For consideration of specific elements. Note that elements identical to US Core 6.0 are imported to QI-Core 6.0; only those elements requiring addition, modification, or removal from QI-Core 5.0.1 are included in this table. CoNote that, unless the element has a MS flag in US Core 6.1.0, we should include those Keep element in the Key Elements Table for QICore but not add an MS Flag. Add (QM) to description of all Keep or Add elements such that that will be included in the Key Elements Table for QI-Core. QI-Core Profile-based path Action Include in QI-Core 6.0 Justification QICoreProcedure.extension: recorded Keep YES Used in existing measures to determine when the procedure information was recorded; this is distinctly different than the occurrence time at which the procedure was performed. QICoreProcedure. reasonCode Keep YES Used in existing measures but NOT present in US Core Key Elements Table. Definition is Coded reason procedure performed; preferred binding to  ProcedureReasonCodes .  QICoreProcedure. report REMOVE NO Present in QI-Core STU5 profile; not present in US Core profile Key Element Table. The QI-core reference to QICore DiagnosticReport Profile for Report and Note Exchange exists to allow reference to identify the procedure not and, perhaps, determine the outcome. It is not at all clear that such Information is available or useful and can directly address required data using Procedure (which is included in a DiagnosticReport Profile for Report and Note Exchange). QICoreProcedure. usedReference REMOVE NO Not present in US Core Key Element Table. Used in existing measure to indicate a specific device category (e.g., antithrombotic devices place as part of a procedure to place such a device on the patient). Feedback has suggested that implementers prefer a direct, precoordinated code for the procedure that also indicates the type of device used rather than having to connect a specific item/device used to perform the procedure. Thus, while modeling allows usedCode or usedReference, feasibility is very limited at best.  Decision is consistent with the decision for QICoreProcedure.usedCode. QICoreProcedure. category DO NOT ADD NO Not present in US Core Key Element Table nor is it present in QICoreProcedure. Use is to classify types of procedures. Previous discussions about using category elements have suggested the need to use category adds burden to measure development and that implementation sites will only include and/or address categories if MS by the US Core version used for interoperability. Note base resource example binding to [Procedure Category Codes| ProcedureCategoryCodes(SNOMEDCT) ] QICoreProcedure.extension Add YES Required to allow use of QICoreProcedure.recorded - Not in US Core Key Elements table. QICoreProcedure.Observation DO NOT ADD NO Not present in US Core Key Elements Table. The observation profiles include the ability to reference the procedure about which the observation is relevant. However, identification such observation from the procedure is unlikely to happen. See note about QICoreProcedure.report above.  DO Not Add. QICoreProcedure.partOf REMOVE NO Not present in US Core Key Elements Table. The use in QDM has been to relate different element but this information is best expressed in the logic with CQL since procedure information is generally not tagged to allow such reference. QICore could consider QICoreProcedure. basedOn to allow reference to the QICoreServiceRequest that initiates the procedure. However, such relationships are difficult to find in the real world. QICoreProcedure.performedDateTime ( performed[x] ) Keep YES QICoreProcedure.performed [x]  with sub-element performedDateTime are both in the QI Core Key Elements table and the US Core Key Elements Table.  A MS flag is not needed as long as the element is in the Key Elements table. QICoreProcedure.performedPeriod ( Period ) DO NOT ADD NO QICoreProcedure.performedPeriod is not currently in the Key Elements Table for QI Core or for US Core. Experience indicates that it is highly unlikely that the period of performance is clearly documented. This issue has caused a lot of discussion with the use case of peri-operative timing (start/incisionTime, end time - is this wound closure, end of anesthesia, transfer time to recovery room or step down unit).  DO not add due to feasibility issues.         QICoreProcedure.extension: incisionDateTime REMOVE NO Not used in existing measures - Requires discussion as recent CQI Workgroup discussions indicated the element may be needed. Need to address feasibility and other potential methods to identify the information potentially required. QICoreProcedure. implicitRules Keep YES Required to address extensions QICoreProcedure. approachBodyStructure Remove NO Not used in existing measures and not present in US Core profile QICoreProcedure. status Keep YES (required binding to Non-Negative Event Status – subset of US Core value set) This element is not identified on the list of items in existing measures; however, patterns generally require status when using FHIR. It is also in the US Core Key Elements table. Note that QI-Core constrains the US Core value required value set set binding ( EventStatus ) to  Non-Negative Event Status  to specifically remove reference to not-done and assure the QICoreProcedureNotDone profile and the QICoreProcedure profile are disjoint.  Retain required binding to  Non-Negative Event Status QICoreProcedure. subject Keep YES (Reference to QI-Core Patient) Inherited from US Core with the exception that QI Core references QICorePatient rather than USCorePatient - retain reference to QICorePatient QICoreProcedure. encounter Remove Discuss with CQI No existing measures use Procedure reference to encounter and most relationships of procedure to encounter occur in the CQL expression based on timing. This element is not in the US Core Key Elements table. QICoreProcedure.extension: performer Remove NO Not present in US Core Key Elements table and not used in existing measures. The performer element was initially added to QI-Core to address potential attribution identification but it has never been used and measure development has moved away from determining attribution as part of the measure logic expression. QICoreProcedure. location Remove NO Not present in US Core Key Elements table and not used in existing measures. There is no existing use case for this element. QICoreProcedure. reasonReference Keep YES Not expressly used in existing measures but allows reference to other resources Condition, Observation, Procedure, DocumentReport DocumentReference. It is NOT present in US Core Key Elements Table. Definition is The justification that the procedure was performed; note that references in QI-Core are to the base FHIR resources, not to the respective QI-Core profiles.  SDecision on reasonReference should be the same as Procedure.reasonCode since it provides a mechanism in FHIR to provide a value set (reasonCode) or refer to a more fully expressed reference. References should be QICoreConditionDiagnosisHealthConcern, QICoreConditionEncounterDiagnosis, QICoreProcedure, QICoreDocumentReport, QICoreDocumentReference. QICoreProcedure. bodySite Remove NO Not used in existing measures and not referenced in US Core Key Elements Table. Measure reference to bodySite generally address the information using the specific procedure code that indicates the body site; hence, the element is not in use. QICoreProcedure. outcome Remove NO While not MS, this element exists in the QI-Core Key Elements Table. It has not been used and it is not in the US Core Key Elements table. Prior HL7 discussions identified that determining successful outcome of a procedure is highly complex and most of the desired information is in non-structured text if it exists at all. QICoreProcedure.extension: focalDevice Remove NO Not specifically used in existing measures and not present in US Core Key Elements Table.  QICoreProcedure. usedCode Remove NO Not present in US Core Key Element Table. Used in existing measure to indicate a specific device category (e.g., antithrombotic devices place as part of a procedure to place such a device on the patient). Feedback has suggested that implementers prefer a direct, precoordinated code for the procedure that also indicates the type of device used rather than having to connect a specific item/device used to perform the procedure. Thus, while modeling allows usedCode or usedReference, feasibility is very limited.  Decision to include or remove should be consistent with (the same) as the decision for QICoreProcedure.usedCode.