eHealth Infrastructure (v2020.4)

StructureDefinition: ehealth-procedurerequest - Detailed Descriptions

Definitions for the ehealth-procedurerequest Profile.

1. ProcedureRequest
Definition

A record of a request for diagnostic investigations, treatments, or operations to be performed.

Control0..*
Alternate Namesdiagnostic request
InvariantsDefined 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.

Control0..1
Typeid
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.

Control0..1
TypeMeta
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.

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.

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.

Control0..1
BindingA 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
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).

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.

Control0..1 This element is affected by the following invariants: dom-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 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.

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.

8. ProcedureRequest.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on ProcedureRequest.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. ProcedureRequest.extension:referenceRange
SliceNamereferenceRange
Definition

Provides guide for interpretation + Must have at least a low or a high or text

This rule have not been made as part of the forge!

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(referenceRange) (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta)
InvariantsDefined 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.extension:sharingPolicy
SliceNamesharingPolicy
Definition

Policy for sharing this resource with national data banks.

Control1..1 This element is affected by the following invariants: ele-1
TypeExtension(sharingPolicy) (Extension Type: CodeableConcept)
InvariantsDefined 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())
11. ProcedureRequest.extension:reuseCriteria
SliceNamereuseCriteria
Definition

Criteria to be met for reuse of responses to be allowed.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(reuseCriteria) (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta)
InvariantsDefined 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())
12. 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.

Control0..*
TypeExtension
Is Modifiertrue
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.

13. ProcedureRequest.identifier
Definition

Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
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.

14. ProcedureRequest.definition
Definition

Protocol or definition followed by this request.

Control1..1
TypeReference(ehealth-activitydefinition)
Alternate Namesprotocol
15. ProcedureRequest.basedOn
Definition

Plan/proposal/order fulfilled by this request.

Control0..0
TypeReference(Resource)
Alternate Namesfulfills
16. ProcedureRequest.replaces
Definition

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

Control0..0
TypeReference(Resource)
17. 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.

Control0..1
TypeIdentifier
Requirements

Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

Alternate NamesgrouperId, 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.

18. ProcedureRequest.requisition.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
19. ProcedureRequest.requisition.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.

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.

SlicingThis element introduces a set of slices on ProcedureRequest.requisition.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
20. ProcedureRequest.requisition.use
Definition

The purpose of this identifier.

Control0..1
BindingIdentifies the purpose for this identifier, if known .
The codes SHALL be taken from IdentifierUse
Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

21. ProcedureRequest.requisition.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingA coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
The codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.

Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

22. ProcedureRequest.requisition.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control0..1
Typeuri
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example
General:http://www.acme.com/identifiers/patient
23. ProcedureRequest.requisition.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control0..1
Typestring
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Example
General:123456
24. ProcedureRequest.requisition.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
25. ProcedureRequest.requisition.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(ehealth-organization)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

26. ProcedureRequest.status
Definition

The status of the order.

Control1..1
BindingThe status of a procedure or diagnostic order.
The codes SHALL be taken from RequestStatus
Typecode
Is Modifiertrue
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.

27. ProcedureRequest.intent
Definition

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

Control1..1
BindingThe kind of procedure or diagnostic request
The codes SHALL be taken from RequestIntent
Typecode
Is Modifiertrue
Comments

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

28. ProcedureRequest.priority
Definition

Indicates how quickly the ProcedureRequest should be addressed with respect to other requests.

Control0..1
BindingIdentifies the level of importance to be assigned to actioning the request
The codes SHALL be taken from RequestPriority
Typecode
Meaning if MissingIf missing, this task should be performed with normal priority
29. ProcedureRequest.doNotPerform
Definition

Set this to true if the record is saying that the procedure should NOT be performed.

Control0..1
Typeboolean
Is Modifiertrue
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 Valuefalse
30. ProcedureRequest.category
Definition

A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").

Control0..*
BindingClassification of the procedure
For example codes, see Procedure Category Codes (SNOMED CT)
TypeCodeableConcept
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.

