My Health Record FHIR Gateway Conformance Artefacts
0.0.1 - draft
My Health Record FHIR Gateway Conformance Artefacts
0.0.1 - draft
My Health Record FHIR Gateway Conformance Artefacts, published by Australian Digital Health Agency. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/mcv/ and changes regularly. See the Directory of published versions
| Official URL: http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-procedure-mcv-1 | Version: 0.0.1 | |||
| Active as of 2024-09-11 | Computable Name: ADHAProcedureMCV | |||
Copyright/Legal: Copyright © 2022 Australian Digital Health Agency - All rights reserved. This content is licensed under a Creative Commons Attribution 4.0 International License. See https://creativecommons.org/licenses/by/4.0/. |
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The purpose of this profile is to provide a Medical Conditions View representation of a procedure for the electronic exchange of health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from AUCoreProcedure
| Name | Flags | Card. | Type | Description & Constraints | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
  Procedure |
0..* | AUCoreProcedure | A procedure in the context of electronic exchange of health information for the Medical COnditions View | |||||||||
  id |
1..1 | id | Logical id of this artifact | |||||||||
| status |
O | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Fixed Value: completed
| ||||||||
| code |
O | 1..1 | CodeableConcept | Identification of the procedure Binding: Procedure  (extensible)
| ||||||||
 subject |
O | 1..1 | Reference(ADHA Patient Match) | Who the procedure was performed on
| ||||||||
| performedDateTime |
SO | 1..1 | dateTime | When the procedure was performed
| ||||||||
 note |
SO | 0..* | Annotation | Additional information about the procedure
| ||||||||
| Documentation for this format | ||||||||||||
| Path | Conformance | ValueSet | URI |
| Procedure.code | extensible | Procedure https://healthterminologies.gov.au/fhir/ValueSet/procedure-1 |
| Name | Flags | Card. | Type | Description & Constraints | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Procedure |
0..* | AUCoreProcedure | A procedure in the context of electronic exchange of health information for the Medical COnditions View | |||||||||
 id |
Σ | 1..1 | id | Logical id of this artifact | ||||||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||||||
  Slices for extension |
Content/Rules for all slices | |||||||||||
   targetBodyStructure |
0..* | Reference(BodyStructure) | The target point for this procedure URL: http://hl7.org/fhir/StructureDefinition/procedure-targetBodyStructure | |||||||||
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||||||
| status |
?!SOΣ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure. Fixed Value: completed
| ||||||||
 code |
SOΣ | 1..1 | CodeableConcept | Identification of the procedure Binding: Procedure (extensible)
| ||||||||
| subject |
SOΣ | 1..1 | Reference(ADHA Patient Match) | Who the procedure was performed on
| ||||||||
| encounter |
SOΣ | 0..1 | Reference(AU Core Encounter) | Encounter created as part of
| ||||||||
| Slices for performed[x] |
SOΣ | 1..1 | dateTime | When the procedure was performed Slice: Unordered, Closed by type:$this
| ||||||||
| performed[x]:performedDateTime |
SOΣ | 1..1 | dateTime | When the procedure was performed
| ||||||||
| reasonCode |
SOΣ | 0..* | CodeableConcept | Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
| ||||||||
| reasonReference |
SOΣ | 0..* | Reference(AU Core Condition | Observation | AU Core Procedure | DocumentReference) | The justification that the procedure was performed
| ||||||||
| note |
SO | 0..* | Annotation | Additional information about the procedure
| ||||||||
| Documentation for this format | ||||||||||||
| Path | Conformance | ValueSet / Code | URI |
| Procedure.status | required | Fixed Value: completedhttp://hl7.org/fhir/ValueSet/event-status|4.0.1from the FHIR Standard | |
| Procedure.code | extensible | Procedure https://healthterminologies.gov.au/fhir/ValueSet/procedure-1 | |
| Procedure.reasonCode | example | ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reasonfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() |
| Name | Flags | Card. | Type | Description & Constraints | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Procedure |
0..* | AUCoreProcedure | A procedure in the context of electronic exchange of health information for the Medical COnditions View | |||||||||
| id |
Σ | 1..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.
