QI-Core Implementation Guide
8.0.0-ballot - STU 8 - ballot

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 8.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

## Resource Profile: QICore Procedure

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure | Version: 8.0.0-ballot
Standards status: Trial-use Active as of 2018-08-22 | Maturity Level: 4 | Computable Name: QICoreProcedure

Profile of Procedure for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
Must Have:

- subject: (QI) Who the procedure was performed on
- code: (QI) What procedure
- status: (QI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown

QI Elements:

- performed[x]: (QI) When the procedure was performed
- reasonCode: (QI) Coded reason procedure performed
- reasonReference: (QI) The justification that the procedure was performed
- basedOn: (QI) A request for this procedure
- code.extension(codeOptions): (QI) Url of a value set of candidate procedures
- extension(recorded): (QI) When the procedure was first captured in the subject's record

Primary code path: code
(PCPath) This element is the primary code path for this resource CQL Retrieve
Usage

The Procedure profile defines the conformance expectations for a Procedure, regardless of whether it is a positive or negative statement. The ProcedureDone and ProcedureNotDone profiles represent the positive and negative statements for a procedure.

To create an expression indicating existence of a procedure, use the profile QICoreProcedureDone; to specifically request information that a procedure intentionally did not occur for a medical, patient or system reason, use the profile QICoreProcedureNotDone.

The following example illustrates the use of the Procedure profile:

    define "Application of Intermittent Pneumatic Compression Devices":
      ["Procedure": "Application of Intermittent Pneumatic Compression Devices (IPC)"] DeviceApplied
        where DeviceApplied.status = 'completed'

See the patterns page for implementation and usage patterns.

### Examples

Appendectomy Example

Usages:

- Derived from this Profile: QICore Procedure Done and QICore Procedure Not Done
- Refer to this Profile: QICore AdverseEvent, QICore Claim, QICore Encounter and QICore ImagingStudy
- Examples for this Profile: Procedure/example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile | An action that is being or was performed on a patient Constraints: us-core-7, prc-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
basedOn | Σ | 0..* | Reference(QICore CarePlan | QICore ServiceRequest) | (QI) A request for this procedure
status | ?!S Σ C | 1..1 | code | (QI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required)
code | S Σ C | 1..1 | CodeableConcept | (QI) What procedure Binding: US Core Procedure Codes (preferred): Codes describing the type of Procedure
Additional Bindings | Purpose
US Core Procedure Codes | Current
Slices for extension |  |  |  | Content/Rules for all slices
extension:codeOptions | C | 0..1 | canonical(ValueSet) | (QI) Url of a value set of candidate procedures URL: http://hl7.org/fhir/StructureDefinition/codeOptions
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the procedure was performed on
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Encounter associated with the procedure
performed[x] | S Σ C | 0..1 |  | (QI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
reasonCode | Σ | 0..* | CodeableConcept | (QI) Coded reason procedure performed Binding: US Core Condition Codes (extensible)
reasonReference | Σ | 0..* | Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile) | (QI) The justification that the procedure was performed
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.status | Base | required | EventStatus | 📦4.0.1 | FHIR Std.
Procedure.code | Base | preferred | US Core Procedure Codes | 📦8.0.0 | US Core v8.0
Procedure.reasonCode | Base | extensible | US Core Condition Codes | 📦8.0.0 | US Core v8.0

