Procedure

An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

Overview

This resource is used to record the details of current and historical procedures performed on or for a patient. A procedure is an activity that is performed on, with, or for a patient as part of the provision of care. This resource provides summary information about the occurrence of the procedure and is not intended to provide real-time snapshots of a procedure as it unfolds.

This profile is used to define the content that will be returned by the API Server in response to requests to access Procedure resources. All elements described in the Definition and Detailed Definitions below are supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

List of profiles we support:

Definition

The official URL for this profile is:

https://fhir.athena.io/StructureDefinition/ah-procedure

The base definition for this profile is:

Procedure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Procedure0..*ProcedureAn action that is being or was performed on a patient
... idΣ0..1idLogical id of this artifact
... metaΣ0..1MetaMetadata about the resource
... implicitRules?!Σ0..1uriA set of rules under which this content was created
... text0..1NarrativeText summary of the resource, for human interpretation
... contained0..*ResourceContained, inline Resources
... Slices for extension1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ahChartSharingGroup0..1Reference(Organization)athenahealth Chart Sharing Group
URL: https://fhir.athena.io/StructureDefinition/ah-chart-sharing-group
... ahPractice1..1Reference(Organization)athenahealth Practice
URL: https://fhir.athena.io/StructureDefinition/ah-practice
... modifierExtension?!0..*ExtensionExtensions that cannot be ignored
... identifierΣ0..*IdentifierExternal Identifiers for this procedure
... status?!Σ1..1codepreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Binding: EventStatus (required): A code specifying the state of the procedure.

... codeΣ0..1CodeableConceptIdentification of the procedure
Binding: ProcedureCodes(SNOMEDCT) (example): A code to identify a specific procedure .

... subjectΣ1..1Reference(Patient)Who the procedure was performed on
... encounterΣ0..1Reference(Encounter)Encounter created as part of
... performed[x]Σ0..1When the procedure was performed
.... performedDateTimedateTime (YYYY-MM-DDThh:mm:ss+zz:zz)
.... performedPeriodPeriod
... performerΣ0..*BackboneElementThe people who performed the procedure
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... modifierExtension?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... actorΣ1..1Reference(Practitioner)The reference to the practitioner
.... onBehalfOf0..1Reference(Organization)Organization the device or practitioner was acting for
... bodySiteΣ0..*CodeableConceptTarget body sites
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... focalDevice0..*BackboneElementManipulated, implanted, or removed device
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... modifierExtension?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... manipulated1..1Reference(Device)Device that was changed

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Procedure.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Procedure.statusrequiredEventStatus
Procedure.codeexampleProcedureCodes(SNOMEDCT)
Procedure.bodySiteexampleSNOMEDCTBodyStructures

Detailed Definitions


Procedure

An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

Cardinality 0..*
Type Root

Procedure.id

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

Cardinality 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.

Procedure.meta

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.

Cardinality 0..1
Type Meta

Procedure.implicitRules

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.

Cardinality 0..1
Type uri
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.

Procedure.language

The base language in which the resource is written.

Cardinality 0..1
Type code Binding: CommonLanguages (preferred)
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).

Procedure.text

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.

Cardinality 0..1
Type Narrative
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.

Procedure.contained

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.

Cardinality 0..*
Type Resource
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.

Procedure.extension

An Extension

Cardinality 1..*
Type Extension

Procedure.extension:ahChartSharingGroup

An Extension used to reference a specific athenahealth chart sharing group Organization.

Cardinality 0..1
Type Extension(AthenaChartSharingGroup)

Procedure.extension:ahPractice

An Extension used to reference a specific athenahealth practice Organization.

Cardinality 1..1
Type Extension(AthenaPractice)

Procedure.modifierExtension

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

Cardinality 0..*
Type Extension
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.
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.

Procedure.identifier

Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.

Cardinality 0..*
Type Identifier
Comments 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 Person resource instances might share the same social insurance number.
Requirements Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.

Procedure.status

A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.

Cardinality 1..1
Type code Binding: EventStatus (required)
Comments The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Procedure.code

The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").

Cardinality 0..1
Type CodeableConcept Binding: ProcedureCodes(SNOMEDCT) (example)
Requirements 0..1 to account for primarily narrative only resources.

Procedure.subject

The person, animal or group on which the procedure was performed.

Cardinality 1..1
Type Reference(Patient)

Procedure.encounter

The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.

Cardinality 0..1
Type Reference(Encounter)
Comments This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Procedure.performed[x]

Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

Cardinality 0..1
Type dateTime (YYYY-MM-DDThh:mm:ss+zz:zz) | Period
Comments Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

Procedure.performer

Limited to "real" people rather than equipment.

Cardinality 0..*
Type BackboneElement

Procedure.performer.id

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

Cardinality 0..1
Type string

Procedure.performer.extension

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.

Cardinality 0..*
Type Extension
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.

Procedure.performer.modifierExtension

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).

Cardinality 0..*
Type Extension
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.
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.

Procedure.performer.actor

The practitioner who was involved in the procedure.

Cardinality 1..1
Type Reference(Practitioner)
Requirements A reference to Device supports use cases, such as pacemakers.

Procedure.performer.onBehalfOf

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

Cardinality 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 performing the action.

Procedure.bodySite

Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.