| |||||||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||
| contained |
0..* | Resource | Contained, inline Resources | |||||||||
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||
| targetBodyStructure |
0..* | Reference(BodyStructure) | The target point for this procedure URL: http://hl7.org/fhir/StructureDefinition/procedure-targetBodyStructure | |||||||||
| 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(CarePlan | ServiceRequest) | A request for this procedure | ||||||||
| partOf |
Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | Part of referenced event | ||||||||
| status |
?!SOΣ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure. Fixed Value: completed
| ||||||||
| 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 |
SOΣ | 1..1 | CodeableConcept | Identification of the procedure Binding: Procedure (extensible)
| ||||||||
| subject |
SOΣ | 1..1 | Reference(ADHA Patient Match) | Who the procedure was performed on
| ||||||||
| encounter |
SOΣ | 0..1 | Reference(AU Core Encounter) | Encounter created as part of
| ||||||||
| Slices for performed[x] |
SOΣ | 1..1 | dateTime | When the procedure was performed Slice: Unordered, Closed by type:$this
| ||||||||
| performed[x]:performedDateTime |
SOΣ | 1..1 | dateTime | When the procedure was performed
| ||||||||
| 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 | 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(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | 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 |
SOΣ | 0..* | CodeableConcept | Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
| ||||||||
| reasonReference |
SOΣ | 0..* | Reference(AU Core Condition | Observation | AU Core Procedure | DocumentReference) | The justification that the procedure was performed
| ||||||||
| bodySite |
OΣC | 0..* | CodeableConcept | Target body sites Binding: Body Site (extensible)au-core-pro-04: If a coded body site is provided, at least one code shall be from SNOMED CT
| ||||||||
| 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 |
SO | 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 | ||||||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| Procedure.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| Procedure.status | required | Fixed Value: completedhttp://hl7.org/fhir/ValueSet/event-status|4.0.1from the FHIR Standard | ||||
| Procedure.statusReason | example | ProcedureNotPerformedReason(SNOMED-CT)http://hl7.org/fhir/ValueSet/procedure-not-performed-reasonfrom the FHIR Standard | ||||
| Procedure.category | example | ProcedureCategoryCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-categoryfrom the FHIR Standard | ||||
| Procedure.code | extensible | Procedure https://healthterminologies.gov.au/fhir/ValueSet/procedure-1 | ||||
| Procedure.performer.function | example | ProcedurePerformerRoleCodeshttp://hl7.org/fhir/ValueSet/performer-rolefrom the FHIR Standard | ||||
| Procedure.reasonCode | example | ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reasonfrom the FHIR Standard | ||||
| Procedure.bodySite | extensible | BodySite https://healthterminologies.gov.au/fhir/ValueSet/body-site-1 | ||||
| Procedure.outcome | example | ProcedureOutcomeCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-outcomefrom the FHIR Standard | ||||
| Procedure.complication | example | Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-codefrom the FHIR Standard | ||||
| Procedure.followUp | example | ProcedureFollowUpCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-followupfrom the FHIR Standard | ||||
| Procedure.focalDevice.action | preferred | ProcedureDeviceActionCodeshttp://hl7.org/fhir/ValueSet/device-actionfrom the FHIR Standard | ||||
| Procedure.usedCode | example | FHIRDeviceTypeshttp://hl7.org/fhir/ValueSet/device-kindfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| au-core-pro-04 | error | Procedure.bodySite | If a coded body site is provided, at least one code shall be from SNOMED CT : coding.exists() implies coding.where(system='http://snomed.info/sct').exists() | |
| 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() |
This structure is derived from AUCoreProcedure
Differential View
This structure is derived from AUCoreProcedure
| Name | Flags | Card. | Type | Description & Constraints | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Procedure |
0..* | AUCoreProcedure | A procedure in the context of electronic exchange of health information for the Medical COnditions View | |||||||||
| id |
1..1 | id | Logical id of this artifact | |||||||||
| status |
O | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Fixed Value: completed
| ||||||||
| code |
O | 1..1 | CodeableConcept | Identification of the procedure Binding: Procedure (extensible)
| ||||||||
| subject |
O | 1..1 | Reference(ADHA Patient Match) | Who the procedure was performed on
| ||||||||
| performedDateTime |
SO | 1..1 | dateTime | When the procedure was performed
| ||||||||
| note |
SO | 0..* | Annotation | Additional information about the procedure
| ||||||||
| Documentation for this format | ||||||||||||
| Path | Conformance | ValueSet | URI |
| Procedure.code | extensible | Procedure https://healthterminologies.gov.au/fhir/ValueSet/procedure-1 |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Procedure |
0..* | AUCoreProcedure | A procedure in the context of electronic exchange of health information for the Medical COnditions View | |||||||||
| id |
Σ | 1..1 | id | Logical id of this artifact | ||||||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||||||
| Slices for extension |
Content/Rules for all slices | |||||||||||
| targetBodyStructure |
0..* | Reference(BodyStructure) | The target point for this procedure URL: http://hl7.org/fhir/StructureDefinition/procedure-targetBodyStructure | |||||||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||||||
| status |
?!SOΣ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure. Fixed Value: completed
| ||||||||
| code |
SOΣ | 1..1 | CodeableConcept | Identification of the procedure Binding: Procedure (extensible)
| ||||||||
| subject |
SOΣ | 1..1 | Reference(ADHA Patient Match) | Who the procedure was performed on
| ||||||||
| encounter |
SOΣ | 0..1 | Reference(AU Core Encounter) | Encounter created as part of
| ||||||||
| Slices for performed[x] |
SOΣ | 1..1 | dateTime | When the procedure was performed Slice: Unordered, Closed by type:$this
| ||||||||
| performed[x]:performedDateTime |
SOΣ | 1..1 | dateTime | When the procedure was performed
| ||||||||
| reasonCode |
SOΣ | 0..* | CodeableConcept | Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
| ||||||||
| reasonReference |
SOΣ | 0..* | Reference(AU Core Condition | Observation | AU Core Procedure | DocumentReference) | The justification that the procedure was performed
| ||||||||
| note |
SO | 0..* | Annotation | Additional information about the procedure
| ||||||||
| Documentation for this format | ||||||||||||
| Path | Conformance | ValueSet / Code | URI |
| Procedure.status | required | Fixed Value: completedhttp://hl7.org/fhir/ValueSet/event-status|4.0.1from the FHIR Standard | |
| Procedure.code | extensible | Procedure https://healthterminologies.gov.au/fhir/ValueSet/procedure-1 | |
| Procedure.reasonCode | example | ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reasonfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Procedure |
0..* | AUCoreProcedure | A procedure in the context of electronic exchange of health information for the Medical COnditions View | |||||||||
| id |
Σ | 1..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.