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
prc-1 | error | Procedure | to indicate what procedure, either at least one coding in the code or a codeOptions extension shall be provided | `code.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor code.coding.exists()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile | An action that is being or was performed on a patient Constraints: prc-1
implicitRules |  | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 1..1 | dateTime | (QI) When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ServiceRequest) | (QI) A request for this procedure
status |  | 1..1 | code | (QI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
code | C | 1..1 | CodeableConcept | (QI) What procedure
Slices for extension |  |  |  | Content/Rules for all slices
extension:codeOptions | C | 0..1 | canonical(ValueSet) | (QI) Url of a value set of candidate procedures URL: http://hl7.org/fhir/StructureDefinition/codeOptions
subject |  | 1..1 | Reference(QICore Patient) | (QI) Who the procedure was performed on
performed[x] |  | 0..1 | dateTime, Period, string, Age, Range | (QI) When the procedure was performed
performer |  |  |  |
actor |  | 1..1 | Reference(QICore Practitioner | QICore Organization | QICore Patient | QICore RelatedPerson) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The reference to the practitioner
reasonCode |  | 0..* | CodeableConcept | (QI) Coded reason procedure performed
reasonReference |  | 0..* | Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile) | (QI) The justification that the procedure was performed
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Description | Expression
prc-1 | error | Procedure | to indicate what procedure, either at least one coding in the code or a codeOptions extension shall be provided | `code.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor code.coding.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile | An action that is being or was performed on a patient Constraints: us-core-7, prc-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | External Identifiers for this procedure
instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(QICore CarePlan | QICore ServiceRequest) | (QI) A request for this procedure
partOf | Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | Part of referenced event
status | ?!S Σ C | 1..1 | code | (QI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required)
statusReason | Σ | 0..1 | CodeableConcept | Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category | Σ | 0..1 | CodeableConcept | Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code | S Σ C | 1..1 | CodeableConcept | (QI) What procedure Binding: US Core Procedure Codes (preferred): Codes describing the type of Procedure
Additional Bindings | Purpose
US Core Procedure Codes | Current
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:codeOptions | C | 0..1 | canonical(ValueSet) | (QI) Url of a value set of candidate procedures URL: http://hl7.org/fhir/StructureDefinition/codeOptions
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the procedure was performed on
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Encounter associated with the procedure
performed[x] | S Σ C | 0..1 |  | (QI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
recorder | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Who recorded the procedure
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Person who asserts this procedure
performer | Σ | 0..* | BackboneElement | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The people who performed the procedure
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function | Σ | 0..1 | CodeableConcept | Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor | Σ | 1..1 | Reference(QICore Practitioner | QICore Organization | QICore Patient | QICore RelatedPerson) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The reference to the practitioner
onBehalfOf |  | 0..1 | Reference(Organization) | Organization the device or practitioner was acting for
location | Σ | 0..1 | Reference(Location) | Where the procedure happened
reasonCode | Σ | 0..* | CodeableConcept | (QI) Coded reason procedure performed Binding: US Core Condition Codes (extensible)
reasonReference | Σ | 0..* | Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile) | (QI) The justification that the procedure was performed
bodySite | Σ | 0..* | CodeableConcept | Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
outcome | Σ | 0..1 | CodeableConcept | The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report |  | 0..* | Reference(DiagnosticReport | DocumentReference | Composition) | Any report resulting from the procedure
complication |  | 0..* | CodeableConcept | Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail |  | 0..* | Reference(Condition) | A condition that is a result of the procedure
followUp |  | 0..* | CodeableConcept | Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note |  | 0..* | Annotation | Additional information about the procedure
focalDevice |  | 0..* | BackboneElement | Manipulated, implanted, or removed device
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
action |  | 0..1 | CodeableConcept | Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated |  | 1..1 | Reference(Device) | Device that was changed
usedReference |  | 0..* | Reference(Device | Medication | Substance) | Items used during procedure
usedCode |  | 0..* | CodeableConcept | Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Procedure.status | Base | required | EventStatus | 📦4.0.1 | FHIR Std.
Procedure.statusReason | Base | example | Procedure Not Performed Reason (SNOMED-CT) | 📦4.0.1 | FHIR Std.
Procedure.category | Base | example | Procedure Category Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.code | Base | preferred | US Core Procedure Codes | 📦8.0.0 | US Core v8.0
Procedure.performer.​function | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
Procedure.reasonCode | Base | extensible | US Core Condition Codes | 📦8.0.0 | US Core v8.0
Procedure.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Procedure.outcome | Base | example | Procedure Outcome Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.complication | Base | example | Condition/Problem/Diagnosis Codes | 📦4.0.1 | FHIR Std.
Procedure.followUp | Base | example | Procedure Follow up Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.focalDevice.​action | Base | preferred | Procedure Device Action Codes | 📦4.0.1 | FHIR Std.
Procedure.usedCode | Base | example | FHIR Device Types | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
prc-1 | error | Procedure | to indicate what procedure, either at least one coding in the code or a codeOptions extension shall be provided | `code.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor code.coding.exists()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

