4.9 Resource ProcedureRequest - Content

4.9.1 Scope and Usage

A Procedure Request is a record of a request for a procedure to be performed. It can be used to represent a procedure that is planned, that is proposed, or that is ordered, as distinguished by the value of the ProcedureRequestStatus field.

A procedure is an activity that is performed with or on a patient as part of the provision of care. Examples include surgical procedures, diagnostic procedures, endoscopic procedures, biopsies, counselling, physiotherapy, exercise, etc. Procedures may be performed by a healthcare professional, a friend or relative or in some cases by the patient themselves.

The procedure request may represent an order that is entered by a practitioner in a CPOE system as well as a proposal made by a clinical decision support (CDS) system based on a patient's clinical record and context of care. Planned procedures referenced by a CarePlan may also be represented by this resource.

4.9.2 Boundaries and Relationships

ProcedureRequest is closely related to other types of "request" resources, particularly DiagnosticOrder and ReferralRequest. In fact, for some services, it may be appropriate to use any one of these resources to request that the procedure be performed. Which one is used may be driven by organization practice and by context. When it is unclear which to use, the following principles may be helpful:

• ProcedureRequest or DiagnosticOrder are typically used when the requesting clinician has and wishes to exercise the authority (and expertise) to decide exactly what action will be done.
• A ReferralRequest is used when the requesting practitioner is seeking another practitioner or organization to use their own expertise and/or authority to determine the specific action to take.
• Whether an activity is deemed to be a procedure or only a diagnostic order is typically driven by how invasive the diagnostic process is. More invasive processes are typically represented as procedures, though the dividing line may vary by organization.

Irrespective of the guidance above, systems should be prepared for some degree of overlap between these resources and be prepared to execute searches against multiple resources in cases where differentiation cannot be guaranteed. As well, in some workflows more than one type of resource or even all three might exist. E.g. Upon receiving a ReferralRequest a practitioner might initiate a DiagnosticOrder. The diagnostic service might then initiate a ProcedureRequest.

The notion of ProcedureRequest and CommunicationRequest are also closely related. The boundary between determining whether an action is considered to be training or counselling (and thus a ProcedureRequest) as opposed to a CommunicationRequest is based on whether there's a specific intent to change the mind-set of the patient. A request to merely disclose information would be considered a CommunicationRequest. Invocation of a process that will involve verification of the patient's comprehension or an attempt to change the patient's mental state would be a ProcedureRequest.

• Structure
• UML
• XML
• JSON
• All

Structure

Name	Flags	Card.	Type	Description & Constraints
ProcedureRequest	Σ		DomainResource	A request for a procedure to be performed
identifier	Σ	0..*	Identifier	Identifier
subject	Σ	1..1	Reference(Patient | Group)	Subject
code	Σ	1..1	CodeableConcept	Procedure Code Procedure Codes (SNOMED CT) (Example)
bodySite	Σ	0..*	CodeableConcept	Target body sites SNOMED CT Body Structures (Example)
reason[x]	Σ	0..1		Indication Procedure Reason Codes (Example)
reasonCodeableConcept			CodeableConcept
reasonReference			Reference(Condition)
scheduled[x]	Σ	0..1		Procedure timing schedule
scheduledDateTime			dateTime
scheduledPeriod			Period
scheduledTiming			Timing
encounter	Σ	0..1	Reference(Encounter)	Encounter
performer	Σ	0..1	Reference(Practitioner | Organization | Patient | RelatedPerson)	Performer
status	?! Σ	0..1	code	proposed | draft | requested | received | accepted | in-progress | completed | suspended | rejected | aborted ProcedureRequestStatus (Required)
notes	Σ	0..*	Annotation	Notes
asNeeded[x]	Σ	0..1		PRN
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
orderedOn	Σ	0..1	dateTime	When Requested
orderer	Σ	0..1	Reference(Practitioner | Patient | RelatedPerson | Device)	Ordering Party
priority	Σ	0..1	code	routine | urgent | stat | asap ProcedureRequestPriority (Required)
Documentation for this format

<ProcedureRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier --></identifier>
 <subject><!-- 1..1 Reference(Patient|Group) Subject --></subject>
 <code><!-- 1..1 CodeableConcept Procedure Code --></code>
 <bodySite><!-- 0..* CodeableConcept Target body sites --></bodySite>
 <reason[x]><!-- 0..1 CodeableConcept|Reference(Condition) Indication --></reason[x]>
 <scheduled[x]><!-- 0..1 dateTime|Period|Timing Procedure timing schedule --></scheduled[x]>
 <encounter><!-- 0..1 Reference(Encounter) Encounter --></encounter>
 <performer><!-- 0..1 Reference(Practitioner|Organization|Patient|RelatedPerson) Performer --></performer>
 <status value="[code]"/><!-- 0..1 proposed | draft | requested | received | accepted | in-progress | completed | suspended | rejected | aborted -->
 <notes><!-- 0..* Annotation Notes --></notes>
 <asNeeded[x]><!-- 0..1 boolean|CodeableConcept PRN --></asNeeded[x]>
 <orderedOn value="[dateTime]"/><!-- 0..1 When Requested -->
 <orderer><!-- 0..1 Reference(Practitioner|Patient|RelatedPerson|Device) Ordering Party --></orderer>
 <priority value="[code]"/><!-- 0..1 routine | urgent | stat | asap -->
</ProcedureRequest>

