R4 Ballot #1 (Mixed Normative/Trial use)
Clinical SummaryThis page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4 R3 R2
| Clinical Decision Support Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Device, Patient, Practitioner |
StructureDefinition for detectedissue
{
"resourceType": "StructureDefinition",
"id": "DetectedIssue",
"meta": {
"lastUpdated": "2018-04-03T12:05:46.262+10:00"
},
"text": {
"status": "generated",
"div": "<div>!-- Snipped for Brevity --></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-ballot-status",
"valueString": "Trial Use"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "cds"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/DetectedIssue",
"name": "DetectedIssue",
"status": "draft",
"date": "2018-04-03T12:05:46+10:00",
"publisher": "Health Level Seven International (Clinical Decision Support)",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "http://hl7.org/fhir"
}
]
},
{
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/dss/index.cfm"
}
]
}
],
"description": "Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition conflict, etc.",
"fhirVersion": "3.3.0",
"mapping": [
{
"identity": "workflow",
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Pattern"
},
{
"identity": "v2",
"uri": "http://hl7.org/v2",
"name": "HL7 v2 Mapping"
},
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM Mapping"
},
{
"identity": "w5",
"uri": "http://hl7.org/fhir/fivews",
"name": "FiveWs Pattern"
}
],
"kind": "resource",
"abstract": false,
"type": "DetectedIssue",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"derivation": "specialization",
"snapshot": {
"element": [
{
"id": "DetectedIssue",
"path": "DetectedIssue",
"short": "Clinical issue with action",
"definition": "Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition conflict, etc.",
"alias": [
"DDI",
"drug-drug interaction",
"Contraindication",
"Alert"
],
"min": 0,
"max": "*",
"base": {
"path": "DetectedIssue",
"min": 0,
"max": "*"
},
"constraint": [
{
"key": "dom-2",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression": "contained.contained.empty()",
"xpath": "not(parent::f:contained and f:contained)",
"source": "DomainResource"
},
{
"key": "dom-1",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
"expression": "contained.text.empty()",
"xpath": "not(parent::f:contained and f:text)",
"source": "DomainResource"
},
{
"key": "dom-4",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "DomainResource"
},
{
"key": "dom-3",
"severity": "error",
"human": "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",
"expression": "contained.all(('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists())",
"xpath": "not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "DomainResource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "workflow",
"map": "Event"
},
{
"identity": "v2",
"map": "Partial mapping from messages containing the AL1 or IAM segment, such as the ADT^A01, ADT^A08, and ADT^A60."
},
{
"identity": "rim",
"map": "Observation[classCode=ALRT, moodCode=EVN)"
}
]
},
{
"id": "DetectedIssue.id",
"path": "DetectedIssue.id",
"short": "Logical id of this artifact",
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "id"
}
],
"isModifier": false,
"isSummary": true
},
{
"id": "DetectedIssue.meta",
"path": "DetectedIssue.meta",
"short": "Metadata about the resource",
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.meta",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Meta"
}
],
"isModifier": false,
"isSummary": true
},
{
"id": "DetectedIssue.implicitRules",
"path": "DetectedIssue.implicitRules",
"short": "A set of rules under which this content was created",
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true
},
{
"id": "DetectedIssue.language",
"path": "DetectedIssue.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"min": 0,
"max": "1",
"base": {
"path": "Resource.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id": "DetectedIssue.text",
"path": "DetectedIssue.text",
"short": "Text summary of the resource, for human interpretation",
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Narrative"
}
],
"condition": [
"dom-1"
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"id": "DetectedIssue.contained",
"path": "DetectedIssue.contained",
"short": "Contained, inline Resources",
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "DetectedIssue.extension",
"path": "DetectedIssue.extension",
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "DetectedIssue.modifierExtension",
"path": "DetectedIssue.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "Not known why this is labelled a modifier",
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "DetectedIssue.identifier",
"path": "DetectedIssue.identifier",
"short": "Unique id for the detected issue",
"definition": "Business identifier associated with the detected issue record.",
"requirements": "Allows linking instances of the same detected issue found on different servers.",
"min": 0,
"max": "*",
"base": {
"path": "DetectedIssue.identifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Identifier"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.identifier"
},
{
"identity": "w5",
"map": "FiveWs.identifier"
