0.3.0 - Second STU ballot

This page is part of a downloaded copy of this specification. This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v0.3.0: STU 1 Ballot 2) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

## StructureDefinition: ProcedureRequestSTU3 - Detailed Descriptions

Definitions for the profile-procedurerequest-stu3 Profile.

1. ProcedureRequest
Definition | A record of a request for diagnostic investigations, treatments, or operations to be performed.
Control | 0..*
Alternate Names | diagnostic request
Invariants | Defined on this element dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty()) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (: contained.where(('#'+id in %resource.descendants().reference).not()).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
2. ProcedureRequest.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control | 0..1
Type | id
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
3. ProcedureRequest.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Control | 0..1
Type | Meta
4. ProcedureRequest.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
Control | 0..1
Type | uri
Is Modifier | true
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
5. ProcedureRequest.language
Definition | The base language in which the resource is written.
Control | 0..1
Binding | A human language. The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable Max Binding: All Languages
Type | code
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
6. ProcedureRequest.text
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Control | 0..1 This element is affected by the following invariants: dom-1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
7. ProcedureRequest.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
8. ProcedureRequest.extension
Definition | An Extension
Control | 0..*
Type | Extension
9. ProcedureRequest.extension:ProcedureRequestInsurance
Definition | Indicates coverage relevant to the request.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(insurance) (Extension Type: Reference(CoverageSTU3))
Must Support | true
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. ProcedureRequest.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
11. ProcedureRequest.identifier
Definition | Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Must Support | true
Comments | The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.
12. ProcedureRequest.definition
Definition | Protocol or definition followed by this request.
Control | 1..1
Type | Reference(ActivityDefinition | PlanDefinition)
Must Support | true
Alternate Names | protocol
13. ProcedureRequest.basedOn
Definition | Plan/proposal/order fulfilled by this request.
Control | 1..1
Type | Reference(Resource)
Must Support | true
Alternate Names | fulfills
14. ProcedureRequest.replaces
Definition | The request takes the place of the referenced completed or terminated request(s).
Control | 0..*
Type | Reference(Resource)
Comments | potentially relevant for CRD in some situations.
15. ProcedureRequest.requisition
Definition | A shared identifier common to all procedure or diagnostic requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.
Control | 0..1
Type | Identifier
Requirements | Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.
Alternate Names | grouperId, groupIdentifier
Comments | Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
16. ProcedureRequest.status
Definition | The status of the order.
Control | 1..1
Binding | The status of a procedure or diagnostic order. The codes SHALL be taken from RequestStatus
Type | code
Is Modifier | true
Must Support | true
Comments | The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Fixed Value | draft
17. ProcedureRequest.intent
Definition | Whether the request is a proposal, plan, an original order or a reflex order.
Control | 1..1
Binding | The kind of procedure or diagnostic request The codes SHALL be taken from RequestIntent
Type | code
Is Modifier | true
Comments | potentially relevant for CRD in some situations.
18. ProcedureRequest.priority
Definition | Indicates how quickly the ProcedureRequest should be addressed with respect to other requests.
Control | 0..1
Binding | Identifies the level of importance to be assigned to actioning the request The codes SHALL be taken from RequestPriority
Type | code
Meaning if Missing | If missing, this task should be performed with normal priority
19. ProcedureRequest.doNotPerform
Definition | Set this to true if the record is saying that the procedure should NOT be performed.
Control | 0..0
Type | boolean
Is Modifier | true
Requirements | Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.
Comments | This element is labeled as a modifier because it indicates that a procedure shouldn't happen, instead of a request for it to happen. In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ProcedureRequest.code and ProcedureRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.
Default Value | false
20. ProcedureRequest.category
Definition | A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").
Control | 0..*
Binding | Classification of the procedure For example codes, see Procedure Category Codes (SNOMED CT)
Type | CodeableConcept
Must Support | true
Requirements | Used for filtering what procedure request are retrieved and displayed.
Comments | There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.
21. ProcedureRequest.code
Definition | A code that identifies a particular procedure, diagnostic investigation, or panel of investigations, that have been requested.
Control | 1..1
Binding | Codes for tests/services that can be performed by procedure or diagnostic services. For laboratory, LOINC is (preferred)[http://build.fhir.org/terminologies.html#preferred] and a valueset using LOINC Order codes is available [here](valueset-diagnostic-requests.html). For example codes, see Procedure Codes (SNOMED CT)
Type | CodeableConcept
Must Support | true
Comments | Many laboratory and radiology procedure codes embed the specimen/organ system in the test ordeer name, for example, serum or serum/plasma glucose, or a chest xray. The specimen may not be recorded separately from the test code.
22. ProcedureRequest.subject
