Dieses Profil beschreibt eine Strahlentherapie in der Onkologie. Das Strahlentherapieprofil für die Onkologie basiert auf dem Prozedurenmodul der MII. Es übernimmt damit die zwingende Angabe von OPS als Kodierung für die Art der Prozedur. Da die Details der Prozedur in den einzelnen Bestrahlungselementen hinterlegt sind, soll hier die OPS für Strahlentherapie kodiert werden.

Das MII-Modul Prozedur besitzt bereits eine Extension Durchführungsabsicht mit Binding auf SNOMED-CT Codes. Da die Intention der Strahlentherapie im oBDS jedoch durch ein oBDS-spezifisches Antwortspektrum erfasst wird, wurde die Prozedur um eine zusätzliches Element "Intention" erweitert. Ebenso wird der Zusammenhang zu eventuellen Operationen (z.B. adjuvant/neoadjuvant) über das Erweiterungselement "Stellung" erfasst.

Die spezifischen Details der Strahlentherapie werden in einzelnen Bestrahlungen unterteilt und berichtet. Dabei wird jede Bestrahlung als Extension erfasst.

Komplikationen der Strahlentherapie werden nicht als Procedure.complication oder Procedure.complicationReference kodiert, sondern wie bei der Systemischen Therapie in einer gesonderten AdverseEvent-Ressource mit Verweis auf die Strahlentherapie-Ressource erfasst. Es ist dabei zu beachten, dass ein Verweis auf die Strahlentherapie-Ressource unspezifisch auf die komplette Strahlentherapie und nicht auf einzelne Bestrahlungen zeigt.

Der Grund der Beendigung (unabhängig ob erfolgreich oder nicht erfolgreich) wird über Procedure.outcome kodiert.

Struktur

Die Entscheidung, die Bestrahlungsdaten als Extension umzusetzen, hat mehrere Gründe.

1. Die Datenstruktur des oBDS sieht die Angabe einer Strahlentherapie-Gesamtperiode mit Start und Ende sowie einem Gesamt-Intentions und Stellung-zur-OP-Datenpunkt vor. Alle weiteren strukturierten Behandlungsinformationen zur Bestrahlung (Strahlenart, Lokalisation, Dosis, Boost etc.) sollen einzeln in einem Element "Bestrahlung" kodiert werden.

2. Die MII-Prozedur verlangt, dass jede Prozedur genau einen Code vorliegen hat, entweder OPS oder SNOMED-CT.

3. Die US-amerikanische FHIR-Datenmodell mCODE bildet die relevanten Datenpunkte in Extensions ab. Zu erwähnen ist allerdings, dass es bei mCODE hier keine Unterscheidung in übergeordnete Strahlentherapie und untergeordnete Bestrahlung gibt. mCODE sieht jedoch dafür auch detaillierte Angaben zur Größe des Zielvolumens vor.

Alternativ wurde auch eine Umsetzung diskutiert, die übergreifende Strahlentherapie als Profil konform zur MII-Prozedur zu belassen, und die untergeordneten Bestrahlungen aus der regulären Procedure zu profilieren. Diese Profilierung wurde wegen der größeren Anzahl von notwenidgen Ressourcen und der vorrausichtlichen Schwierigkeit der korrekten Belegung des OPS/SNOMED Codes verworfen.

Kategorie und Codes

Kategorie

• Die verwendete MII-Prozedur empfiehlt die Abbildung der Kategorie mittels der in SNOMED übertragenen OPS-Hauptkategorien (https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/ValueSet/procedures-category-sct)
• Die vorliegende Kategorie SNOMED 277132007 | Therapeutic procedure , die der OPS Kategorie 8 ("Nicht-operative therapeutische Maßnahmen") entspricht, beinhaltet sowohl Strahlen - als auch Nuklearmedizinische Therapie als auch bestimmte systemische Therapien (z.B. Chemo- und Immuntherapie), wobei andere systemische medikamtöse Therapien (z.B. Hormontherapie, Targeted Therapy) auch unter Kategorie 6 "Medikamente" kodiert werden können. Er ist daher unspezifisch und nicht geeignet, um z.B. innerhalb einer Forschungsfrage gezielt nach Nuklearmedizinischen Therapien zu filtern.