31. ProcedureRequest.code
Definition

A code that identifies a particular procedure, diagnostic investigation, or panel of investigations, that have been requested.

Control1..1
BindingThe codes SHALL be taken from Activity Definition Code
TypeCodeableConcept
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.

32. 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).

Control1..1
TypeReference(ehealth-patient)
33. ProcedureRequest.context
Definition

An encounter or episode of care that provides additional information about the healthcare context in which this request is made.

Control1..1
TypeReference(ehealth-episodeofcare)
Alternate Namesencounter
34. ProcedureRequest.occurrence[x]
Definition

The date/time at which the diagnostic testing should occur.

Control0..1
TypeChoice of: dateTime, Period, Timing
[x] NoteSee Choice of Data Types for further information about how to use [x]
Alternate Namesschedule
35. 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.

Control0..1
BindingA 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
TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
36. ProcedureRequest.authoredOn
Definition

When the request transitioned to being actionable.

Control0..1
TypedateTime
Alternate NamesorderedOn
37. ProcedureRequest.requester
Definition

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

Control0..1
TypeBackboneElement
Alternate Namesauthor, orderer
Comments

This not the dispatcher, but rather who is the authorizer.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
38. 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.

Control0..1
Typestring
39. 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.

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.

40. 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.

Control0..*
TypeExtension
Is Modifiertrue
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.

41. ProcedureRequest.requester.agent
Definition

The device, practitioner or organization who initiated the request.

Control1..1
TypeReference(ehealth-device | ehealth-practitioner | ehealth-organization)
42. ProcedureRequest.requester.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control0..1
TypeReference(ehealth-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.

43. ProcedureRequest.performerType
Definition

Desired type of performer for doing the diagnostic testing.

Control0..1
BindingIndicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.
For example codes, see Participant Roles
TypeCodeableConcept
Comments

this is a role, not a participation type. I.e. does not describe the task, but describes the capacity. For example, “compounding pharmacy” or “psychiatrist” or “internal referral”.

44. ProcedureRequest.performer
Definition

The desired perfomer for doing the diagnostic testing. For example, the surgeon, dermatopathologist, endoscopist, etc.

Control0..1
TypeReference(ehealth-practitioner | ehealth-organization | ehealth-patient | ehealth-device | ehealth-relatedperson | HealthcareService)
Comments

If needed, use an extension for listing alternative performers and/or roles and/or preference.

45. 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.

Control0..*
BindingDiagnosis or problem codes justifying the reason for requesting the procedure or diagnostic investigation.
For example codes, see Procedure Reason Codes
TypeCodeableConcept
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.

46. 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.

Control0..*
TypeReference(ehealth-condition | ehealth-observation)
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.

47. 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.

Control0..*
TypeReference(Resource)
Alternate NamesAsk at order entry question, AOE
48. ProcedureRequest.specimen
Definition

One or more specimens that the laboratory procedure will use.

Control0..*
TypeReference(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.

49. ProcedureRequest.bodySite
Definition

Anatomic location where the procedure should be performed. This is the target site.

Control0..*
BindingCodes describing anatomical locations. May include laterality.
For example codes, see SNOMED CT Body Structures
TypeCodeableConcept
Requirements

Knowing where the procedure is performed is important for tracking if multiple sites are possible.

Alternate Nameslocation
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.

50. 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.

Control0..*
TypeAnnotation
51. ProcedureRequest.note.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
52. ProcedureRequest.note.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.

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.

SlicingThis element introduces a set of slices on ProcedureRequest.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
53. ProcedureRequest.note.author[x]
Definition

The individual responsible for making the annotation.

Control0..1
TypeChoice of: Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson), string
[x] NoteSee Choice of Data Types for further information about how to use [x]
54. ProcedureRequest.note.time
Definition

Indicates when this particular annotation was made.

Control0..1
TypedateTime
55. ProcedureRequest.note.text
Definition

The text of the annotation.

Control1..1
Typestring
56. ProcedureRequest.relevantHistory
Definition

Key events in the history of the request.

Control0..*
TypeReference(ehealth-provenance)
Comments

This may 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.