This profile describes a systemic therapy or watchful waiting therapy in oncology.

Description

Within the oBDS, several clinical concepts are represented within the Systemic Therapy

• Systemic therapies
  • Chemotherapy
  • Immunotherapy
  • Targeted therapy
  • Combination therapies of the above therapies
  • Hormone therapy
  • Stem cell and bone marrow transplantation
• Watchful therapies
  • Watchful Waiting
  • Active Surveillance
  • Wait and see

For these individual therapies, the oBDS captures further data elements that are represented here, including:

• Start and end time point of the therapy
• Relationship to surgery and intent of the therapy
• The reason for termination (regardless of whether successful or unsuccessful)
• The therapy protocol used with substance combinations (according to the oBDS implementation guide).

Category

• The MII procedure used recommends representing the category using the OPS main categories transferred into SNOMED (https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/ValueSet/procedures-category-sct)
• The present category SNOMED 277132007 | Therapeutic procedure, which corresponds to OPS category 8 ("Non-operative therapeutic measures"), includes both radiotherapy and nuclear medicine therapy as well as certain systemic therapies (e.g. chemotherapy and immunotherapy), whereas other systemic medication-based therapies (e.g. hormone therapy, targeted therapy) can also be coded under category 6 "Medications". It is therefore unspecific and not suitable, for example, for specifically filtering for nuclear medicine therapies within a research question.

Code

• As code, the MII procedure requires an OPS code or a SNOMED code.
• Medication-based systemic therapies are coded by different OPS categories depending on the type of therapy.
• For watchful therapies, no OPS codes are stored in the current catalog.
• In the MII procedure, exactly one coding (OPS or SNOMED CT) SHOULD be used for exactly one therapy. Additional procedures are represented as separate Procedure resources.

Therapy protocol

• As usedCode, the specific therapy protocols used in the systemic therapy are documented.
• The protocols are based on the oBDS implementation guide and contain standardized substance combinations.
• Leading element for oBDS 16.4: The protocol is primarily documented on the therapy bracket (Procedure.usedCode, bound extensible to the protocol ValueSet). The additional free-text entry in MedicationStatement.note.text of the individual substance resources serves solely to assign individual substances to their regimen (e.g. for combination therapies) and is not an independent second coding.
• Each protocol is documented with its characteristic designation (e.g. "FOLFOX", "R-CHOP", "AC") and the active ingredients it contains.
• Coding is done via the MII CodeSystem Systemic Therapy Protocols, which covers all common oncological therapy protocols.
• Protocols not included can still be documented - however, harmonization across sites is decisive here. New protocols should therefore be submitted via GitHub Issues.

Implementation recommendation

The above points result in the following coding recommendation for systemic / watchful therapy from the oBDS:

• Category as SNOMED code
  • Category for systemic therapies 18629005 | Administration of drug or medicament (procedure)
  • Category for watchful therapies: none (no suitable parent concept, direct search via coding recommended)
• Coding
  • Systemic therapy via OPS as follows. Note that the exact active ingredient is coded via ATC as part of the MedicationStatement resource. Additional documentation of the medication via
    • Chemotherapy via OPS 8-54 or more specific
    • Immunotherapy via OPS 8-54 or more specific (additional specification of )
    • Stem cell therapy via OPS 8-86 or more specific
    • Hormone therapy via OPS 6-xxx.y (e.g. 6-009.0 for Olaparib, oral for prostate cancer)
  • Watchful therapy via SNOMED-CT as follows
    • Watchful Waiting: SNOMED-CT 373818007 | No anti-cancer treatment - watchful waiting (finding)
    • Active Surveillance: SNOMED-CT 424313000 | Active surveillance (regime/therapy)
    • Wait and see: SNOMED-CT 310341009 | Follow-up (wait and see) (finding)

Conformance

The present profiling is compatible with the procedure profile of the ISiK base modules level 4. https://simplifier.net/isik-basis-v4/isikprozedur

Mapping dataset to FHIR

The mapping of the dataset fields is documented in the logical model: MII LM Onkologie.