Code

• Als Code wird von der MII-Prozedur ein OPS-Code oder ein SNOMED-Code verlangt.
• OPS beinhaltet Kodierungen für Strahlentherapie (8-52) und Nuklearmedizinische Behandlung (8-53) mit ausführlichen Unterkodierungen. Im oBDS selbst wird bei Strahlentherapie und Nuklearmedizin jedoch nicht nach OPS kodiert, sondern folgt einer krebsregisterspezifischen Kodierung von Lokalisation, Applikationsart und Strahlungsart sowie weiteren Datenpunkten.
• In der MII-Prozedur SOLL genau eine Kodierung (OPS oder SNOMED CT)für genau eine Therapie verwendet werden. Zusätzliche Prozeduren werden als einzelne Procedure-Ressourcen abgebildet.

Implementierungsempfehlung

Aus den oben genannten Punkten ergibt sich folgende Kodierempfehlung für die oBDS-Strahlentherapie:

• Kategorie als SNOMED - Code
  • Kategorie für Strahlentherapie 1287742003 | Radiotherapy (procedure)
  • Kategorie für Nuklearmedizin 399315003 | Radionuclide therapy (procedure)
• Kodierung über OPS
  • Strahlentherapie als OPS 8-52 Strahlentherapie (oder genauer wenn vorhanden)
  • Nuklearmedizinische Therapie als OPS 8-53 Nuklearmedizinische Therapie (oder genauer wenn vorhanden)

oBDS 2014 zu 2021 Zielgebiet Migration

Die Strahlentherapie Zielgebiet-Kodierung hat sich zwischen oBDS 2014 und 2021 grundlegend geändert:

Migrationsstrategie

• oBDS 2014: Verwendete kombinierte Codes mit Suffixen (+ mit Lymphknoten, - ohne Lymphknoten, . ohne nähere Angabe)
• oBDS 2021: Trennt Organe (Sektionen 1-8) und Lymphabflussregionen (Sektion 9) in separate Bestrahlungen
• Beispiel: oBDS 2014 Code "3.1.+" (Mamma mit Lymphknoten) wird zu zwei separaten Codes: #3.1 (Mamma) und #9.3 (Axilläre Lymphknoten)
• ValueSet: Unterstützt beide CodeSystems für Abwärtskompatibilität

Konformität

Die vorliegende Profilierung ist kompatibel mit dem Prozedurenprofil der ISiK-Basismodule Stufe 4. https://simplifier.net/isik-basis-v4/isikprozedur

Mapping Datensatz zu FHIR

Die Zuordnung der Datensatzfelder ist im logischen Modell dokumentiert: MII LM Onkologie.

Mapping Einheitlicher onkologischer Basisdatensatz (oBDS) zu FHIR

Die oBDS-Mappings sind in der Artefaktdarstellung des Profils hinterlegt: MII PR Onkologie Strahlentherapie.

Beispiele

mii-exa-onko-strahlentherapie

• Schlüsselelemente-Tabelle
• Differential-Tabelle
• Snapshot-Tabelle
• Statistiken/Referenzen
• Alle

