The current ServiceRequest allows to add details on the procedure using the orderDetail field. This allows for adding CodeableConcepts, but not the values associated with them. In some cases this requires referring to settings to be used with a device, in which case we would like to refer to a DeviceDefinition resource. In other cases we want to specify the focal device (amongst several devices).

In our systems, additional details (including values) related to procedures are stored in a formal manner. Examples of such data elements are:

1. Oxygen at 2 liters/minute per nasal canula
2. Oxygen via venti mask at 50%
3. Elevate foot 5 inches off bed
4. Attach leg to 5 lbs of buck’s traction
5. Ambulate at least 20 feet, using walker bid.  
6. Start mechanical ventilation, DeviceDefinition: Puritan Bennett, Mode: SMIV, Resp rate setting: 12, Pressure support: 8 cmH2O, PEEP: 8, FiO2: 100%, Tube Compensation: on, Tidal Volume: 6 to 8 ml/kg of body weight, Adjust parameters to keep O2 saturation >= 92
7. Bedrest with bedside commode (device is bedside commode)
8. Call physician for SPB > 180 or DBP > 105  (systolic and diastolic BP) – parameters: SPB > 180 or DBP > 105 
9. Insert endotracheal tube (focal device) using fiberoptic endoscopy
10. Insert peripheral IV Line (focal device) with 18 Gauge Angiocath (other device) and cover with heparin cap (other device)

 There is grey area between elements to be added to ServiceRequest and those that are further details on a standard procedures for which a RequestGroup could be used.

The use of RequestGroup requires indication of the plan to follow which in many cases is not done in a formal manner. In these cases, we would still want to provide a formal specification of those order details.

 The suggestion/proposal is to change orderDetail into a code+value pair as in DeviceRequest.parameter consisting of the CodeableConcept (1..1) and optional value[x] (0..1).

 This would allow our applications to specify these parameters/details in a formal/structured way enabling several use cases such as:

• Enabling user entry checks - such as values not entered out of bounds or values that are missing, but should be mandatory.    
• Automatic transfer of the indicated values to the Procedures and devices used. Reducing copying and thereby reducing copy/past errors.
• Structured data can be studied.  Much of these orders end up in databases for research and quality reports.   For example, what was the average flow of oxygen ordered for COVID patients using nasal cannula and how many of them ended upon on vents? 
• Later quality checks.   Advisories/alerts can compare the order with the procedure.   The order was for 2 L, the nurse charts 4 L – well why is there is discrepancy? Send an advisory that the care does not match what was ordered.