Mapping Uniform Oncological Base Dataset (oBDS) to FHIR

The oBDS mappings are recorded in the artefact view of this profile: MII PR Onkologie Systemische Therapie.

Examples

mii-exa-onko-systemische-therapie-1

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

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)	MII EX Onko Systemische Therapie Intention URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie Intention (required)
coding	Σ	0..*	Coding	Intention der systemischen oder abwartenden Therapie
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
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SΣ	0..1	string	Plain text representation of the concept
extension:StellungZurOp	S	0..*	(Complex)	MII EX Onko Systemische Therapie Stellung zur OP URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie Stellung (required)
coding	Σ	0..*	Coding	Stellung der systemischen Therapie zu einer Operation
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
code	Σ	1..1	code	Symbol in syntax defined by the system
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:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$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:All Slices				Content/Rules for all slices
code	Σ	0..1	code	Symbol in syntax defined by the system
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
coding:systemische_therapie_art	SΣ	0..1	Coding	Art der systemischen oder abwartenden Therapie Binding: MII VS Onkologie Systemische Therapie Art (required)
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	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	Startdatum der systemischen oder abwartenden Therapie
end	SΣC	0..1	dateTime	Enddatum der systemischen oder abwartenden Therapie
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: MII VS Onkologie Systemische Therapie Ende Grund (required)
coding	Σ	0..*	Coding	Grund für Ende der systemischen oder abwartenden Therapie
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-ende-grund
code	SΣ	0..1	code	Symbol in syntax defined by the system
note	S	0..*	Annotation	Hinweis
usedCode	S	0..*	CodeableConcept	Coded items used during the procedure Binding: MII VS Onkologie Systemische Therapie Protokolle (extensible)
coding	Σ	0..*	Coding	Protokoll der systemischen Therapie
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
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 Systemische Therapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Systemische Therapie Stellung	📦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.code.coding:systemische_therapie_art	Base	required	MII VS Onkologie Systemische Therapie Art	📦2027.0.0-ballot.1	This IG
Procedure.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Procedure.outcome	Base	required	MII VS Onkologie Systemische Therapie Ende Grund	📦2027.0.0-ballot.1	This IG
Procedure.usedCode	Base	extensible	MII VS Onkologie Systemische Therapie Protokolle	📦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()

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)	MII EX Onko Systemische Therapie Intention URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-intention
value[x]
coding		0..*	Coding	Intention der systemischen oder abwartenden Therapie
code		1..1	code	Symbol in syntax defined by the system
extension:StellungZurOp	S	0..*	(Complex)	MII EX Onko Systemische Therapie Stellung zur OP URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-stellungzurop
value[x]
coding		0..*	Coding	Stellung der systemischen Therapie zu einer Operation
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(Procedure | Observation | MedicationAdministration)	Part of referenced event
code		1..1	CodeableConcept	Code
coding		1..*	Coding	Code defined by a terminology system
code		0..1	code	Symbol in syntax defined by the system
Slices for coding				Content/Rules for all slices
coding:systemische_therapie_art		0..1	Coding	Art der systemischen oder abwartenden Therapie Binding: MII VS Onkologie Systemische Therapie Art (required)
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
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	Startdatum der systemischen oder abwartenden Therapie
end	S	0..1	dateTime	Enddatum der systemischen oder abwartenden Therapie
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 Binding: MII VS Onkologie Systemische Therapie Ende Grund (required)
coding		0..*	Coding	Grund für Ende der systemischen oder abwartenden Therapie
system		0..1	uri	Identity of the terminology system Required Pattern: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-ende-grund
code	S	0..1	code	Symbol in syntax defined by the system
usedCode	S	0..*	CodeableConcept	Coded items used during the procedure Binding: MII VS Onkologie Systemische Therapie Protokolle (extensible)
coding		0..*	Coding	Protokoll der systemischen Therapie
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Procedure.code.coding:systemische_therapie_art	Base	required	MII VS Onkologie Systemische Therapie Art	📦2027.0.0-ballot.1	This IG
Procedure.outcome	Base	required	MII VS Onkologie Systemische Therapie Ende Grund	📦2027.0.0-ballot.1	This IG
Procedure.usedCode	Base	extensible	MII VS Onkologie Systemische Therapie Protokolle	📦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)	MII EX Onko Systemische Therapie Intention URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie 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	Intention der systemischen oder abwartenden Therapie
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)	MII EX Onko Systemische Therapie Stellung zur OP URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie Stellung (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	Stellung der systemischen Therapie zu einer Operation
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:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	Σ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$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: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
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	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
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
coding:systemische_therapie_art	SΣ	0..1	Coding	Art der systemischen oder abwartenden Therapie Binding: MII VS Onkologie Systemische Therapie Art (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	Σ	1..1	uri	Identity of the terminology system
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	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	Startdatum der systemischen oder abwartenden Therapie
end	SΣC	0..1	dateTime	Enddatum der systemischen oder abwartenden Therapie
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: MII VS Onkologie Systemische Therapie 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
coding	Σ	0..*	Coding	Grund für Ende der systemischen oder abwartenden Therapie
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	0..1	uri	Identity of the terminology system Required Pattern: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-ende-grund
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	S	0..*	CodeableConcept	Coded items used during the procedure Binding: MII VS Onkologie Systemische Therapie Protokolle (extensible)
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	Protokoll der systemischen Therapie
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
text	Σ	0..1	string	Plain text representation of the concept
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 Systemische Therapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Systemische Therapie Stellung	📦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.code.coding:systemische_therapie_art	Base	required	MII VS Onkologie Systemische Therapie Art	📦2027.0.0-ballot.1	This IG
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	required	MII VS Onkologie Systemische Therapie 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	extensible	MII VS Onkologie Systemische Therapie Protokolle	📦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()