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Procedure	C	0..*	MII_PR_Prozedur_Procedure	An action that is being or was performed on a patient Constraints: proc-mii-1
id	SΣ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
source	SΣ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:Dokumentationsdatum	S	0..1	(Complex)	Dokumentationsdatum URL: http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum"
value[x]	S	1..1	dateTime	Value of extension
extension:durchfuehrungsabsicht	S	0..1	(Complex)	Durchführungsabsicht URL: https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht"
value[x]	S	1..1	Coding	Value of extension Binding: MII VS Prozedur Durchführungsabsicht [SNOMED CT] (required)
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	SΣ	1..1	code	Symbol in syntax defined by the system
extension:Intention	S	1..1	(Complex)	Intention der Strahlentherapie URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Intention (required)
text	SΣ	0..1	string	Plain text representation of the concept
extension:StellungZurOp	S	0..*	(Complex)	Stellung der Strahlentherapie zu einer Operation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Stellung zur OP (required)
text	SΣ	0..1	string	Plain text representation of the concept
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for basedOn	SΣ	0..*	Reference(CarePlan)	A request for this procedure Slice: Unordered, Open by type:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Observation)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur OPS Kategorien [SNOMED CT] (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
version		0..1	string	Version of the system - if relevant
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	SΣ	1..1	code	Symbol in syntax defined by the system
code	SΣC	1..1	CodeableConcept	Code Binding: ProcedureCodes(SNOMEDCT) (example): A code to identify a specific procedure . Constraints: sct-ops-1
Slices for coding	SΣ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:ops	SΣ	0..1	CodingOPS	Operationen- und Prozedurenschlüssel (OPS) Code Binding: MII VS Prozedur OPS (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
Slices for extension				Content/Rules for all slices
extension:Seitenlokalisation	S	0..1	(Complex)	Optional Extensions Element URL: http://fhir.de/StructureDefinition/seitenlokalisation
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/seitenlokalisation"
value[x]	S	1..1	Coding	Value of extension Binding: KBV_VS_SFHIR_ICD_SEITENLOKALISATION (required)
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
system	SΣ	1..1	uri	Canonische CodeSystem URL für OPS Fixed Value: http://fhir.de/CodeSystem/bfarm/ops
version	SΣ	1..1	string	Die Jahresversion des OPS Kataloges. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
code	SΣC	1..1	code	Der OPS-Code Constraints: ops-regex Example Einfacher OPS-Code: 5-470
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur Prozeduren [SNOMED CT] (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
version		0..1	string	Version of the system - if relevant
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	SΣ	1..1	code	Symbol in syntax defined by the system
subject	SΣ	1..1	Reference(Patient)	Who the procedure was performed on
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
encounter	SΣ	0..1	Reference(Encounter)	Kontakt (Aufenthaltsbezug)
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
Slices for performed[x]	SΣ	1..1	Period	Durchführungsdatum Slice: Unordered, Closed by type:$this
performed[x]:All Slices				Content/Rules for all slices
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performed[x]:performedPeriod	SΣ	0..1	Period	Durchführungszeitraum
start	SΣC	1..1	dateTime	Start der Strahlentherapie
end	SΣC	0..1	dateTime	Ende der Strahlentherapie
performed[x]:performedDateTime	SΣ	0..1	dateTime	When the procedure was performed
reasonReference	SΣ	0..*	Reference(MII PR Onkologie Diagnose Primärtumor | Condition)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	Körperstelle Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Slices for extension				Content/Rules for all slices
extension:bodySite		0..1	Reference(BodyStructure)	Target anatomic location or structure URL: http://hl7.org/fhir/StructureDefinition/bodySite
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:snomed-ct	SΣ	0..1	Coding	SNOMED CT Code
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
version	SΣ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
coding	SΣ	0..*	Coding	Grund für Ende der Strahlentherapie Binding: MII VS Onkologie Strahlentherapie Ende Grund (required)
system	SΣ	0..1	uri	Identity of the terminology system
code	SΣ	0..1	code	Symbol in syntax defined by the system
note	S	0..*	Annotation	Hinweis
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Procedure.extension:durchfuehrungsabsicht.​value[x]	Base	required	MII VS Prozedur Durchführungsabsicht [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.extension:Intention.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Stellung zur OP	📦2027.0.0-ballot.1	This IG
Procedure.status	Base	required	EventStatus	📍4.0.1	FHIR Std.
Procedure.category	Base	example	Procedure Category Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.category.coding:sct	Base	preferred	MII VS Prozedur OPS Kategorien [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code	Base	example	Procedure Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.code.coding:ops	Base	required	MII VS Prozedur OPS	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code.coding:ops.​extension:Seitenlokalisation.​value[x]	Base	required	KBV_VS_SFHIR_ICD_SEITENLOKALISATION	⏿1.00	127.0.0.1
Procedure.code.coding:sct	Base	required	MII VS Prozedur Prozeduren [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Procedure.outcome	Base	example	Procedure Outcome Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.outcome.coding	Base	required	MII VS Onkologie Strahlentherapie Ende Grund	📦2027.0.0-ballot.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
ops-regex	warning	Procedure.code.coding:ops.code	In code sind nur gültige OPS-Codes ohne Zusätze erlaubt	matches('^[1|3|5|6|8|9]-[a-zA-Z0-9]{3}([.][a-zA-Z0-9]{1,2})?$')
proc-mii-1	error	Procedure	Falls die Prozedur per OPS kodiert wird, MUSS eine SNOMED-CT kodierte Category abgebildet werden	code.coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists() implies category.coding.where(system = 'http://snomed.info/sct').exists()
sct-ops-1	error	Procedure.code	Eine Prozedur MUSS mit OPS oder SNOMED-CT kodiert werden.	coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()