},
{
"identity": "v2",
"map": "IAM-7"
},
{
"identity": "rim",
"map": ".id"
}
]
},
{
"id": "DetectedIssue.status",
"path": "DetectedIssue.status",
"short": "registered | preliminary | final | amended +",
"definition": "Indicates the status of the detected issue.",
"comment": "This element is labeled as a modifier because the status contains the codes cancelled and entered-in-error that mark the issue as not currently valid.",
"alias": [
"status"
],
"min": 1,
"max": "1",
"base": {
"path": "DetectedIssue.status",
"min": 1,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueStatus"
}
],
"strength": "required",
"description": "Indicates the status of the identified issue",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/observation-status"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "FiveWs.status"
}
]
},
{
"id": "DetectedIssue.category",
"path": "DetectedIssue.category",
"short": "Issue Category, e.g. drug-drug, duplicate therapy, etc.",
"definition": "Identifies the general type of issue identified.",
"alias": [
"type"
],
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueCategory"
}
],
"strength": "preferred",
"description": "Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/detectedissue-category"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.code"
},
{
"identity": "w5",
"map": "FiveWs.class"
},
{
"identity": "v2",
"map": "AL1-2 / IAM-9"
},
{
"identity": "rim",
"map": ".code"
}
]
},
{
"id": "DetectedIssue.severity",
"path": "DetectedIssue.severity",
"short": "high | moderate | low",
"definition": "Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.",
"alias": [
"severity"
],
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.severity",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueSeverity"
}
],
"strength": "required",
"description": "Indicates the potential degree of impact of the identified issue on the patient.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/detectedissue-severity"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.grade"
},
{
"identity": "v2",
"map": "AL1-4/ IAR-2"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value"
}
]
},
{
"id": "DetectedIssue.patient",
"path": "DetectedIssue.patient",
"short": "Associated patient",
"definition": "Indicates the patient whose record the detected issue is associated with.",
"requirements": "While the subject could be inferred by tracing the subject of the implicated resources, it's useful to have a direct link for query purposes.",
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.patient",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Patient"
]
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.subject"
},
{
"identity": "w5",
"map": "FiveWs.subject[x]"
},
{
"identity": "v2",
"map": "PID-3"
},
{
"identity": "rim",
"map": ".participation[typeCode=SBJ].role[classCode=PAT]"
},
{
"identity": "w5",
"map": "FiveWs.subject"
}
]
},
{
"id": "DetectedIssue.date",
"path": "DetectedIssue.date",
"short": "When identified",
"definition": "The date or date-time when the detected issue was initially identified.",
"requirements": "No-one can be responsible for mitigation prior to the issue being identified.",
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.date",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.occurrence[x]"
},
{
"identity": "w5",
"map": "FiveWs.recorded"
},
{
"identity": "v2",
"map": "ALI-6 / IAM-11"
},
{
"identity": "rim",
"map": ".effectiveTime"
}
]
},
{
"id": "DetectedIssue.author",
"path": "DetectedIssue.author",
"short": "The provider or device that identified the issue",
"definition": "Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.",
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.author",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.performer.actor"
},
{
"identity": "w5",
"map": "FiveWs.author"
},
{
"identity": "v2",
"map": "IAM-14 / IAM-16"
},
{
"identity": "rim",
"map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]"
}
]
},
{
"id": "DetectedIssue.implicated",
"path": "DetectedIssue.implicated",
"short": "Problem resource",
"definition": "Indicates the resource representing the current activity or proposed activity that is potentially problematic.",
"comment": "There's an implicit constraint on the number of implicated resources based on DetectedIssue.type; e.g. For drug-drug, there would be more than one. For timing, there would typically only be one.",
"alias": [
"cause"
],
"min": 0,
"max": "*",
"base": {
"path": "DetectedIssue.implicated",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.reasonReference"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]"
}
]
},
{
"id": "DetectedIssue.detail",
"path": "DetectedIssue.detail",
"short": "Description and context",
"definition": "A textual explanation of the detected issue.",
"comment": "Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.",
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.detail",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "workflow",
"map": "Event.note"
},
{
"identity": "v2",
"map": "AL1-5 / IAM-8"
},
{
"identity": "rim",
"map": ".text"
}
]
},
{
"id": "DetectedIssue.reference",
"path": "DetectedIssue.reference",
"short": "Authority for issue",
