure.context.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.context.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
100. Procedure.context.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control1..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

101. Procedure.context.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

102. Procedure.context.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Summarytrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

103. Procedure.performed[x]
Definition

The date(time)/period over which the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

Control1..1
TypeChoice of: dateTime, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
104. Procedure.performer
Definition

Limited to 'real' people rather than equipment.

Control0..*
TypeBackboneElement
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
105. Procedure.performer.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
106. Procedure.performer.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

107. Procedure.performer.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

108. Procedure.performer.role
Definition

For example: surgeon, anaethetist, endoscopist.

Control0..1
BindingFor example codes, see Procedure Performer Role Codes A code that identifies the role of a performer of the procedure
TypeCodeableConcept
Summarytrue
109. Procedure.performer.actor
Definition

The practitioner who was involved in the procedure.

Control1..1
TypeReference(RelatedPerson|Device|CareConnect-Organization-1|CareConnectPatient1|CareConnect-Practitioner-1)
Summarytrue
Requirements

A reference to Device supports use cases, such as pacemakers.

110. Procedure.performer.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control0..1
TypeReference(CareConnect-Organization-1)
Requirements

Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

111. Procedure.location
Definition

The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.

Control0..1
TypeReference(CareConnect-Location-1)
Summarytrue
Requirements

Ties a procedure to where the records are likely kept.

112. Procedure.reasonCode
Definition

The coded reason why the procedure was performed. This may be coded entity of some type, or may simply be present as text.

Control0..*
BindingFor example codes, see Procedure Reason Codes A code that identifies the reason a procedure is required
TypeCodeableConcept
Summarytrue
113. Procedure.reasonReference
Definition

The condition that is the reason why the procedure was performed.

Control0..*
TypeReference(CareConnect-Observation-1|CareConnect-Condition-1)
Summarytrue
Comments

e.g. endoscopy for dilatation and biopsy, combination diagnosis and therapeutic.

114. Procedure.bodySite
Definition

Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.

Control0..*
BindingFor example codes, see SNOMED CT Body Structures Codes describing anatomical locations. May include laterality
TypeCodeableConcept
Summarytrue
115. Procedure.bodySite.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
116. Procedure.bodySite.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.bodySite.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
117. Procedure.bodySite.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

SlicingThis element introduces a set of slices on Procedure.bodySite.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
118. Procedure.bodySite.coding:snomedCT
SliceNamesnomedCT
Definition

A reference to a code defined by a terminology system.

Control0..1
BindingThe codes SHALL be taken from Care Connect Body Site; other codes may be used where these codes are not suitable A code from the SNOMED Clinical Terminology UK
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

119. Procedure.bodySite.coding:snomedCT.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
120. Procedure.bodySite.coding:snomedCT.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Procedure.bodySite.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
121. Procedure.bodySite.coding:snomedCT.extension:snomedCTDescriptionID
SliceNamesnomedCTDescriptionID
Definition

The SNOMED CT Description ID for the display.

Control0..*
TypeExtension(Extension-coding-sctdescid) (Complex Extension)
122. Procedure.bodySite.coding:snomedCT.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
123. Procedure.bodySite.coding:snomedCT.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

124. Procedure.bodySite.coding:snomedCT.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

125. Procedure.bodySite.coding:snomedCT.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

126. Procedure.bodySite.coding:snomedCT.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

127. Procedure.bodySite.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

128. Procedure.outcome
Definition

The outcome of the procedure - did it resolve reasons for the procedure being performed?

Control0..1
BindingThe codes SHALL be taken from Procedure Outcome Codes (SNOMED CT)
TypeCodeableConcept
Must Supporttrue
Summarytrue
Comments

If outcome contains narrative text only, it can be captured using the CodeableConcept.text.

129. Procedure.outcome.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
130. Procedure.outcome.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.outcome.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
131. Procedure.outcome.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

132. Procedure.outcome.coding.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
133. Procedure.outcome.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.outcome.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
134. Procedure.outcome.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

135. Procedure.outcome.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

136. Procedure.outcome.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

137. Procedure.outcome.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

138. Procedure.outcome.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

139. Procedure.outcome.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

140. Procedure.report
Definition

This could be a histology result, pathology report, surgical report, etc..

Control0..*
TypeReference(DiagnosticReport)
Comments

There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.

141. Procedure.complication
Definition

Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.

Control0..*
BindingFor example codes, see Condition/Problem/Diagnosis Codes Codes describing complications that resulted from a procedure
TypeCodeableConcept
Comments

If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.

142. Procedure.complication.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
143. Procedure.complication.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.complication.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
144. Procedure.complication.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

SlicingThis element introduces a set of slices on Procedure.complication.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
145. Procedure.complication.coding:snomedCT
SliceNamesnomedCT
Definition

A reference to a code defined by a terminology system.