{
  "resourceType" : "ProcedureRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier
  "subject" : { Reference(Patient|Group) }, // R!  Subject
  "code" : { CodeableConcept }, // R!  Procedure Code
  "bodySite" : [{ CodeableConcept }], // Target body sites
  // reason[x]: Indication. One of these 2:
  "reasonCodeableConcept" : { CodeableConcept },
  "reasonReference" : { Reference(Condition) },
  // scheduled[x]: Procedure timing schedule. One of these 3:
  "scheduledDateTime" : "<dateTime>",
  "scheduledPeriod" : { Period },
  "scheduledTiming" : { Timing },
  "encounter" : { Reference(Encounter) }, // Encounter
  "performer" : { Reference(Practitioner|Organization|Patient|RelatedPerson) }, // Performer
  "status" : "<code>", // proposed | draft | requested | received | accepted | in-progress | completed | suspended | rejected | aborted
  "notes" : [{ Annotation }], // Notes
  // asNeeded[x]: PRN. One of these 2:
  "asNeededBoolean" : <boolean>,
  "asNeededCodeableConcept" : { CodeableConcept },
  "orderedOn" : "<dateTime>", // When Requested
  "orderer" : { Reference(Practitioner|Patient|RelatedPerson|Device) }, // Ordering Party
  "priority" : "<code>" // routine | urgent | stat | asap
}

Structure

Name	Flags	Card.	Type	Description & Constraints
ProcedureRequest	Σ		DomainResource	A request for a procedure to be performed
identifier	Σ	0..*	Identifier	Identifier
subject	Σ	1..1	Reference(Patient | Group)	Subject
code	Σ	1..1	CodeableConcept	Procedure Code Procedure Codes (SNOMED CT) (Example)
bodySite	Σ	0..*	CodeableConcept	Target body sites SNOMED CT Body Structures (Example)
reason[x]	Σ	0..1		Indication Procedure Reason Codes (Example)
reasonCodeableConcept			CodeableConcept
reasonReference			Reference(Condition)
scheduled[x]	Σ	0..1		Procedure timing schedule
scheduledDateTime			dateTime
scheduledPeriod			Period
scheduledTiming			Timing
encounter	Σ	0..1	Reference(Encounter)	Encounter
performer	Σ	0..1	Reference(Practitioner | Organization | Patient | RelatedPerson)	Performer
status	?! Σ	0..1	code	proposed | draft | requested | received | accepted | in-progress | completed | suspended | rejected | aborted ProcedureRequestStatus (Required)
notes	Σ	0..*	Annotation	Notes
asNeeded[x]	Σ	0..1		PRN
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
orderedOn	Σ	0..1	dateTime	When Requested
orderer	Σ	0..1	Reference(Practitioner | Patient | RelatedPerson | Device)	Ordering Party
priority	Σ	0..1	code	routine | urgent | stat | asap ProcedureRequestPriority (Required)
Documentation for this format

UML Diagram

XML Template

<ProcedureRequest xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier --></identifier>
 <subject><!-- 1..1 Reference(Patient|Group) Subject --></subject>
 <code><!-- 1..1 CodeableConcept Procedure Code --></code>
 <bodySite><!-- 0..* CodeableConcept Target body sites --></bodySite>
 <reason[x]><!-- 0..1 CodeableConcept|Reference(Condition) Indication --></reason[x]>
 <scheduled[x]><!-- 0..1 dateTime|Period|Timing Procedure timing schedule --></scheduled[x]>
 <encounter><!-- 0..1 Reference(Encounter) Encounter --></encounter>
 <performer><!-- 0..1 Reference(Practitioner|Organization|Patient|RelatedPerson) Performer --></performer>
 <status value="[code]"/><!-- 0..1 proposed | draft | requested | received | accepted | in-progress | completed | suspended | rejected | aborted -->
 <notes><!-- 0..* Annotation Notes --></notes>
 <asNeeded[x]><!-- 0..1 boolean|CodeableConcept PRN --></asNeeded[x]>
 <orderedOn value="[dateTime]"/><!-- 0..1 When Requested -->
 <orderer><!-- 0..1 Reference(Practitioner|Patient|RelatedPerson|Device) Ordering Party --></orderer>
 <priority value="[code]"/><!-- 0..1 routine | urgent | stat | asap -->
</ProcedureRequest>

JSON Template

{
  "resourceType" : "ProcedureRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier
  "subject" : { Reference(Patient|Group) }, // R!  Subject
  "code" : { CodeableConcept }, // R!  Procedure Code
  "bodySite" : [{ CodeableConcept }], // Target body sites
  // reason[x]: Indication. One of these 2:
  "reasonCodeableConcept" : { CodeableConcept },
  "reasonReference" : { Reference(Condition) },
  // scheduled[x]: Procedure timing schedule. One of these 3:
  "scheduledDateTime" : "<dateTime>",
  "scheduledPeriod" : { Period },
  "scheduledTiming" : { Timing },
  "encounter" : { Reference(Encounter) }, // Encounter
  "performer" : { Reference(Practitioner|Organization|Patient|RelatedPerson) }, // Performer
  "status" : "<code>", // proposed | draft | requested | received | accepted | in-progress | completed | suspended | rejected | aborted
  "notes" : [{ Annotation }], // Notes
  // asNeeded[x]: PRN. One of these 2:
  "asNeededBoolean" : <boolean>,
  "asNeededCodeableConcept" : { CodeableConcept },
  "orderedOn" : "<dateTime>", // When Requested
  "orderer" : { Reference(Practitioner|Patient|RelatedPerson|Device) }, // Ordering Party
  "priority" : "<code>" // routine | urgent | stat | asap
}