QI-Core Implementation Guide
4.1.1 - STU 4.1.1 US

This page is part of the Quality Improvement Core Framework (v4.1.1: STU 4) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: QICoreDeviceNotRequested - Detailed Descriptions

Draft as of 2019-07-11

Definitions for the qicore-devicenotrequested resource profile.

1. DeviceRequest
Definition

Represents a request for a patient to employ a medical device. The device may be an implantable device, or an external assistive device, such as a walker.

Control0..*
InvariantsDefined on this element
dnr-1: to indicate what device was not requested, either at least one coding in the code or a notDoneValueSet extension shall be provided (: code.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor code.coding.exists())
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 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.`div`.exists())
2. DeviceRequest.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typestring
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. DeviceRequest.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Control0..1
TypeMeta
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. DeviceRequest.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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is Modifiertrue
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. DeviceRequest.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages
Max Binding: AllLanguages A human language.

Typecode
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).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. DeviceRequest.text
Definition

A human-readable narrative that contains a summary of the resource and can 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.

Control0..1
TypeNarrative
Alternate Namesnarrative, 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 information is added later.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. DeviceRequest.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.

Control0..*
TypeResource
Alternate Namesinline 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

8. DeviceRequest.extension
Definition

An Extension

Control0..*
TypeExtension
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on DeviceRequest.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. DeviceRequest.extension:doNotPerformReason
SliceNamedoNotPerformReason
Definition

Indicates the reason the event was not performed.

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(QICoreDoNotPerformReason) (Extension Type: CodeableConcept)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. DeviceRequest.modifierExtension
Definition

An Extension

Control0..*
TypeExtension
Is Modifiertrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on DeviceRequest.modifierExtension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
11. DeviceRequest.modifierExtension:doNotPerform
SliceNamedoNotPerform
Definition

An Extension

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(Extension-5.0-DeviceRequest.doNotPerform) (Extension Type: boolean)
Is Modifiertrue
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
12. DeviceRequest.modifierExtension:doNotPerform.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
13. DeviceRequest.modifierExtension:doNotPerform.extension
Definition

An Extension

Control0..0
TypeExtension
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on DeviceRequest.modifierExtension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
14. DeviceRequest.modifierExtension:doNotPerform.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-DeviceRequest.doNotPerform
15. DeviceRequest.modifierExtension:doNotPerform.value[x]
Definition

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

Control1..1
Typeboolean
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Fixed Valuetrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. DeviceRequest.identifier
Definition

Identifiers assigned to this order by the orderer or by the receiver.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. DeviceRequest.instantiatesCanonical
Definition

The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this DeviceRequest.

Control0..*
Typecanonical(ActivityDefinition | PlanDefinition)
Comments

Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. DeviceRequest.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this DeviceRequest.

Control0..*
Typeuri
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. DeviceRequest.basedOn
Definition

Plan/proposal/order fulfilled by this request.

Control0..*
TypeReference(Resource)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. DeviceRequest.priorRequest
Definition

The request takes the place of the referenced completed or terminated request(s).

Control0..*
TypeReference(Resource)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. DeviceRequest.groupIdentifier
Definition

Composite request this is part of.

Control0..1
TypeIdentifier
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. DeviceRequest.status
Definition

The status of the request.

Control1..1
BindingThe codes SHALL be taken from RequestStatus Codes representing the status of the request.

Typecode
Is Modifiertrue
Must Supporttrue
Comments

This element is labeled as a modifier because the status contains the codes cancelled and entered-in-error that mark the request as not currently valid.

Fixed Valuecompleted
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. DeviceRequest.intent
Definition

Whether the request is a proposal, plan, an original order or a reflex order.

Control1..1
BindingThe codes SHALL be taken from RequestIntent The kind of diagnostic request.

Typecode
Is Modifiertrue
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. DeviceRequest.priority
Definition

Indicates how quickly the {{title}} should be addressed with respect to other requests.

Control0..1
BindingThe codes SHALL be taken from RequestPriority Identifies the level of importance to be assigned to actioning the request.