Control0..1
BindingThe codes SHALL be taken from Care Connect Condition Code A code from the SNOMED Clinical Terminology UK
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

146. Procedure.complication.coding:snomedCT.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
147. Procedure.complication.coding:snomedCT.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Procedure.complication.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
148. Procedure.complication.coding:snomedCT.extension:snomedCTDescriptionID
SliceNamesnomedCTDescriptionID
Definition

The SNOMED CT Description ID for the display.

Control0..*
TypeExtension(Extension-coding-sctdescid) (Complex Extension)
149. Procedure.complication.coding:snomedCT.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
150. Procedure.complication.coding:snomedCT.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

151. Procedure.complication.coding:snomedCT.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

152. Procedure.complication.coding:snomedCT.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

153. Procedure.complication.coding:snomedCT.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

154. Procedure.complication.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

155. Procedure.complicationDetail
Definition

Any complications that occurred during the procedure, or in the immediate post-performance period.

Control0..*
TypeReference(CareConnect-Condition-1)
Requirements

This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.

156. Procedure.followUp
Definition

If the procedure required specific follow up - e.g. removal of sutures. The followup may be represented as a simple note, or could potentially be more complex in which case the CarePlan resource can be used.

Control0..*
BindingThe codes SHOULD be taken from Procedure Follow up Codes (SNOMED CT)
TypeCodeableConcept
Must Supporttrue
157. Procedure.followUp.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
158. Procedure.followUp.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.followUp.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
159. Procedure.followUp.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

160. Procedure.followUp.coding.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
161. Procedure.followUp.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.followUp.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
162. Procedure.followUp.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

163. Procedure.followUp.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

164. Procedure.followUp.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

165. Procedure.followUp.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

166. Procedure.followUp.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

167. Procedure.followUp.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

168. Procedure.note
Definition

Any other notes about the procedure. E.g. the operative notes.

Control0..*
TypeAnnotation
169. Procedure.note.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
170. Procedure.note.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
171. Procedure.note.author[x]
Definition

The individual responsible for making the annotation.

Control0..1
TypeChoice of: Reference(RelatedPerson|CareConnectPatient1|CareConnect-Practitioner-1), string
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
172. Procedure.note.time
Definition

Indicates when this particular annotation was made.

Control0..1
TypedateTime
Summarytrue
173. Procedure.note.text
Definition

The text of the annotation.

Control1..1
Typestring
174. Procedure.focalDevice
Definition

A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.

Control0..*
TypeBackboneElement
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
175. Procedure.focalDevice.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
176. Procedure.focalDevice.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

177. Procedure.focalDevice.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

178. Procedure.focalDevice.action
Definition

The kind of change that happened to the device during the procedure.

Control0..1
BindingThe codes SHALL be taken from Procedure Device Action Codes
TypeCodeableConcept
Must Supporttrue
179. Procedure.focalDevice.action.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
180. Procedure.focalDevice.action.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.focalDevice.action.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
181. Procedure.focalDevice.action.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

182. Procedure.focalDevice.action.coding.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
183. Procedure.focalDevice.action.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.focalDevice.action.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
184. Procedure.focalDevice.action.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

185. Procedure.focalDevice.action.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

186. Procedure.focalDevice.action.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Summarytrue
Requirements

Need to refer to a particular code in the system.

187. Procedure.focalDevice.action.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control1..1
Typestring
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

188. Procedure.focalDevice.action.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Summarytrue
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

189. Procedure.focalDevice.action.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Summarytrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

190. Procedure.focalDevice.manipulated
Definition

The device that was manipulated (changed) during the procedure.

Control1..1
TypeReference(Device)
Must Supporttrue
191. Procedure.focalDevice.manipulated.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
192. Procedure.focalDevice.manipulated.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Procedure.focalDevice.manipulated.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
193. Procedure.focalDevice.manipulated.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control1..1 This element is affected by the following invariants: ref-1
Typestring
Summarytrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

194. Procedure.focalDevice.manipulated.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

195. Procedure.focalDevice.manipulated.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Summarytrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

196. Procedure.usedReference
Definition

Identifies medications, devices and any other substance used as part of the procedure.

Control0..*
TypeReference(Device|Substance|CareConnect-Medication-1)
Requirements

Used for tracking contamination, etc.

Comments

For devices actually implanted or removed, use Procedure.device.

197. Procedure.usedCode
Definition

Identifies coded items that were used as part of the procedure.

Control0..*
BindingFor example codes, see FHIR Device Types Codes describing items used during a procedur
TypeCodeableConcept
Comments

For devices actually implanted or removed, use Procedure.device.