# US Core Procedure Profile - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core Procedure Profile**

## Resource Profile: US Core Procedure Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 5 | *Computable Name*:USCoreProcedureProfile |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.53 | | |

 
The US Core Procedure Profile inherits from the FHIR [Procedure](https://hl7.org/fhir/R4/procedure.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) **Procedures** Data Class. It sets minimum expectations for the Procedure resource to record, search, and fetch procedure information associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. 

**Example Usage Scenarios:**

The following are example usage scenarios for this profile:

* Query for procedures performed on a Patient
* [Record or update](us-core-roadmap.md#future-candidate-requirements-under-consideration) a procedure performed on a Patient

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory](must-support.md) definition) or must be supported if the data is present in the sending system ([Must Support](must-support.md) definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views](#profile) below provides the formal summary, definitions, and terminology requirements.

**Each Procedure Must Have:**

1. a status
1. a code that identifies the type of procedure performed on the patient1
1. a patient
1. when the procedure was performed2

**Each Procedure Must Support:**

1. the encounter associated with the procedure

**Additional USCDI Requirements:**

This [Additional USCDI Requirements](must-support.md#additional-uscdi-requirements) element is not Mandatory or Must Support but is required for ONC Health IT certification testing and is included in the formal definition of the profile and the Procedure examples.

1. who was involved in the procedure3
1. a reason or indication for referral or consultation4

1,2,3,4 see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

* 2The `Procedure.performed` is mandatory if `Procedure.status` is "completed" or "in-progress".
* 1Unless exchanging legacy or text-only data, procedure codes **SHOULD** be taken from SNOMED-CT, CPT, HCPCS II, ICD-10-PCS, CDT, or LOINC.[§](requirements.md#CONF-0895) 
* Only LOINC concepts that reflect actual procedures **SHOULD** be used.[§](requirements.md#CONF-0480)
 
* A procedure including an implantable device **SHOULD** use `Procedure.focalDevice` referencing the [US Core Device Profile](StructureDefinition-us-core-device.md).[§](requirements.md#CONF-0892)
* See the [Screening and Assessments](screening-and-assessments.md) guidance page for more information when exchanging Social Determinants of Health (SDOH) Procedures
* 4Servers and Clients **SHALL** support both US Core ServiceRequest and US Core Procedure Profiles for communicating the reason or justification for a referral as Additional USCDI Requirements.[§](requirements.md#CONF-0482),[§](requirements.md#CONF-0483) Typically, the reason or justification for a referral or consultation is communicated through `Procedure.basedOn` linking the Procedure to the US Core ServiceRequest Profile that includes either `ServiceRequest.reasonCode` or `ServiceRequest.reasonReference`. When the Procedure does not have an associated ServiceRequest, it is communicated through the US Core Procedure Profile's `Procedure.reasonCode` or `Procedure.reasonReference`. Depending on the procedure being documented, a Server will select the appropriate Profile to use. 
* Although both `Procedure.reasonCode` and `Procedure.reasonReference` are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but **SHALL** support at least one of these elements.[§](requirements.md#CONF-0484) The certifying Client application **SHALL** support both elements.[§](requirements.md#CONF-0485) 
* when using `Procedure.reasonReference`: 
* Servers **SHALL** support **at least one** target resource in `Procedure.reasonReference`.[§](requirements.md#CONF-0486) Clients **SHALL** support all target resources in `Procedure.reasonReference`.[§](requirements.md#CONF-0487)
* The referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](general-guidance.md#referencing-us-core-profiles).[§](requirements.md#CONF-0488)
 
 
 

* 3The profile elements `Procedure.asserter and Procedure.performer.actor` communicate the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

**Usages:**

* Refer to this Profile: [US Core Encounter Profile](StructureDefinition-us-core-encounter.md)
* Examples for this Profile: [Procedure/defib-implant](Procedure-defib-implant.md) and [Procedure/rehab](Procedure-rehab.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.core|current/StructureDefinition/StructureDefinition-us-core-procedure.json)

**Changes since version 8.0.1:**

* The resource metadata has changed (copyright)

* The data elements list has changed

* One or more text definitions, invariants or bindings have changed

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-procedure.csv), [Excel](StructureDefinition-us-core-procedure.xlsx), [Schematron](StructureDefinition-us-core-procedure.sch) 

### Notes:

-------

**Quick Start**  

-------

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to procedure data **SHALL** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/Procedure.rs` [§](requirements.md#CONF-0150)

#### Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. **SHALL** support searching for all procedures for a patient using the **[`patient`](SearchParameter-us-core-procedure-patient.md)** search parameter:`GET [base]/Procedure?patient={Type/}[id]`Example:
1. GET [base]/Procedure?patient=1291938
**Implementation Notes:** Fetches a bundle of all Procedure resources for the specified patient ([how to search by reference](http://hl7.org/fhir/R4/search.html#reference))
1. **SHALL** support searching using the combination of the **[`patient`](SearchParameter-us-core-procedure-patient.md)** and **[`date`](SearchParameter-us-core-procedure-date.md)** search parameters:
* including support for these `date` comparators: `gt,lt,ge,le`
* including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]]&...`)
`GET [base]/Procedure?patient={Type/}[id]&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}`Example:
1. GET [base]/Procedure?patient=1137192&date=ge2019-01-14
**Implementation Notes:** Fetches a bundle of all Procedure resources for the specified patient and date ([how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token))

#### Optional Search Parameters:

The following search parameter combinations **SHOULD** be supported:

1. **SHOULD**support searching using the combination of the**[`patient`](SearchParameter-us-core-procedure-patient.md)**and**[`status`](SearchParameter-us-core-procedure-status.md)**search parameters:
* including support for **OR** search on `status` (e.g.`status={system|}[code],{system|}[code],...`)
`GET [base]/Procedure?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}`Example:
1. GET [base]/Procedure?patient=1137192&status=completed
**Implementation Notes:** Fetches a bundle of all Procedure resources for the specified patient and status ([how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token))
1. **SHOULD**support searching using the combination of the**[`patient`](SearchParameter-us-core-procedure-patient.md)**and**[`code`](SearchParameter-us-core-procedure-code.md)**and**[`date`](SearchParameter-us-core-procedure-date.md)**search parameters:
* including optional support for **OR** search on `code` (e.g.`code={system|}[code],{system|}[code],...`)
* including support for these `date` comparators: `gt,lt,ge,le`
* including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]]&...`)
`GET [base]/Procedure?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}`Example:
1. GET [base]/Procedure?patient=1137192&date=ge2019-01-14T00:00:00Z&code=http://snomed.info/sct|35637008
**Implementation Notes:** Fetches a bundle of all Procedure resources for the specified patient and date and procedure code(s). **SHOULD** support search by multiple codes. ([how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date))



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-procedure",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 5
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.53"
  }],
  "version" : "9.0.0",
  "name" : "USCoreProcedureProfile",
  "title" : "US Core Procedure Profile",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-10-17",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core Procedure Profile inherits from the FHIR [Procedure](https://hl7.org/fhir/R4/procedure.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI)  *Procedures* Data Class. It sets minimum expectations for the Procedure resource to record, search, and fetch procedure information associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Procedure",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Procedure",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Procedure",
      "path" : "Procedure",
      "constraint" : [{
        "key" : "us-core-7",
        "severity" : "error",
        "human" : "Performed SHALL be present if the status is 'completed' or 'in-progress'",
        "expression" : "(status='completed' or status='in-progress') implies performed.exists()"
      }],
      "mustSupport" : false
    },
    {
      "id" : "Procedure.basedOn",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Procedure.basedOn",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: A request for this procedure",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : false
    },
    {
      "id" : "Procedure.status",
      "path" : "Procedure.status",
      "condition" : ["us-core-7"],
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "valueSet" : "http://hl7.org/fhir/ValueSet/event-status"
      }
    },
    {
      "id" : "Procedure.code",
      "path" : "Procedure.code",
      "min" : 1,
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "description" : "Codes describing the type of Procedure",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code"
      }
    },
    {
      "id" : "Procedure.subject",
      "path" : "Procedure.subject",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/Group"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Procedure.encounter",
      "path" : "Procedure.encounter",
      "short" : "Encounter associated with the procedure",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Procedure.performed[x]",
      "path" : "Procedure.performed[x]",
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "dateTime"
      },
      {
        "code" : "Period"
      },
      {
        "code" : "string"
      },
      {
        "code" : "Age"
      },
      {
        "code" : "Range"
      }],
      "condition" : ["us-core-7"],
      "mustSupport" : true
    },
    {
      "id" : "Procedure.performer",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Procedure.performer",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The people who performed the procedure"
    },
    {
      "id" : "Procedure.performer.actor",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Procedure.performer.actor",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: The reference to the practitioner",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }]
    },
    {
      "id" : "Procedure.reasonCode",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Procedure.reasonCode",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Coded reason procedure performed",
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code"
      }
    },
    {
      "id" : "Procedure.reasonReference",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Procedure.reasonReference",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Profile justifying the reason procedure performed"
    }]
  }
}

```