| |||||||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||
| contained |
0..* | Resource | Contained, inline Resources | |||||||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||
| targetBodyStructure |
0..* | Reference(BodyStructure) | The target point for this procedure URL: http://hl7.org/fhir/StructureDefinition/procedure-targetBodyStructure | |||||||||
| 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(CarePlan | ServiceRequest) | A request for this procedure | ||||||||
| partOf |
Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | Part of referenced event | ||||||||
| status |
?!SOΣ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure. Fixed Value: completed
| ||||||||
| 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 |
SOΣ | 1..1 | CodeableConcept | Identification of the procedure Binding: Procedure (extensible)
| ||||||||
| subject |
SOΣ | 1..1 | Reference(ADHA Patient Match) | Who the procedure was performed on
| ||||||||
| encounter |
SOΣ | 0..1 | Reference(AU Core Encounter) | Encounter created as part of
| ||||||||
| Slices for performed[x] |
SOΣ | 1..1 | dateTime | When the procedure was performed Slice: Unordered, Closed by type:$this
| ||||||||
| performed[x]:performedDateTime |
SOΣ | 1..1 | dateTime | When the procedure was performed
| ||||||||
| 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 | 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(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | 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 |
SOΣ | 0..* | CodeableConcept | Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
| ||||||||
| reasonReference |
SOΣ | 0..* | Reference(AU Core Condition | Observation | AU Core Procedure | DocumentReference) | The justification that the procedure was performed
| ||||||||
| bodySite |
OΣC | 0..* | CodeableConcept | Target body sites Binding: Body Site (extensible)au-core-pro-04: If a coded body site is provided, at least one code shall be from SNOMED CT
| ||||||||
| 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 |
SO | 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 | ||||||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| Procedure.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| Procedure.status | required | Fixed Value: completedhttp://hl7.org/fhir/ValueSet/event-status|4.0.1from the FHIR Standard | ||||
| Procedure.statusReason | example | ProcedureNotPerformedReason(SNOMED-CT)http://hl7.org/fhir/ValueSet/procedure-not-performed-reasonfrom the FHIR Standard | ||||
| Procedure.category | example | ProcedureCategoryCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-categoryfrom the FHIR Standard | ||||
| Procedure.code | extensible | Procedure https://healthterminologies.gov.au/fhir/ValueSet/procedure-1 | ||||
| Procedure.performer.function | example | ProcedurePerformerRoleCodeshttp://hl7.org/fhir/ValueSet/performer-rolefrom the FHIR Standard | ||||
| Procedure.reasonCode | example | ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reasonfrom the FHIR Standard | ||||
| Procedure.bodySite | extensible | BodySite https://healthterminologies.gov.au/fhir/ValueSet/body-site-1 | ||||
| Procedure.outcome | example | ProcedureOutcomeCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-outcomefrom the FHIR Standard | ||||
| Procedure.complication | example | Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-codefrom the FHIR Standard | ||||
| Procedure.followUp | example | ProcedureFollowUpCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-followupfrom the FHIR Standard | ||||
| Procedure.focalDevice.action | preferred | ProcedureDeviceActionCodeshttp://hl7.org/fhir/ValueSet/device-actionfrom the FHIR Standard | ||||
| Procedure.usedCode | example | FHIRDeviceTypeshttp://hl7.org/fhir/ValueSet/device-kindfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| au-core-pro-04 | error | Procedure.bodySite | If a coded body site is provided, at least one code shall be from SNOMED CT : coding.exists() implies coding.where(system='http://snomed.info/sct').exists() | |
| 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() |
This structure is derived from AUCoreProcedure
Other representations of profile: CSV, Excel, Schematron
IG © 2024+ Australian Digital Health Agency. Package au.digitalhealth.r4.mhr-fhir-gw#0.0.1 based on FHIR 4.0.1. Generated 2024-09-11
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