R6 Ballot (2nd Draft)
AdministrationPublish-box (todo)
Patient Care  Work Group | Maturity Level: 1 | Trial Use | Security Category: Patient | Compartments: Device, Patient, Practitioner |
Prospective warnings of potential issues when providing care to the patient.
A flag is a warning or notification of some sort presented to the user - who may be a clinician or some other person involved in patient care. It usually represents something of sufficient significance to warrant a special display of some sort - rather than just a note in the resource. A flag has a subject representing the resource that will trigger its display. This subject can be of different types, as described in the examples below:
A flag is typically presented as a label in a prominent location in the record to notify the clinician of the potential issues, though it may also appear in other contexts; e.g. notes applicable to a radiology technician, or to a clinician performing a home visit. For patients, the information in the flag will often be derived from the record, and therefore, for a thorough and careful clinician, who has the time to review the notes will be redundant. However, given the volume of information frequently found in patients' records and the potentially serious consequences of losing sight of some facts, this redundancy is deemed appropriate. As well, some flags may reflect information not captured by any other resource in the record. (E.g. "Patient has large dog at home")
In line with its purpose, a flag is concise, highlighting a small set of high-priority issues among the much larger set of data in the chart. Readers who want more detail should consult the chart or other source of information. Caution should be exercised in creating Flag instances. If entries are created for information that could be gleaned in a sufficiently timely fashion by reviewing the patient record, the flag list will itself become overwhelming and will cease to serve its intended purpose.
Flags are expected to persist in a record for some period of time and are, at most, targeted to particular types of practitioners or to practitioners in a particular system.
Examples of Patient related issues that might appear in flags:
Examples of issues that should not appear only in flags:
Note that we include "latex allergy" in the "in scope" list, and "allergy" in the "not in scope" list. The Flag resource is not designed to replace the normal order checking process, and one should not expect to see all allergies in Flags. However, if there is an activity that might occur prior to careful evaluation of the record (e.g. donning of latex gloves) and that activity might pose a risk to the patient, that is the sort of eventuality the Flag is intended to support.
Specific guidelines about what type of information is appropriate to expose using Flag, as well as what categories of individuals should see particular flags, will vary by interoperability community.
Flags may highlight a highly condensed view of information found in the AllergyIntolerance, Condition, Observation, Procedure and possibly other resources. A common extension allows the linkage of a Flag to the supporting detail resource. The purpose of these other resources is to provide detailed clinical information. The purpose of a Flag is to alert practitioners to information that is important to influence their interaction with a Patient prior to detailed review of the record.
Flags are not used to convey information to a specific individual or organization (e.g. an abnormal lab result reported to the ordering clinician, reporting of an adverse reaction to a regulatory authority). These are handled using the CommunicationRequest and the Communication resources.
Flags are not raised as a result of a reported or proposed action (e.g. drug-drug interactions, duplicate therapy warnings). These would be handled using DetectedIssue.
No references for this Resource.
Structure
See the Extensions for this resource
UML Diagram (Legend)
XML Template
<Flag xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Business identifier --></identifier> <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error --> <category><!-- 0..* CodeableConcept Clinical, administrative, etc --></category> <code><!-- 1..1 CodeableConcept Coded or textual message to display to user --></code> <subject><!-- 1..1 Reference(Group|Location|Medication|Organization|Patient| PlanDefinition|Practitioner|PractitionerRole|Procedure|RelatedPerson) Who/What is flag about? --></subject> <period><!-- 0..1 Period Time period when flag is active --></period> <encounter><!-- 0..1 Reference(Encounter) Alert relevant during encounter --></encounter> <author><!-- 0..1 Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) Flag creator --></author> <supportingInfo><!-- 0..* Reference(AllergyIntolerance|Condition|Observation| Procedure|RiskAssessment) Extra information to use in context of the flag --></supportingInfo> </Flag>
JSON Template
{
"resourceType" : "Flag",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Business identifier
"status" : "<code>", // R! active | inactive | entered-in-error
"category" : [{ CodeableConcept }], // Clinical, administrative, etc
"code" : { CodeableConcept }, // R! Coded or textual message to display to user
"subject" : { Reference(Group|Location|Medication|Organization|Patient|
PlanDefinition|Practitioner|PractitionerRole|Procedure|RelatedPerson) }, // R! Who/What is flag about?
"period" : { Period }, // Time period when flag is active
"encounter" : { Reference(Encounter) }, // Alert relevant during encounter
"author" : { Reference(Device|Organization|Patient|Practitioner|
PractitionerRole|RelatedPerson) }, // Flag creator
"supportingInfo" : [{ Reference(AllergyIntolerance|Condition|Observation|
Procedure|RiskAssessment) }] // Extra information to use in context of the flag
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes from both R4 and R4B
| Flag | |
| Flag.subject |
|
| Flag.author |
|
| Flag.supportingInfo |
|
See the Full Difference for further information
This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.
Structure
See the Extensions for this resource
XML Template
<Flag xmlns="http://hl7.org/fhir">
JSON Template
{
"resourceType" : "Flag",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Business identifier
"status" : "<code>", // R! active | inactive | entered-in-error
"category" : [{ CodeableConcept }], // Clinical, administrative, etc
"code" : { CodeableConcept }, // R! Coded or textual message to display to user
"subject" : { Reference(Group|Location|Medication|Organization|Patient|
PlanDefinition|Practitioner|PractitionerRole|Procedure|RelatedPerson) }, // R! Who/What is flag about?
"period" : { Period }, // Time period when flag is active
"encounter" : { Reference(Encounter) }, // Alert relevant during encounter
"author" : { Reference(Device|Organization|Patient|Practitioner|
PractitionerRole|RelatedPerson) }, // Flag creator
"supportingInfo" : [{ Reference(AllergyIntolerance|Condition|Observation|
Procedure|RiskAssessment) }] // Extra information to use in context of the flag
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes from both R4 and R4B
| Flag | |
| Flag.subject |
|
| Flag.author |
|
| Flag.supportingInfo |
|
See the Full Difference for further information
This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.
Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis
| Path | ValueSet | Type | Documentation |
|---|---|---|---|
| Flag.status | FlagStatus | Required | Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error. |
| Flag.category | FlagCategory | Example | Example list of general categories for flagged issues. (Not complete or necessarily appropriate.) |
| Flag.code | FlagCode | Example | Example list of detail codes for flagged issues. (Not complete or necessarily appropriate.) |
The Flag resource is sometimes used as "patient notes" and MAY be used to warn of issues such as:
Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| author | reference | Flag creator | Flag.author (Practitioner, Organization, Device, Patient, PractitionerRole, RelatedPerson) |
|
| category | token | The category of the flag, such as clinical, administrative, etc. | Flag.category | |
| date | date | Time period when flag is active | Flag.period | 26 Resources |
| encounter | reference | Alert relevant during encounter | Flag.encounter (Encounter) |
29 Resources |
| identifier | token | Business identifier | Flag.identifier | 65 Resources |
| patient | reference | The identity of a subject to list flags for | Flag.subject.where(resolve() is Patient) (Patient) |
65 Resources |
| status | token | active | inactive | entered-in-error | Flag.status | |
| subject | reference | The identity of a subject to list flags for | Flag.subject (Practitioner, Group, Organization, Medication, Patient, PlanDefinition, Procedure, PractitionerRole, RelatedPerson, Location) |
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot2 generated on Mon, Aug 12, 2024 16:58+0800.
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