Typecode
Meaning if MissingIf missing, normal priority
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. DeviceRequest.code[x]
Definition

The details of the device to be used.

Control1..1 This element is affected by the following invariants: dnr-1
BindingFor example codes, see FHIRDeviceTypes Codes for devices that can be requested.

TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. DeviceRequest.code[x].id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
27. DeviceRequest.code[x].extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, 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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on DeviceRequest.code[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
28. DeviceRequest.code[x].extension:doNotPerformValueSet
SliceNamedoNotPerformValueSet
Definition

Specifies the value set that characterizes the events or activities that did not occur or were not performed.

Control0..1 This element is affected by the following invariants: dnr-1
TypeExtension(NotDoneValueSet) (Extension Type: canonical(ValueSet))
Must Supporttrue
Requirements

Must be able to indicate the value set from which the expected event would be drawn, had it occurred.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
29. DeviceRequest.code[x].coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
30. DeviceRequest.code[x].text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control0..1
Typestring
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
31. DeviceRequest.parameter
Definition

Specific parameters for the ordered item. For example, the prism value for lenses.

Control0..*
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. DeviceRequest.parameter.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
33. DeviceRequest.parameter.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, 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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
34. DeviceRequest.parameter.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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, 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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
35. DeviceRequest.parameter.code
Definition

A code or string that identifies the device detail being asserted.

Control0..1
Binding

A code that identifies the device detail.

TypeCodeableConcept
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. DeviceRequest.parameter.value[x]
Definition

The value of the device detail.

Control0..1
TypeChoice of: CodeableConcept, Quantity, Range, boolean
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

Range means device should have a value that falls somewhere within the specified range.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
37. DeviceRequest.subject
Definition

The patient who will use the device.

Control1..1
TypeReference(QICorePatient)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
38. DeviceRequest.encounter
Definition

An encounter that provides additional context in which this request is made.

Control0..1
TypeReference(QICoreEncounter)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
39. DeviceRequest.occurrence[x]
Definition

The timing schedule for the use of the device. The Schedule data type allows many different expressions, for example. "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013".

Control0..1
TypeChoice of: dateTime, Period, Timing
[x] NoteSee Choice of Data Types for further information about how to use [x]
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
40. DeviceRequest.authoredOn
Definition

When the request transitioned to being actionable.

Control1..1
TypedateTime
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
41. DeviceRequest.requester
Definition

The individual who initiated the request and has responsibility for its activation.

Control0..1
TypeReference(Device | Practitioner | PractitionerRole | Organization)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
42. DeviceRequest.performerType
Definition

Desired type of performer for doing the diagnostic testing.

Control0..1
BindingFor example codes, see ParticipantRoles Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

TypeCodeableConcept
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
43. DeviceRequest.performer
Definition

The desired performer for doing the diagnostic testing.

Control0..1
TypeReference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
44. DeviceRequest.reasonCode
Definition

Reason or justification for the use of this device.

Control0..*
BindingFor example codes, see Condition/Problem/DiagnosisCodes Diagnosis or problem codes justifying the reason for requesting the device.

TypeCodeableConcept
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
45. DeviceRequest.reasonReference
Definition

Reason or justification for the use of this device.

Control0..*
TypeReference(Condition | Observation | DiagnosticReport | DocumentReference)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
46. DeviceRequest.insurance
Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Control0..*
TypeReference(Coverage | ClaimResponse)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
47. DeviceRequest.supportingInfo
Definition

Additional clinical information about the patient that may influence the request fulfilment. For example, this may include where on the subject's body the device will be used (i.e. the target site).

Control0..*
TypeReference(Resource)
Requirements

Knowing where the device is targeted is important for tracking if multiple sites are possible.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
48. DeviceRequest.note
Definition

Details about this request that were not represented at all or sufficiently in one of the attributes provided in a class. These may include for example a comment, an instruction, or a note associated with the statement.

Control0..*
TypeAnnotation
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
49. DeviceRequest.relevantHistory
Definition

Key events in the history of the request.

Control0..*
TypeReference(Provenance)
Comments

This might not include provenances for all versions of the request - only those deemed "relevant" or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a "relevant" change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))