Definition | On whom or what the procedure or diagnostic is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).
Control | 1..1
Type | Reference(PatientSTU3)
Must Support | true
23. ProcedureRequest.context
Definition | An encounter or episode of care that provides additional information about the healthcare context in which this request is made.
Control | 0..1
Type | Reference(EncounterSTU3)
Alternate Names | encounter
Comments | potentially relevant for CRD in some situations.
24. ProcedureRequest.occurrence[x]
Definition | The date/time at which the diagnostic testing should occur.
Control | 0..1
Type | Choice of: dateTime, Period, Timing
[x] Note | See Choice of Data Types for further information about how to use [x]
Must Support | true
Alternate Names | schedule
25. ProcedureRequest.asNeeded[x]
Definition | If a CodeableConcept is present, it indicates the pre-condition for performing the procedure. For example "pain", "on flare-up", etc.
Control | 0..1
Binding | A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc. For example codes, see SNOMED CT Medication As Needed Reason Codes
Type | Choice of: boolean, CodeableConcept
[x] Note | See Choice of Data Types for further information about how to use [x]
Comments | potentially relevant for CRD in some situations.
26. ProcedureRequest.authoredOn
Definition | When the request transitioned to being actionable.
Control | 1..1
Type | dateTime
Must Support | true
Alternate Names | orderedOn
27. ProcedureRequest.requester
Definition | The individual who initiated the request and has responsibility for its activation.
Control | 1..1
Type | BackboneElement
Must Support | true
Alternate Names | author, orderer
Comments | This not the dispatcher, but rather who is the authorizer.
Invariants | Defined on this element ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
28. ProcedureRequest.requester.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control | 0..1
Type | string
29. ProcedureRequest.requester.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
30. ProcedureRequest.requester.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Control | 0..*
Type | Extension
Is Modifier | true
Alternate Names | extensions, user content, modifiers
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
31. ProcedureRequest.requester.agent
Definition | The device, practitioner or organization who initiated the request.
Control | 1..1
Type | Reference(PractitionerSTU3)
Must Support | true
32. ProcedureRequest.requester.onBehalfOf
Definition | The organization the device or practitioner was acting on behalf of.
Control | 0..1
Type | Reference(Organization)
Requirements | Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when authoring the request.
Comments | potentially relevant for CRD in some situations.
33. ProcedureRequest.performerType
Definition | Desired type of performer for doing the diagnostic testing.
Control | 0..1
Binding | Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc. For example codes, see Participant Roles
Type | CodeableConcept
Comments | potentially relevant for CRD in some situations.
34. ProcedureRequest.performer
Definition | The desired perfomer for doing the diagnostic testing. For example, the surgeon, dermatopathologist, endoscopist, etc.
Control | 0..1
Type | Reference(PractitionerSTU3)
Must Support | true
Comments | If needed, use an extension for listing alternative performers and/or roles and/or preference.
35. ProcedureRequest.reasonCode
Definition | An explanation or justification for why this diagnostic investigation is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInformation.
Control | 0..*
Binding | Diagnosis or problem codes justifying the reason for requesting the procedure or diagnostic investigation. For example codes, see Procedure Reason Codes
Type | CodeableConcept
Must Support | true
Comments | This may be used to decide how the diagnostic investigation will be performed, or even if it will be performed at all. Use CodeableConcept text element if the data is free (uncoded) text as shown in the CT Scan example.
36. ProcedureRequest.reasonReference
Definition | Indicates another resource that provides a justification for why this diagnostic investigation is being requested. May relate to the resources referred to in supportingInformation.
Control | 0..*
Type | Reference(US Core Condition Profile | US Core Result Observation)
Must Support | true
Comments | potentially relevant for CRD in some situations.
37. ProcedureRequest.supportingInfo
Definition | Additional clinical information about the patient or specimen that may influence the procedure or diagnostics or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.
Control | 0..*
Type | Reference(Resource)
Alternate Names | Ask at order entry question, AOE
Comments | potentially relevant for CRD in some situations.
38. ProcedureRequest.specimen
Definition | One or more specimens that the laboratory procedure will use.
Control | 0..*
Type | Reference(Specimen)
Comments | Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, If the request is entered first with an unknown specimen, The Specimen resource references to the ProcedureRequest.
39. ProcedureRequest.bodySite
Definition | Anatomic location where the procedure should be performed. This is the target site.
Control | 0..*
Binding | Codes describing anatomical locations. May include laterality. For example codes, see SNOMED CT Body Structures
Type | CodeableConcept
Requirements | Knowing where the procedure is performed is important for tracking if multiple sites are possible.
Alternate Names | location
Comments | Only used if not implicit in the code found in ProcedureRequest.type. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedurerequest-targetBodySite.
40. ProcedureRequest.note
Definition | Any other notes and comments made about the service request. For example, letting provider know that "patient hates needles" or other provider instructions.
Control | 0..*
Type | Annotation
Comments | potentially relevant for CRD in some situations.
41. ProcedureRequest.relevantHistory
Definition | Key events in the history of the request.
Control | 0..*
Type | Reference(Provenance)
Comments | potentially relevant for CRD in some situations.