Cardinality 0..*
Type CodeableConcept Binding: SNOMEDCTBodyStructures (example)
Comments If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

Procedure.focalDevice

A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.

Cardinality 0..*
Type BackboneElement

Procedure.focalDevice.id

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

Cardinality 0..1
Type string

Procedure.focalDevice.extension

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.

Cardinality 0..*
Type Extension
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.

Procedure.focalDevice.modifierExtension

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).

Cardinality 0..*
Type Extension
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.
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.

Procedure.focalDevice.manipulated

The device that was manipulated (changed) during the procedure.

Cardinality 1..1
Type Reference(Device)

Interactions

READ

Read interactions are executed as specified in the HL7 FHIR RESTful API read specification. To read Procedure resources, an application will perform an HTTP GET specifying the logical ID of the Procedure being retrieved.

The [patient|user|system]/Procedure.read authorization scope is required.

GET
/fhir/r4/Procedure/{logicalId}
Try in Postman

Parameters

required

conditional required

Name Type Description
logicalId string (REQUIRED) The logical ID of the resource (alias: Resource.id). It is specified in the URL path and not as a query parameter.

Response Codes

Response code Description
200 OK The requested Procedure resource was found and is contained within the body of the HTTP response.
400 Bad Request The server could not understand the request due to invalid syntax. The body of the HTTP response will contain an OperationOutcome resource that indicates the invalid request could not be processed.
404 Not Found The requested resource does not exist. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
410 Gone The requested resource has been permanently deleted from server with no forwarding address. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

GET SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Procedure resources using the HTTP GET method, an application will perform the HTTP GET specifying the query parameters associated with the Procedure in the URL.

The [patient|user|system]/Procedure.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Device.read
  • [patient|user|system]/Encounter.read
  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Practitioner.read
  • [patient|user|system]/Provenance.read

GET
/fhir/r4/Procedure
Try in Postman

Parameters

Procedure search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
patient reference (CONDITIONAL REQUIRED) Procedure.patient resource reference to FHIR Patient resource
date date Procedure.period resource reference to FHIR Period resource
_count number The number of Procedure resources to return per page for paged search results.
cursor token Search by cursor token for first resource to return in a paged search result
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
encounter reference Procedure.encounter resource reference to FHIR Encounter resource
performer reference Procedure.performer.actor resource reference to FHIR Pracitioner resource
ah-provider-group reference Search by athenahealth Provider Group (e.g., 'ah-provider-group=Organization/a-[practiceId].PG-[providerGroupId]') for resources containing the 'Athena Provider Group' Extension
device-name reference Search for Procedures having a referenced Device
_id token (CONDITIONAL REQUIRED) Procedure._id resource reference to FHIR Procedure resource
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Procedure:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Procedure:performer - Included resource(s) Device, Organization, Patient, Practitioner and required scope(s) [patient|user|system]/Device.read, [patient|user|system]/Organization.read, [patient|user|system]/Patient.read, [patient|user|system]/Practitioner.read
  • Procedure:device-name - Included resource(s) Device and required scope(s) [patient|user|system]/Device.read
  • Procedure:ah-provider-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Procedure:encounter - Included resource(s) Encounter and required scope(s) [patient|user|system]/Encounter.read
  • Procedure:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

POST SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Procedure resources using the HTTP POST method, an application will perform the HTTP POST specifying the query parameters associated with the Procedure in the request body.

The [patient|user|system]/Procedure.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Device.read
  • [patient|user|system]/Encounter.read
  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Practitioner.read
  • [patient|user|system]/Provenance.read

POST
/fhir/r4/Procedure/_search
Try in Postman

Request Header

Content-Type: application/x-www-form-urlencoded

Request Body

param1=value1&param2=value2...

Parameters

Procedure search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
patient reference (CONDITIONAL REQUIRED) Procedure.patient resource reference to FHIR Patient resource
date date Procedure.period resource reference to FHIR Period resource
_count number The number of Procedure resources to return per page for paged search results.
cursor token Search by cursor token for first resource to return in a paged search result
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
encounter reference Procedure.encounter resource reference to FHIR Encounter resource
performer reference Procedure.performer.actor resource reference to FHIR Pracitioner resource
ah-provider-group reference Search by athenahealth Provider Group (e.g., 'ah-provider-group=Organization/a-[practiceId].PG-[providerGroupId]') for resources containing the 'Athena Provider Group' Extension
device-name reference Search for Procedures having a referenced Device
_id token (CONDITIONAL REQUIRED) Procedure._id resource reference to FHIR Procedure resource
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Procedure:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Procedure:performer - Included resource(s) Device, Organization, Patient, Practitioner and required scope(s) [patient|user|system]/Device.read, [patient|user|system]/Organization.read, [patient|user|system]/Patient.read, [patient|user|system]/Practitioner.read
  • Procedure:device-name - Included resource(s) Device and required scope(s) [patient|user|system]/Device.read
  • Procedure:ah-provider-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Procedure:encounter - Included resource(s) Encounter and required scope(s) [patient|user|system]/Encounter.read
  • Procedure:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
Was this information helpful? Yes | No Thank you for your feedback! What went wrong? Incomplete or incorrect information | Irrelevant Content | Others
Submit

On this Page