Diese Struktur ist abgeleitet von MII_PR_Prozedur_Procedure

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Procedure		0..*	MII_PR_Prozedur_Procedure	An action that is being or was performed on a patient
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:Intention	S	1..1	(Complex)	Intention der Strahlentherapie URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention
value[x]
coding
code		1..1	code	Symbol in syntax defined by the system
extension:StellungZurOp	S	0..*	(Complex)	Stellung der Strahlentherapie zu einer Operation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop
value[x]
coding
code		1..1	code	Symbol in syntax defined by the system
Slices for basedOn	S	0..*	Reference(CarePlan)	A request for this procedure Slice: Unordered, Open by type:$this.resolve()
basedOn:tumorkonferenz	S	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	S	0..*	Reference(Observation)	Part of referenced event
subject		1..1	Reference(Patient)	Who the procedure was performed on
performed[x]		1..1	Period	Durchführungsdatum
start		0..1	dateTime	Starting time with inclusive boundary
end		0..1	dateTime	End time with inclusive boundary, if not ongoing
Slices for performed[x]				Content/Rules for all slices
performed[x]:performedPeriod		0..1	Period	Durchführungszeitraum
start	S	1..1	dateTime	Start der Strahlentherapie
end	S	0..1	dateTime	Ende der Strahlentherapie
reasonReference	S	0..*	Reference(MII PR Onkologie Diagnose Primärtumor | Condition)	The justification that the procedure was performed
outcome	S	0..1	CodeableConcept	The result of procedure
coding	S	0..*	Coding	Grund für Ende der Strahlentherapie Binding: MII VS Onkologie Strahlentherapie Ende Grund (required)
system	S	0..1	uri	Identity of the terminology system
code	S	0..1	code	Symbol in syntax defined by the system
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Procedure.outcome.coding	Base	required	MII VS Onkologie Strahlentherapie Ende Grund	📦2027.0.0-ballot.1	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Procedure	C	0..*	MII_PR_Prozedur_Procedure	An action that is being or was performed on a patient Constraints: proc-mii-1
id	SΣ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	SΣ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:Dokumentationsdatum	S	0..1	(Complex)	Dokumentationsdatum URL: http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum"
value[x]	S	1..1	dateTime	Value of extension
extension:durchfuehrungsabsicht	S	0..1	(Complex)	Durchführungsabsicht URL: https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht"
value[x]	S	1..1	Coding	Value of extension Binding: MII VS Prozedur Durchführungsabsicht [SNOMED CT] (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
extension:Intention	S	1..1	(Complex)	Intention der Strahlentherapie URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Intention (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-intention
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
extension:StellungZurOp	S	0..*	(Complex)	Stellung der Strahlentherapie zu einer Operation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Stellung zur OP (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-stellungzurop
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Identifiers for this procedure
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
Slices for basedOn	SΣ	0..*	Reference(CarePlan)	A request for this procedure Slice: Unordered, Open by type:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Observation)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	Σ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur OPS Kategorien [SNOMED CT] (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣC	1..1	CodeableConcept	Code Binding: ProcedureCodes(SNOMEDCT) (example): A code to identify a specific procedure . Constraints: sct-ops-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:ops	SΣ	0..1	CodingOPS	Operationen- und Prozedurenschlüssel (OPS) Code Binding: MII VS Prozedur OPS (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:Seitenlokalisation	S	0..1	(Complex)	Optional Extensions Element URL: http://fhir.de/StructureDefinition/seitenlokalisation
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/seitenlokalisation"
value[x]	S	1..1	Coding	Value of extension Binding: KBV_VS_SFHIR_ICD_SEITENLOKALISATION (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	Canonische CodeSystem URL für OPS Fixed Value: http://fhir.de/CodeSystem/bfarm/ops
version	SΣ	1..1	string	Die Jahresversion des OPS Kataloges. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
code	SΣC	1..1	code	Der OPS-Code Constraints: ops-regex Example Einfacher OPS-Code: 5-470
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur Prozeduren [SNOMED CT] (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	Who the procedure was performed on