- QICore CarePlan (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-careplan)
- QICore ServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)
- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICore Practitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICore Organization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICore RelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)
- QICore Condition Encounter Diagnosis (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis)
- QICore Condition Problems Health Concerns (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns)
- QICore DiagnosticReport Profile for Report and Note Exchange (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-diagnosticreport-note)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
- http://hl7.org/fhir/StructureDefinition/codeOptions|8.0.0-ballot

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile | An action that is being or was performed on a patient Constraints: us-core-7, prc-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
basedOn | Σ | 0..* | Reference(QICore CarePlan | QICore ServiceRequest) | (QI) A request for this procedure
status | ?!S Σ C | 1..1 | code | (QI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required)
code | S Σ C | 1..1 | CodeableConcept | (QI) What procedure Binding: US Core Procedure Codes (preferred): Codes describing the type of Procedure
Additional Bindings | Purpose
US Core Procedure Codes | Current
Slices for extension |  |  |  | Content/Rules for all slices
extension:codeOptions | C | 0..1 | canonical(ValueSet) | (QI) Url of a value set of candidate procedures URL: http://hl7.org/fhir/StructureDefinition/codeOptions
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the procedure was performed on
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Encounter associated with the procedure
performed[x] | S Σ C | 0..1 |  | (QI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
reasonCode | Σ | 0..* | CodeableConcept | (QI) Coded reason procedure performed Binding: US Core Condition Codes (extensible)
reasonReference | Σ | 0..* | Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile) | (QI) The justification that the procedure was performed
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.status | Base | required | EventStatus | 📦4.0.1 | FHIR Std.
Procedure.code | Base | preferred | US Core Procedure Codes | 📦8.0.0 | US Core v8.0
Procedure.reasonCode | Base | extensible | US Core Condition Codes | 📦8.0.0 | US Core v8.0

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
prc-1 | error | Procedure | to indicate what procedure, either at least one coding in the code or a codeOptions extension shall be provided | `code.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor code.coding.exists()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile | An action that is being or was performed on a patient Constraints: prc-1
implicitRules |  | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 1..1 | dateTime | (QI) When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
basedOn |  | 0..* | Reference(QICore CarePlan | QICore ServiceRequest) | (QI) A request for this procedure
status |  | 1..1 | code | (QI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
code | C | 1..1 | CodeableConcept | (QI) What procedure
Slices for extension |  |  |  | Content/Rules for all slices
extension:codeOptions | C | 0..1 | canonical(ValueSet) | (QI) Url of a value set of candidate procedures URL: http://hl7.org/fhir/StructureDefinition/codeOptions
subject |  | 1..1 | Reference(QICore Patient) | (QI) Who the procedure was performed on
performed[x] |  | 0..1 | dateTime, Period, string, Age, Range | (QI) When the procedure was performed
performer |  |  |  |
actor |  | 1..1 | Reference(QICore Practitioner | QICore Organization | QICore Patient | QICore RelatedPerson) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The reference to the practitioner
reasonCode |  | 0..* | CodeableConcept | (QI) Coded reason procedure performed
reasonReference |  | 0..* | Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile) | (QI) The justification that the procedure was performed
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Description | Expression
prc-1 | error | Procedure | to indicate what procedure, either at least one coding in the code or a codeOptions extension shall be provided | `code.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor code.coding.exists()`

