This section details the design approach using FHIR Resources to support the PRSB heading model which use the Procedure Resource. The Procedure Resource is referenced via the List Resource.
Resources Used for Profile Design
The FHIR Resources are profiled to create the procedure list as follows:
- CareConnect-ITK-Procedure-List-1 - A CareConnect derived NHS Digital Profile for recording a snapshot of the list of Procedures for the patient.
- CareConnect-ITK-Procedure-1 - A CareConnect derived NHS Digital Profile for procedures. The Procedure Resource is used to record an action that is or was performed on a patient.
This Resource acts as a container for the procedures. The following is an example of the main elements used:
- identifier - uniquely identifies this list of procedures (UUIDs)
- code - the type of list (for example SNOMED CT concept for “requested procedures”)
- status - should always be “current”
- mode - should always be “snapshot”
- subject - a reference to the patient whose procedure list this is
- Encounter - a reference to the context in which the list was created (the inpatient stay for example)
- date - when the list was prepared
- source - who or what defined the list
- entry - a reference to the Procedure Resource entry
This Resource is used to record detailed information about a procedure. The following is an example of the elements that can be used:
- identifier - uniquely identifies this procedure (UUIDs)
- status - completed, aborted etc
- category - Classification of the procedure
- code - identification of the procedure
- bodySite - the body site of the procedure
- complicationDetail - details of any intra-operative complications encountered during the procedure, arising during the patient’s stay in the recovery unit or directly attributable to the procedure
- anestheticIssues - details of any adverse reaction to any anaesthetic agents including local anaesthesia. Problematic intubation, transfusion reaction, etc.
- note - any further textual comment to clarify such as statement that information is partial or incomplete
- performed - when procedure was performed
- subject - the patient
- outcome - the result of procedure
|71388002 | Procedure (procedure) | hierarcy AND Procedure with explicit context (situation)|
|SCTID: 129125009 [EXTENSIBLE]|
Terminology binding as a SNOMED Expression:
|<<129125009 |Procedure with explicit context||
Procedure.code can carry combined bodySite expression:
|Laterality only - 448243002 | external fixation of femur | :272741003 | laterality | = 7771000 | left ||
|Refined site and laterality - 448243002 | external fixation of femur | :405813007 | procedure site - Direct | = 41111004 | bone structure of shaft of femur | , 272741003 | laterality | = 7771000 | left ||
|<<442083009 |anatomical or acquired body structure||
Note: that this includes the following two sub-hierarchies
- 91723000 anatomical structure
- 280115004 acquired body structure
So, an alternative is only:
- 91723000 anatomical structure
References the condition resource.
Uses the Extension-CareConnect-AnaestheticIssues-1 extension to either references the condition resource or carry a SNOMED CT concept to detail the anaesthetic issues the patient had.
Any further textual comment to clarify such as statement that information is partial or incomplete. MUST be repeated in the FHIR element Composition.section.text.
How the Procedure List is Constructed
The Procedure list is constructed as a single list. The diagram below shows the Resources used and relationships between the Resources.
Procedure List Item Example
Example to show a procedure list