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
encounter	SΣ	0..1	Reference(Encounter)	Kontakt (Aufenthaltsbezug)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Slices for performed[x]	SΣ	1..1	Period	Durchführungsdatum Slice: Unordered, Closed by type:$this
performed[x]:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performed[x]:performedPeriod	SΣ	0..1	Period	Durchführungszeitraum
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Start der Strahlentherapie
end	SΣC	0..1	dateTime	Ende der Strahlentherapie
performed[x]:performedDateTime	SΣ	0..1	dateTime	When the procedure was performed
recorder	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Who recorded the procedure
asserter	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Person who asserts this procedure
performer	Σ	0..*	BackboneElement	The people who performed the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
location	Σ	0..1	Reference(Location)	Where the procedure happened
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
reasonReference	SΣ	0..*	Reference(MII PR Onkologie Diagnose Primärtumor | Condition)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	Körperstelle Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:bodySite		0..1	Reference(BodyStructure)	Target anatomic location or structure URL: http://hl7.org/fhir/StructureDefinition/bodySite
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:snomed-ct	SΣ	0..1	Coding	SNOMED CT Code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
version	SΣ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	0..*	Coding	Grund für Ende der Strahlentherapie Binding: MII VS Onkologie Strahlentherapie Ende Grund (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note	S	0..*	Annotation	Hinweis
focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Device)	Device that was changed
usedReference		0..*	Reference(Device | Medication | Substance)	Items used during procedure
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Procedure.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Procedure.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Procedure.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Procedure.extension:durchfuehrungsabsicht.​value[x]	Base	required	MII VS Prozedur Durchführungsabsicht [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.extension:Intention.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Stellung zur OP	📦2027.0.0-ballot.1	This IG
Procedure.status	Base	required	EventStatus	📍4.0.1	FHIR Std.
Procedure.statusReason	Base	example	Procedure Not Performed Reason (SNOMED-CT)	📍4.0.1	FHIR Std.
Procedure.category	Base	example	Procedure Category Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.category.coding:sct	Base	preferred	MII VS Prozedur OPS Kategorien [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code	Base	example	Procedure Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.code.coding:ops	Base	required	MII VS Prozedur OPS	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code.coding:ops.​extension:Seitenlokalisation.​value[x]	Base	required	KBV_VS_SFHIR_ICD_SEITENLOKALISATION	⏿1.00	127.0.0.1
Procedure.code.coding:sct	Base	required	MII VS Prozedur Prozeduren [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.subject.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Procedure.encounter.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Procedure.performer.​function	Base	example	Procedure Performer Role Codes	📍4.0.1	FHIR Std.
Procedure.reasonCode	Base	example	Procedure Reason Codes	📍4.0.1	FHIR Std.
Procedure.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Procedure.outcome	Base	example	Procedure Outcome Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.outcome.coding	Base	required	MII VS Onkologie Strahlentherapie Ende Grund	📦2027.0.0-ballot.1	This IG
Procedure.complication	Base	example	Condition/Problem/Diagnosis Codes	📍4.0.1	FHIR Std.
Procedure.followUp	Base	example	Procedure Follow up Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.focalDevice.​action	Base	preferred	Procedure Device Action Codes	📍4.0.1	FHIR Std.
Procedure.usedCode	Base	example	FHIR Device Types	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
ops-regex	warning	Procedure.code.coding:ops.code	In code sind nur gültige OPS-Codes ohne Zusätze erlaubt	matches('^[1|3|5|6|8|9]-[a-zA-Z0-9]{3}([.][a-zA-Z0-9]{1,2})?$')
proc-mii-1	error	Procedure	Falls die Prozedur per OPS kodiert wird, MUSS eine SNOMED-CT kodierte Category abgebildet werden	code.coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists() implies category.coding.where(system = 'http://snomed.info/sct').exists()
sct-ops-1	error	Procedure.code	Eine Prozedur MUSS mit OPS oder SNOMED-CT kodiert werden.	coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()