"definition": "The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.",
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri"
}
]
},
{
"id": "DetectedIssue.mitigation",
"path": "DetectedIssue.mitigation",
"short": "Step taken to address",
"definition": "Indicates an action that has been taken or is committed to reduce or eliminate the likelihood of the risk identified by the detected issue from manifesting. Can also reflect an observation of known mitigating factors that may reduce/eliminate the need for any action.",
"min": 0,
"max": "*",
"base": {
"path": "DetectedIssue.mitigation",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]"
}
]
},
{
"id": "DetectedIssue.mitigation.id",
"path": "DetectedIssue.mitigation.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "DetectedIssue.mitigation.extension",
"path": "DetectedIssue.mitigation.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "DetectedIssue.mitigation.modifierExtension",
"path": "DetectedIssue.mitigation.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "DetectedIssue.mitigation.action",
"path": "DetectedIssue.mitigation.action",
"short": "What mitigation?",
"definition": "Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.",
"comment": "The \"text\" component can be used for detail or when no appropriate code exists.",
"min": 1,
"max": "1",
"base": {
"path": "DetectedIssue.mitigation.action",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueMitigationAction"
}
],
"strength": "preferred",
"description": "Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action"
},
"mapping": [
{
"identity": "rim",
"map": ".code"
}
]
},
{
"id": "DetectedIssue.mitigation.date",
"path": "DetectedIssue.mitigation.date",
"short": "Date committed",
"definition": "Indicates when the mitigating action was documented.",
"comment": "This might not be the same as when the mitigating step was actually taken.",
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.mitigation.date",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": ".effectiveTime"
}
]
},
{
"id": "DetectedIssue.mitigation.author",
"path": "DetectedIssue.mitigation.author",
"short": "Who is committing?",
"definition": "Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.",
"min": 0,
"max": "1",
"base": {
"path": "DetectedIssue.mitigation.author",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner"
]
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]"
}
]
}
]
},
"differential": {
"element": [
{
"id": "DetectedIssue",
"path": "DetectedIssue",
"short": "Clinical issue with action",
"definition": "Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition conflict, etc.",
"alias": [
"DDI",
"drug-drug interaction",
"Contraindication",
"Alert"
],
"min": 0,
"max": "*",
"mapping": [
{
"identity": "workflow",
"map": "Event"
},
{
"identity": "v2",
"map": "Partial mapping from messages containing the AL1 or IAM segment, such as the ADT^A01, ADT^A08, and ADT^A60."
},
{
"identity": "rim",
"map": "Observation[classCode=ALRT, moodCode=EVN)"
}
]
},
{
"id": "DetectedIssue.identifier",
"path": "DetectedIssue.identifier",
"short": "Unique id for the detected issue",
"definition": "Business identifier associated with the detected issue record.",
"requirements": "Allows linking instances of the same detected issue found on different servers.",
"min": 0,
"max": "*",
"type": [
{
"code": "Identifier"
}
],
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.identifier"
},
{
"identity": "w5",
"map": "FiveWs.identifier"
},
{
"identity": "v2",
"map": "IAM-7"
},
{
"identity": "rim",
"map": ".id"
}
]
},
{
"id": "DetectedIssue.status",
"path": "DetectedIssue.status",
"short": "registered | preliminary | final | amended +",
"definition": "Indicates the status of the detected issue.",
"comment": "This element is labeled as a modifier because the status contains the codes cancelled and entered-in-error that mark the issue as not currently valid.",
"alias": [
"status"
],
"min": 1,
"max": "1",
"type": [
{
"code": "code"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueStatus"
}
],
"strength": "required",
"description": "Indicates the status of the identified issue",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/observation-status"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "FiveWs.status"
}
]
},
{
"id": "DetectedIssue.category",
"path": "DetectedIssue.category",
"short": "Issue Category, e.g. drug-drug, duplicate therapy, etc.",
"definition": "Identifies the general type of issue identified.",
"alias": [
"type"
],
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueCategory"
}
],
"strength": "preferred",
"description": "Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/detectedissue-category"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.code"
},
{
"identity": "w5",
"map": "FiveWs.class"
},
{
"identity": "v2",
"map": "AL1-2 / IAM-9"
},
{
"identity": "rim",
"map": ".code"
}
]
},
{
"id": "DetectedIssue.severity",
"path": "DetectedIssue.severity",
"short": "high | moderate | low",
"definition": "Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.",
"alias": [
"severity"
],
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueSeverity"
}
],
"strength": "required",
