Canadian Baseline
1.2.0 - CI Build
Canadian Baseline
1.2.0 - CI Build
Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-procedure | Version: 1.2.0 | |||
| Draft as of 2024-12-13 | Computable Name: ProcedureProfile | |||
Proposed constraints and extensions on the Procedure Resource
This profile is seeking broader community and implementer feedback.
The cardinality on procedure.performed[x] has been constrained to 1..1. While this did not cause any Due Diligence Review Issues with IPS or US Core, we are seeking feedback from additional implementers on whether this cardinality restriction poses problems for their FHIR implementations.
This profile also socializes an example of a subset of SNOMED CT codes for procedures that is made available through the Infoway Terminology Gateway: https://fhir.infoway-inforoute.ca/ValueSet/interventioncode. This extensional value set was developed after initial review of the profiles but has been added in. We are seeking community feedback as to whether this subset is in use today by Canadian implementers or whether or not we should point to the larger value set of SNOMED CT codes contained in the IPS Value Set.
Feedback can be provided using the Simplifier issue log for this profile.
This profile sets minimum expectations for the Procedure resource to record, search and fetch current or historical procedures performed on or for a patient. It identifies which elements and value sets SHALL be present in the resource when using this profile.
This profile defines localization concepts for use in an Canadian context.
All elements or attributes defined in FHIR have cardinality as part of their definition - a minimum number of required appearances and a maximum number.
Most elements in FHIR specification have a minimum cardinality of 0, which means that they may be missing from a resource when it is exchanged between systems.
Required elements:
Some elements are labeled as MustSupport meaning that implementations that produce or consume resources SHALL provide "support" for the element in some meaningful way (see Must Support definition).
Following elements are marked as Must Support in the Procedure profile to aid record matching in databases with many pediatric records.
Must Support elements:
This Procedure profile is used to provide summary information about the occurrence of current or historical procedures performed on or for a patient, and is not intended to provide real-time snapshots of a procedure as it unfolds. Examples include surgical procedures, diagnostic procedures, endoscopic procedures, biopsies, counseling, physiotherapy, personal support services, adult day care services, non-emergency transportation, home modification, exercise and so on.
A slice for absentOrUnknownProcedure comes from the IPS-UV specification and has been socialized in the profile as a way to represent a standard set of codes for identifying absent or unknown procedures. While the profile expects that a procedure.code be present (cardinality of 1..1) the use of the slice is entirely optional.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Procedure |
0..* | Procedure | Procedure Profile dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |
  implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
 partOf |
Σ | 0..* | Reference(Procedure Profile | Observation Profile (General Use) | MedicationAdministration Profile) | Part of referenced event ele-1: All FHIR elements must have a @value or children |
| status |
?!SΣ | 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. ele-1: All FHIR elements must have a @value or children |
  code |
SΣ | 1..1 | CodeableConcept | Identification of the procedure Binding: InterventionCode  (preferred): Extensional Subset of SNOMED CT and SNOMED CT CA Extension Codes to describe Services/Activities performed by Primary Health Care Providers.ele-1: All FHIR elements must have a @value or children |
   Slices for coding |
Σ | 0..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this ele-1: All FHIR elements must have a @value or children |
   coding:absentOrUnknownProcedure |
Σ | 0..1 | Coding | Code for absent problem or for unknown procedure Binding: Absent or Unknown Procedures - IPS (required): A code to identify absent or unknown procedures ele-1: All FHIR elements must have a @value or children |
| subject |
SΣ | 1..1 | Reference(Patient Profile) | Who the procedure was performed on ele-1: All FHIR elements must have a @value or children |
| encounter |
Σ | 0..1 | Reference(Encounter Profile) | Encounter created as part of ele-1: All FHIR elements must have a @value or children |
 performed[x] |
SΣ | 1..1 | When the procedure was performed ele-1: All FHIR elements must have a @value or children | |
 performed[x]All Types |
Content/Rules for all Types | |||
  Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| data-absent-reason |
0..1 | code | performed[x] absence reason URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| performedDateTime |
dateTime | |||
| performedPeriod |
Period | |||
| performedString |
string | |||
| performedAge |
Age | |||
 performedRange |
Range | |||
| recorder |
Σ | 0..1 | Reference(Patient Profile | RelatedPerson | Practitioner Profile (General) | PractitionerRole Profile (General)) | Who recorded the procedure ele-1: All FHIR elements must have a @value or children |
| asserter |
Σ | 0..1 | Reference(Patient Profile | RelatedPerson | Practitioner Profile (General) | PractitionerRole Profile (General)) | Person who asserts this procedure ele-1: All FHIR elements must have a @value or children |
| location |
Σ | 0..1 | Reference(Location Profile) | Where the procedure happened ele-1: All FHIR elements must have a @value or children |
| reasonReference |
Σ | 0..* | Reference(Condition Profile | Observation Profile (General Use) | Procedure Profile | DiagnosticReport Profile for Laboratory Results Reporting | Diagnostic Report for Report and Note Exchange Profile | DocumentReference Profile for metadata about the document) | The justification that the procedure was performed ele-1: All FHIR elements must have a @value or children |
| complicationDetail |
0..* | Reference(Condition Profile) | A condition that is a result of the procedure ele-1: All FHIR elements must have a @value or children | |
| usedReference |
0..* | Reference(Device Profile (Implantable) | Medication Profile | Substance) | Items used during procedure ele-1: All FHIR elements must have a @value or children | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Procedure.status | required | EventStatushttp://hl7.org/fhir/ValueSet/event-status|4.0.1from the FHIR Standard | |
| Procedure.code | preferred | InterventionCode https://fhir.infoway-inforoute.ca/ValueSet/interventioncode | |
| Procedure.code.coding:absentOrUnknownProcedure | required | AbsentOrUnknownProceduresUvIpshttp://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-procedures-uv-ips |
| 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() |
Other representations of profile: CSV, Excel, Schematron
The Procedure.code element is used to specify a procedure that is performed.
The Procedure.code element is CodeableConcept data type meaning that more than one Coding sub-elements can be present. One of these Coding sub-elements MAY use InterventionCodeSubsetOperatingRoomProcedure value set from Canada Health Infoway.
Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").