Schlüsselelemente-Ansicht

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Procedure	C	0..*	MII_PR_Prozedur_Procedure	An action that is being or was performed on a patient Constraints: proc-mii-1
id	SΣ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
source	SΣ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:Dokumentationsdatum	S	0..1	(Complex)	Dokumentationsdatum URL: http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum"
value[x]	S	1..1	dateTime	Value of extension
extension:durchfuehrungsabsicht	S	0..1	(Complex)	Durchführungsabsicht URL: https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht"
value[x]	S	1..1	Coding	Value of extension Binding: MII VS Prozedur Durchführungsabsicht [SNOMED CT] (required)
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	SΣ	1..1	code	Symbol in syntax defined by the system
extension:Intention	S	1..1	(Complex)	Intention der Strahlentherapie URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Intention (required)
text	SΣ	0..1	string	Plain text representation of the concept
extension:StellungZurOp	S	0..*	(Complex)	Stellung der Strahlentherapie zu einer Operation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Stellung zur OP (required)
text	SΣ	0..1	string	Plain text representation of the concept
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for basedOn	SΣ	0..*	Reference(CarePlan)	A request for this procedure Slice: Unordered, Open by type:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Observation)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur OPS Kategorien [SNOMED CT] (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
version		0..1	string	Version of the system - if relevant
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	SΣ	1..1	code	Symbol in syntax defined by the system
code	SΣC	1..1	CodeableConcept	Code Binding: ProcedureCodes(SNOMEDCT) (example): A code to identify a specific procedure . Constraints: sct-ops-1
Slices for coding	SΣ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:ops	SΣ	0..1	CodingOPS	Operationen- und Prozedurenschlüssel (OPS) Code Binding: MII VS Prozedur OPS (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
Slices for extension				Content/Rules for all slices
extension:Seitenlokalisation	S	0..1	(Complex)	Optional Extensions Element URL: http://fhir.de/StructureDefinition/seitenlokalisation
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/seitenlokalisation"
value[x]	S	1..1	Coding	Value of extension Binding: KBV_VS_SFHIR_ICD_SEITENLOKALISATION (required)
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
system	SΣ	1..1	uri	Canonische CodeSystem URL für OPS Fixed Value: http://fhir.de/CodeSystem/bfarm/ops
version	SΣ	1..1	string	Die Jahresversion des OPS Kataloges. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
code	SΣC	1..1	code	Der OPS-Code Constraints: ops-regex Example Einfacher OPS-Code: 5-470
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur Prozeduren [SNOMED CT] (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
version		0..1	string	Version of the system - if relevant
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	SΣ	1..1	code	Symbol in syntax defined by the system
subject	SΣ	1..1	Reference(Patient)	Who the procedure was performed on
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
encounter	SΣ	0..1	Reference(Encounter)	Kontakt (Aufenthaltsbezug)
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
Slices for performed[x]	SΣ	1..1	Period	Durchführungsdatum Slice: Unordered, Closed by type:$this
performed[x]:All Slices				Content/Rules for all slices
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performed[x]:performedPeriod	SΣ	0..1	Period	Durchführungszeitraum
start	SΣC	1..1	dateTime	Start der Strahlentherapie
end	SΣC	0..1	dateTime	Ende der Strahlentherapie
performed[x]:performedDateTime	SΣ	0..1	dateTime	When the procedure was performed
reasonReference	SΣ	0..*	Reference(MII PR Onkologie Diagnose Primärtumor | Condition)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	Körperstelle Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Slices for extension				Content/Rules for all slices
extension:bodySite		0..1	Reference(BodyStructure)	Target anatomic location or structure URL: http://hl7.org/fhir/StructureDefinition/bodySite
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:snomed-ct	SΣ	0..1	Coding	SNOMED CT Code
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
version	SΣ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
coding	SΣ	0..*	Coding	Grund für Ende der Strahlentherapie Binding: MII VS Onkologie Strahlentherapie Ende Grund (required)
system	SΣ	0..1	uri	Identity of the terminology system
code	SΣ	0..1	code	Symbol in syntax defined by the system
note	S	0..*	Annotation	Hinweis
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Procedure.extension:durchfuehrungsabsicht.​value[x]	Base	required	MII VS Prozedur Durchführungsabsicht [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.extension:Intention.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Stellung zur OP	📦2027.0.0-ballot.1	This IG
Procedure.status	Base	required	EventStatus	📍4.0.1	FHIR Std.
Procedure.category	Base	example	Procedure Category Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.category.coding:sct	Base	preferred	MII VS Prozedur OPS Kategorien [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code	Base	example	Procedure Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.code.coding:ops	Base	required	MII VS Prozedur OPS	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code.coding:ops.​extension:Seitenlokalisation.​value[x]	Base	required	KBV_VS_SFHIR_ICD_SEITENLOKALISATION	⏿1.00	127.0.0.1
Procedure.code.coding:sct	Base	required	MII VS Prozedur Prozeduren [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Procedure.outcome	Base	example	Procedure Outcome Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.outcome.coding	Base	required	MII VS Onkologie Strahlentherapie Ende Grund	📦2027.0.0-ballot.1	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
ops-regex	warning	Procedure.code.coding:ops.code	In code sind nur gültige OPS-Codes ohne Zusätze erlaubt	matches('^[1|3|5|6|8|9]-[a-zA-Z0-9]{3}([.][a-zA-Z0-9]{1,2})?$')
proc-mii-1	error	Procedure	Falls die Prozedur per OPS kodiert wird, MUSS eine SNOMED-CT kodierte Category abgebildet werden	code.coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists() implies category.coding.where(system = 'http://snomed.info/sct').exists()
sct-ops-1	error	Procedure.code	Eine Prozedur MUSS mit OPS oder SNOMED-CT kodiert werden.	coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()