"description": "Indicates the potential degree of impact of the identified issue on the patient.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/detectedissue-severity"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.grade"
},
{
"identity": "v2",
"map": "AL1-4/ IAR-2"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value"
}
]
},
{
"id": "DetectedIssue.patient",
"path": "DetectedIssue.patient",
"short": "Associated patient",
"definition": "Indicates the patient whose record the detected issue is associated with.",
"requirements": "While the subject could be inferred by tracing the subject of the implicated resources, it's useful to have a direct link for query purposes.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Patient"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.subject"
},
{
"identity": "w5",
"map": "FiveWs.subject[x]"
},
{
"identity": "v2",
"map": "PID-3"
},
{
"identity": "rim",
"map": ".participation[typeCode=SBJ].role[classCode=PAT]"
},
{
"identity": "w5",
"map": "FiveWs.subject"
}
]
},
{
"id": "DetectedIssue.date",
"path": "DetectedIssue.date",
"short": "When identified",
"definition": "The date or date-time when the detected issue was initially identified.",
"requirements": "No-one can be responsible for mitigation prior to the issue being identified.",
"min": 0,
"max": "1",
"type": [
{
"code": "dateTime"
}
],
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.occurrence[x]"
},
{
"identity": "w5",
"map": "FiveWs.recorded"
},
{
"identity": "v2",
"map": "ALI-6 / IAM-11"
},
{
"identity": "rim",
"map": ".effectiveTime"
}
]
},
{
"id": "DetectedIssue.author",
"path": "DetectedIssue.author",
"short": "The provider or device that identified the issue",
"definition": "Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.performer.actor"
},
{
"identity": "w5",
"map": "FiveWs.author"
},
{
"identity": "v2",
"map": "IAM-14 / IAM-16"
},
{
"identity": "rim",
"map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]"
}
]
},
{
"id": "DetectedIssue.implicated",
"path": "DetectedIssue.implicated",
"short": "Problem resource",
"definition": "Indicates the resource representing the current activity or proposed activity that is potentially problematic.",
"comment": "There's an implicit constraint on the number of implicated resources based on DetectedIssue.type; e.g. For drug-drug, there would be more than one. For timing, there would typically only be one.",
"alias": [
"cause"
],
"min": 0,
"max": "*",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.reasonReference"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]"
}
]
},
{
"id": "DetectedIssue.detail",
"path": "DetectedIssue.detail",
"short": "Description and context",
"definition": "A textual explanation of the detected issue.",
"comment": "Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.note"
},
{
"identity": "v2",
"map": "AL1-5 / IAM-8"
},
{
"identity": "rim",
"map": ".text"
}
]
},
{
"id": "DetectedIssue.reference",
"path": "DetectedIssue.reference",
"short": "Authority for issue",
"definition": "The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.",
"min": 0,
"max": "1",
"type": [
{
"code": "uri"
}
],
"mapping": [
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri"
}
]
},
{
"id": "DetectedIssue.mitigation",
"path": "DetectedIssue.mitigation",
"short": "Step taken to address",
"definition": "Indicates an action that has been taken or is committed to reduce or eliminate the likelihood of the risk identified by the detected issue from manifesting. Can also reflect an observation of known mitigating factors that may reduce/eliminate the need for any action.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"mapping": [
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]"
}
]
},
{
"id": "DetectedIssue.mitigation.action",
"path": "DetectedIssue.mitigation.action",
"short": "What mitigation?",
"definition": "Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.",
"comment": "The \"text\" component can be used for detail or when no appropriate code exists.",
"min": 1,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DetectedIssueMitigationAction"
}
],
"strength": "preferred",
"description": "Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action"
},
"mapping": [
{
"identity": "rim",
"map": ".code"
}
]
},
{
"id": "DetectedIssue.mitigation.date",
"path": "DetectedIssue.mitigation.date",
"short": "Date committed",
"definition": "Indicates when the mitigating action was documented.",
"comment": "This might not be the same as when the mitigating step was actually taken.",
"min": 0,
"max": "1",
"type": [
{
"code": "dateTime"
}
],
"mapping": [
{
"identity": "rim",
"map": ".effectiveTime"
}
]
},
{
"id": "DetectedIssue.mitigation.author",
"path": "DetectedIssue.mitigation.author",
"short": "Who is committing?",
"definition": "Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner"
]
}
],
"mapping": [
{
"identity": "rim",
"map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]"
}
]
}
]
}
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
®© HL7.org 2011+. FHIR Mixed Nomative/Trial Use Ballot (v3.3.0-13671) generated on Tue, Apr 3, 2018 12:14+1000. QA Page
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