Key Elements View

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)	MII EX Onko Systemische Therapie Intention URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie Intention (required)
coding	Σ	0..*	Coding	Intention der systemischen oder abwartenden Therapie
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
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SΣ	0..1	string	Plain text representation of the concept
extension:StellungZurOp	S	0..*	(Complex)	MII EX Onko Systemische Therapie Stellung zur OP URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie Stellung (required)
coding	Σ	0..*	Coding	Stellung der systemischen Therapie zu einer Operation
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
code	Σ	1..1	code	Symbol in syntax defined by the system
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:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$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:All Slices				Content/Rules for all slices
code	Σ	0..1	code	Symbol in syntax defined by the system
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
coding:systemische_therapie_art	SΣ	0..1	Coding	Art der systemischen oder abwartenden Therapie Binding: MII VS Onkologie Systemische Therapie Art (required)
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	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	Startdatum der systemischen oder abwartenden Therapie
end	SΣC	0..1	dateTime	Enddatum der systemischen oder abwartenden Therapie
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: MII VS Onkologie Systemische Therapie Ende Grund (required)
coding	Σ	0..*	Coding	Grund für Ende der systemischen oder abwartenden Therapie
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-ende-grund
code	SΣ	0..1	code	Symbol in syntax defined by the system
note	S	0..*	Annotation	Hinweis
usedCode	S	0..*	CodeableConcept	Coded items used during the procedure Binding: MII VS Onkologie Systemische Therapie Protokolle (extensible)
coding	Σ	0..*	Coding	Protokoll der systemischen Therapie
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
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 Systemische Therapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Systemische Therapie Stellung	📦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.code.coding:systemische_therapie_art	Base	required	MII VS Onkologie Systemische Therapie Art	📦2027.0.0-ballot.1	This IG
Procedure.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Procedure.outcome	Base	required	MII VS Onkologie Systemische Therapie Ende Grund	📦2027.0.0-ballot.1	This IG
Procedure.usedCode	Base	extensible	MII VS Onkologie Systemische Therapie Protokolle	📦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 View