Differential-Ansicht

Diese Struktur ist abgeleitet von MII_PR_Prozedur_Procedure

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Procedure		0..*	MII_PR_Prozedur_Procedure	An action that is being or was performed on a patient
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:Intention	S	1..1	(Complex)	Intention der Strahlentherapie URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention
value[x]
coding
code		1..1	code	Symbol in syntax defined by the system
extension:StellungZurOp	S	0..*	(Complex)	Stellung der Strahlentherapie zu einer Operation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop
value[x]
coding
code		1..1	code	Symbol in syntax defined by the system
Slices for basedOn	S	0..*	Reference(CarePlan)	A request for this procedure Slice: Unordered, Open by type:$this.resolve()
basedOn:tumorkonferenz	S	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	S	0..*	Reference(Observation)	Part of referenced event
subject		1..1	Reference(Patient)	Who the procedure was performed on
performed[x]		1..1	Period	Durchführungsdatum
start		0..1	dateTime	Starting time with inclusive boundary
end		0..1	dateTime	End time with inclusive boundary, if not ongoing
Slices for performed[x]				Content/Rules for all slices
performed[x]:performedPeriod		0..1	Period	Durchführungszeitraum
start	S	1..1	dateTime	Start der Strahlentherapie
end	S	0..1	dateTime	Ende der Strahlentherapie
reasonReference	S	0..*	Reference(MII PR Onkologie Diagnose Primärtumor | Condition)	The justification that the procedure was performed
outcome	S	0..1	CodeableConcept	The result of procedure
coding	S	0..*	Coding	Grund für Ende der Strahlentherapie Binding: MII VS Onkologie Strahlentherapie Ende Grund (required)
system	S	0..1	uri	Identity of the terminology system
code	S	0..1	code	Symbol in syntax defined by the system
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Procedure.outcome.coding	Base	required	MII VS Onkologie Strahlentherapie Ende Grund	📦2027.0.0-ballot.1	This IG

