HL7.FHIR.US.QICORE\QICore Procedure

QI-Core Implementation Guide
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This page is part of the Quality Improvement Core Framework (v6.0.0-ballot: STU6 (v6.0.0) Ballot 1) based on FHIR R4. The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: QICore Procedure

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure				Version: 6.0.0-ballot
Active as of 2018-08-22				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.

Usage

To create an expression specifically requesting information that a procedure intentionally did not occur for a medical, patient or system reason, use the profile QICore-Procedurenotdone.

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

Usage:

Refer to this Resource Profile: QICore AdverseEvent, QICore Claim, QICore Encounter and QICore ImagingStudy
Examples for this Resource Profile: Procedure/example

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from USCoreProcedureProfile

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	USCoreProcedureProfile	An action that is being or was performed on a patient
implicitRules	S	0..1	uri	A set of rules under which this content was created
recorded	S	1..1	dateTime	When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
status	S	1..1	code	preparation \| in-progress \| on-hold \| stopped \| completed \| entered-in-error \| unknown Binding: Non-Negative Event Status (required)
subject	S	1..1	Reference(QICore Patient)	(USCDI) Who the procedure was performed on
performer
actor		1..1	Reference(QICore Practitioner \| QICore Organization \| QICore Patient \| QICore RelatedPerson)	The reference to the practitioner
reasonCode	S	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference	S	0..*	Reference(QICore Condition Encounter Diagnosis \| QICore Condition Problems Health Concerns \| QICore DiagnosticReport Profile for Report and Note Exchange \| US Core DocumentReference Profile)	The justification that the procedure was performed
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Procedure.status	required	NonNegativeEventStatus
Procedure.reasonCode	preferred	ProcedureReasonCodes

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	USCoreProcedureProfile	An action that is being or was performed on a patient
implicitRules	?!SΣ	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
recorded	S	1..1	dateTime	When the procedure was first captured in the subject's record URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣC	1..1	code	preparation \| in-progress \| on-hold \| stopped \| completed \| entered-in-error \| unknown Binding: Non-Negative Event Status (required)
code	SΣ	1..1	CodeableConcept	(USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure
subject	SΣ	1..1	Reference(QICore Patient)	(USCDI) Who the procedure was performed on
performed[x]	SΣC	0..1		(USCDI) When the procedure was performed
performedDateTime			dateTime
reasonCode	SΣ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference	SΣ	0..*	Reference(QICore Condition Encounter Diagnosis \| QICore Condition Problems Health Concerns \| QICore DiagnosticReport Profile for Report and Note Exchange \| US Core DocumentReference Profile)	The justification that the procedure was performed
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Procedure.status	required	NonNegativeEventStatus
Procedure.code	extensible	USCoreProcedureCodes
Procedure.reasonCode	preferred	ProcedureReasonCodes

Constraints

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()
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()