For FHIR, a custom extension is made to provide the reference from DeviceUseStatement (zib MedicalDevice) to Location to align with the zib MedicalDevice, although a more FHIR native way would be to refer a Procedure resource and from there refer the Location. Since there is a degree of overlap between the concepts of MedicalDevice::Location and Procedure::Location if the Procedure reference the MedicalDevice, such an indirect reference in favor of a custom extension could be justified.

However, in consultation with the zib centre and the Validatieraad, it has been concluded that the indirect reference only applies to the narrow usecase where MedicalDevice’s are implants. Although it is not likely that a Location is registered for other situations, the zib model doesn’t provide enough certainty to replace the custom extension.

Therefore, the possibility of replacing the custom extension with the Location reference in the Procedure resource needs to be documented in the profiles for zibs MedicalDevice and Procedure. This involves a textual explanation and a mapping to MedicalDevice::Location on Procedure.location in the zib-Procedure profile.