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile | An action that is being or was performed on a patient Constraints: us-core-7, prc-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | External Identifiers for this procedure
instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(QICore CarePlan | QICore ServiceRequest) | (QI) A request for this procedure
partOf | Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | Part of referenced event
status | ?!S Σ C | 1..1 | code | (QI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required)
statusReason | Σ | 0..1 | CodeableConcept | Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category | Σ | 0..1 | CodeableConcept | Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code | S Σ C | 1..1 | CodeableConcept | (QI) What procedure Binding: US Core Procedure Codes (preferred): Codes describing the type of Procedure
Additional Bindings | Purpose
US Core Procedure Codes | Current
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:codeOptions | C | 0..1 | canonical(ValueSet) | (QI) Url of a value set of candidate procedures URL: http://hl7.org/fhir/StructureDefinition/codeOptions
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the procedure was performed on
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Encounter associated with the procedure
performed[x] | S Σ C | 0..1 |  | (QI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
recorder | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Who recorded the procedure
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Person who asserts this procedure
performer | Σ | 0..* | BackboneElement | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The people who performed the procedure
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function | Σ | 0..1 | CodeableConcept | Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor | Σ | 1..1 | Reference(QICore Practitioner | QICore Organization | QICore Patient | QICore RelatedPerson) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The reference to the practitioner
onBehalfOf |  | 0..1 | Reference(Organization) | Organization the device or practitioner was acting for
location | Σ | 0..1 | Reference(Location) | Where the procedure happened
reasonCode | Σ | 0..* | CodeableConcept | (QI) Coded reason procedure performed Binding: US Core Condition Codes (extensible)
reasonReference | Σ | 0..* | Reference(QICore Condition Encounter Diagnosis | QICore Condition Problems Health Concerns | QICore DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile) | (QI) The justification that the procedure was performed
bodySite | Σ | 0..* | CodeableConcept | Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
outcome | Σ | 0..1 | CodeableConcept | The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report |  | 0..* | Reference(DiagnosticReport | DocumentReference | Composition) | Any report resulting from the procedure
complication |  | 0..* | CodeableConcept | Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail |  | 0..* | Reference(Condition) | A condition that is a result of the procedure
followUp |  | 0..* | CodeableConcept | Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note |  | 0..* | Annotation | Additional information about the procedure
focalDevice |  | 0..* | BackboneElement | Manipulated, implanted, or removed device
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
action |  | 0..1 | CodeableConcept | Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated |  | 1..1 | Reference(Device) | Device that was changed
usedReference |  | 0..* | Reference(Device | Medication | Substance) | Items used during procedure
usedCode |  | 0..* | CodeableConcept | Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Procedure.status | Base | required | EventStatus | 📦4.0.1 | FHIR Std.
Procedure.statusReason | Base | example | Procedure Not Performed Reason (SNOMED-CT) | 📦4.0.1 | FHIR Std.
Procedure.category | Base | example | Procedure Category Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.code | Base | preferred | US Core Procedure Codes | 📦8.0.0 | US Core v8.0
Procedure.performer.​function | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
Procedure.reasonCode | Base | extensible | US Core Condition Codes | 📦8.0.0 | US Core v8.0
Procedure.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Procedure.outcome | Base | example | Procedure Outcome Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.complication | Base | example | Condition/Problem/Diagnosis Codes | 📦4.0.1 | FHIR Std.
Procedure.followUp | Base | example | Procedure Follow up Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.focalDevice.​action | Base | preferred | Procedure Device Action Codes | 📦4.0.1 | FHIR Std.
Procedure.usedCode | Base | example | FHIR Device Types | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
prc-1 | error | Procedure | to indicate what procedure, either at least one coding in the code or a codeOptions extension shall be provided | `code.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor code.coding.exists()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

- QICore CarePlan (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-careplan)
- QICore ServiceRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest)
- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICore Practitioner (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-practitioner)
- QICore Organization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICore RelatedPerson (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-relatedperson)
- QICore Condition Encounter Diagnosis (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis)
- QICore Condition Problems Health Concerns (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns)
- QICore DiagnosticReport Profile for Report and Note Exchange (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-diagnosticreport-note)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/5.0/StructureDefinition/extension-Procedure.recorded
- http://hl7.org/fhir/StructureDefinition/codeOptions|8.0.0-ballot

Maturity: 4

Other representations of profile: CSV, Excel, Schematron