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)	MII EX Onko Systemische Therapie Intention URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-intention
value[x]
coding		0..*	Coding	Intention der systemischen oder abwartenden Therapie
code		1..1	code	Symbol in syntax defined by the system
extension:StellungZurOp	S	0..*	(Complex)	MII EX Onko Systemische Therapie Stellung zur OP URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-stellungzurop
value[x]
coding		0..*	Coding	Stellung der systemischen Therapie zu einer Operation
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(Procedure | Observation | MedicationAdministration)	Part of referenced event
code		1..1	CodeableConcept	Code
coding		1..*	Coding	Code defined by a terminology system
code		0..1	code	Symbol in syntax defined by the system
Slices for coding				Content/Rules for all slices
coding:systemische_therapie_art		0..1	Coding	Art der systemischen oder abwartenden Therapie Binding: MII VS Onkologie Systemische Therapie Art (required)
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
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	Startdatum der systemischen oder abwartenden Therapie
end	S	0..1	dateTime	Enddatum der systemischen oder abwartenden Therapie
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 Binding: MII VS Onkologie Systemische Therapie Ende Grund (required)
coding		0..*	Coding	Grund für Ende der systemischen oder abwartenden Therapie
system		0..1	uri	Identity of the terminology system Required Pattern: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-ende-grund
code	S	0..1	code	Symbol in syntax defined by the system
usedCode	S	0..*	CodeableConcept	Coded items used during the procedure Binding: MII VS Onkologie Systemische Therapie Protokolle (extensible)
coding		0..*	Coding	Protokoll der systemischen Therapie
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Procedure.code.coding:systemische_therapie_art	Base	required	MII VS Onkologie Systemische Therapie Art	📦2027.0.0-ballot.1	This IG
Procedure.outcome	Base	required	MII VS Onkologie Systemische Therapie Ende Grund	📦2027.0.0-ballot.1	This IG
Procedure.usedCode	Base	extensible	MII VS Onkologie Systemische Therapie Protokolle	📦2027.0.0-ballot.1	This IG

Snapshot ViewView

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)	MII EX Onko Systemische Therapie Intention URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-intention"
value[x]		1..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie 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	Intention der systemischen oder abwartenden Therapie
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)	MII EX Onko Systemische Therapie Stellung zur OP URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-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-systemische-therapie-stellungzurop"
value[x]		0..1	CodeableConcept	Value of extension Binding: MII VS Onkologie Systemische Therapie Stellung (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	Stellung der systemischen Therapie zu einer Operation
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:$this.resolve()
basedOn:tumorkonferenz	SΣ	0..1	Reference(MII PR Onkologie Tumorkonferenz)	A request for this procedure
partOf	SΣ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣ	1..1	code	Status Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	Σ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	SΣ	0..1	CodeableConcept	Kategorie Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:$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: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
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	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
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
coding:systemische_therapie_art	SΣ	0..1	Coding	Art der systemischen oder abwartenden Therapie Binding: MII VS Onkologie Systemische Therapie Art (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	Σ	1..1	uri	Identity of the terminology system
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	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	Startdatum der systemischen oder abwartenden Therapie
end	SΣC	0..1	dateTime	Enddatum der systemischen oder abwartenden Therapie
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: MII VS Onkologie Systemische Therapie 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
coding	Σ	0..*	Coding	Grund für Ende der systemischen oder abwartenden Therapie
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	0..1	uri	Identity of the terminology system Required Pattern: https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-ende-grund
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	S	0..*	CodeableConcept	Coded items used during the procedure Binding: MII VS Onkologie Systemische Therapie Protokolle (extensible)
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	Protokoll der systemischen Therapie
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
text	Σ	0..1	string	Plain text representation of the concept
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 Systemische Therapie Intention	📦2027.0.0-ballot.1	This IG
Procedure.extension:StellungZurOp.​value[x]	Base	required	MII VS Onkologie Systemische Therapie Stellung	📦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.code.coding:systemische_therapie_art	Base	required	MII VS Onkologie Systemische Therapie Art	📦2027.0.0-ballot.1	This IG
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	required	MII VS Onkologie Systemische Therapie 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	extensible	MII VS Onkologie Systemische Therapie Protokolle	📦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()

Summary

Mandatory: 2 elements(5 nested mandatory elements)
Must-Support: 13 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-systemische-therapie-intention
• https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-ex-onko-systemische-therapie-stellungzurop

Slices

This structure defines the following Slices:

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