Snapshot-AnsichtView

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Procedure	C	0..*	MII_PR_Prozedur_Procedure	An action that is being or was performed on a patient Constraints: proc-mii-1
id	SΣ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	SΣ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:Dokumentationsdatum	S	0..1	(Complex)	Dokumentationsdatum URL: http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/ProzedurDokumentationsdatum"
value[x]	S	1..1	dateTime	Value of extension
extension:durchfuehrungsabsicht	S	0..1	(Complex)	Durchführungsabsicht URL: https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url	S	1..1	uri	"https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Durchfuehrungsabsicht"
value[x]	S	1..1	Coding	Value of extension Binding: MII VS Prozedur Durchführungsabsicht [SNOMED CT] (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
extension:Intention	S	1..1	(Complex)	Intention der Strahlentherapie URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Intention (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-intention
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
extension:StellungZurOp	S	0..*	(Complex)	Stellung der Strahlentherapie zu einer Operation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Strahlentherapie Stellung zur OP (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-stellungzurop
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Identifiers for this procedure
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
Slices for basedOn	SΣ	0..*	Reference(CarePlan)	A request for this procedure Slice: Unordered, Open by type:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Observation)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	Σ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur OPS Kategorien [SNOMED CT] (preferred) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣC	1..1	CodeableConcept	Code Binding: ProcedureCodes(SNOMEDCT) (example): A code to identify a specific procedure . Constraints: sct-ops-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$this
coding:ops	SΣ	0..1	CodingOPS	Operationen- und Prozedurenschlüssel (OPS) Code Binding: MII VS Prozedur OPS (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for extension				Content/Rules for all slices
extension:Seitenlokalisation	S	0..1	(Complex)	Optional Extensions Element URL: http://fhir.de/StructureDefinition/seitenlokalisation
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Additional content defined by implementations Slice: Unordered, Open by value:url
url	S	1..1	uri	"http://fhir.de/StructureDefinition/seitenlokalisation"
value[x]	S	1..1	Coding	Value of extension Binding: KBV_VS_SFHIR_ICD_SEITENLOKALISATION (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
system	SΣ	1..1	uri	Canonische CodeSystem URL für OPS Fixed Value: http://fhir.de/CodeSystem/bfarm/ops
version	SΣ	1..1	string	Die Jahresversion des OPS Kataloges. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
code	SΣC	1..1	code	Der OPS-Code Constraints: ops-regex Example Einfacher OPS-Code: 5-470
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:sct	SΣ	0..1	Coding	SNOMED CT Code Binding: MII VS Prozedur Prozeduren [SNOMED CT] (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	Who the procedure was performed on
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
encounter	SΣ	0..1	Reference(Encounter)	Kontakt (Aufenthaltsbezug)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Slices for performed[x]	SΣ	1..1	Period	Durchführungsdatum Slice: Unordered, Closed by type:$this
performed[x]:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performed[x]:performedPeriod	SΣ	0..1	Period	Durchführungszeitraum
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Start der Strahlentherapie
end	SΣC	0..1	dateTime	Ende der Strahlentherapie
performed[x]:performedDateTime	SΣ	0..1	dateTime	When the procedure was performed
recorder	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Who recorded the procedure
asserter	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Person who asserts this procedure
performer	Σ	0..*	BackboneElement	The people who performed the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
location	Σ	0..1	Reference(Location)	Where the procedure happened
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
reasonReference	SΣ	0..*	Reference(MII PR Onkologie Diagnose Primärtumor | Condition)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	Körperstelle Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:bodySite		0..1	Reference(BodyStructure)	Target anatomic location or structure URL: http://hl7.org/fhir/StructureDefinition/bodySite
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:snomed-ct	SΣ	0..1	Coding	SNOMED CT Code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
version	SΣ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	0..*	Coding	Grund für Ende der Strahlentherapie Binding: MII VS Onkologie Strahlentherapie Ende Grund (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note	S	0..*	Annotation	Hinweis
focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Device)	Device that was changed
usedReference		0..*	Reference(Device | Medication | Substance)	Items used during procedure
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Procedure.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Procedure.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Procedure.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Procedure.extension:durchfuehrungsabsicht.​value[x]	Base	required	MII VS Prozedur Durchführungsabsicht [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.extension:Intention.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Strahlentherapie Stellung zur OP	📦2027.0.0-ballot.1	This IG
Procedure.status	Base	required	EventStatus	📍4.0.1	FHIR Std.
Procedure.statusReason	Base	example	Procedure Not Performed Reason (SNOMED-CT)	📍4.0.1	FHIR Std.
Procedure.category	Base	example	Procedure Category Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.category.coding:sct	Base	preferred	MII VS Prozedur OPS Kategorien [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code	Base	example	Procedure Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.code.coding:ops	Base	required	MII VS Prozedur OPS	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.code.coding:ops.​extension:Seitenlokalisation.​value[x]	Base	required	KBV_VS_SFHIR_ICD_SEITENLOKALISATION	⏿1.00	127.0.0.1
Procedure.code.coding:sct	Base	required	MII VS Prozedur Prozeduren [SNOMED CT]	📦2027.0.0-ballot	MII Implementation Guide Core Dataset Base v2027.0
Procedure.subject.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Procedure.encounter.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Procedure.performer.​function	Base	example	Procedure Performer Role Codes	📍4.0.1	FHIR Std.
Procedure.reasonCode	Base	example	Procedure Reason Codes	📍4.0.1	FHIR Std.
Procedure.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Procedure.outcome	Base	example	Procedure Outcome Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.outcome.coding	Base	required	MII VS Onkologie Strahlentherapie Ende Grund	📦2027.0.0-ballot.1	This IG
Procedure.complication	Base	example	Condition/Problem/Diagnosis Codes	📍4.0.1	FHIR Std.
Procedure.followUp	Base	example	Procedure Follow up Codes (SNOMED CT)	📍4.0.1	FHIR Std.
Procedure.focalDevice.​action	Base	preferred	Procedure Device Action Codes	📍4.0.1	FHIR Std.
Procedure.usedCode	Base	example	FHIR Device Types	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
ops-regex	warning	Procedure.code.coding:ops.code	In code sind nur gültige OPS-Codes ohne Zusätze erlaubt	matches('^[1|3|5|6|8|9]-[a-zA-Z0-9]{3}([.][a-zA-Z0-9]{1,2})?$')
proc-mii-1	error	Procedure	Falls die Prozedur per OPS kodiert wird, MUSS eine SNOMED-CT kodierte Category abgebildet werden	code.coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists() implies category.coding.where(system = 'http://snomed.info/sct').exists()
sct-ops-1	error	Procedure.code	Eine Prozedur MUSS mit OPS oder SNOMED-CT kodiert werden.	coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()

Diese Struktur ist abgeleitet von MII_PR_Prozedur_Procedure

Summary

Mandatory: 2 elements(1 nested mandatory element)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

• MII PR Onkologie Tumorkonferenz (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz)
• MII PR Onkologie Diagnose Primärtumor (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-diagnose-primaertumor)

Extensions

This structure refers to these extensions:

• https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-intention
• https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-strahlentherapie-stellungzurop

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Procedure.basedOn