DSTU2

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5.20 Resource Flag - Content

Patient Care Work GroupMaturity Level: 1Compartments: Device, Patient, Practitioner

Prospective warnings of potential issues when providing care to the patient.

5.20.1 Scope and Usage

A flag is a warning or notification of some sort presented to the user - who may be a clinician or some other person involve in patient care. It usually represents something of sufficient significance to be 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 note that a patient has an overdue account, which the provider may wish to discuss with them - in case of hardship for example (subject = Patient)
  • An outbreak of Ebola in a particular region (subject=Location) so that all patients from that region have a higher risk of having that condition
  • A particular provider is unavailable for referrals over a given period (subject = Practitioner)
  • A patient who is enrolled in a clinical trial (subject=Group)

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 particular system.

Examples of Patient related issues that might appear in flags:

  • Risks to the patient (functional risk of falls, spousal restraining order, latex allergy)
  • Patient's needs for special accommodations (hard of hearing, need for easy-open caps)
  • Risks to providers (dog in house, patient may bite, infection control precautions)
  • Administrative concerns (incomplete information, pre-payment required due to credit risk)

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.

5.20.2 Boundaries and Relationships

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.

5.20.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Flag DomainResourceKey information to flag to healthcare providers
... identifier Σ0..*IdentifierBusiness identifier
... category Σ0..1CodeableConceptClinical, administrative, etc.
Flag Category (Example)
... status ?! Σ1..1codeactive | inactive | entered-in-error
FlagStatus (Required)
... period Σ0..1PeriodTime period when flag is active
... subject Σ1..1Reference(Patient | Location | Group | Organization | Practitioner)Who/What is flag about?
... encounter Σ0..1Reference(Encounter)Alert relevant during encounter
... author Σ0..1Reference(Device | Organization | Patient | Practitioner)Flag creator
... code Σ1..1CodeableConceptPartially deaf, Requires easy open caps, No permanent address, etc.
Flag Code (Example)

doco Documentation for this format

UML Diagram

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Flag DomainResourceKey information to flag to healthcare providers
... identifier Σ0..*IdentifierBusiness identifier
... category Σ0..1CodeableConceptClinical, administrative, etc.
Flag Category (Example)
... status ?! Σ1..1codeactive | inactive | entered-in-error
FlagStatus (Required)
... period Σ0..1PeriodTime period when flag is active
... subject Σ1..1Reference(Patient | Location | Group | Organization | Practitioner)Who/What is flag about?
... encounter Σ0..1Reference(Encounter)Alert relevant during encounter
... author Σ0..1Reference(Device | Organization | Patient | Practitioner)Flag creator
... code Σ1..1CodeableConceptPartially deaf, Requires easy open caps, No permanent address, etc.
Flag Code (Example)

doco Documentation for this format

UML Diagram

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

5.20.3.1 Terminology Bindings

PathDefinitionTypeReference
Flag.category A general category for flags for filtering/display purposes.ExampleFlag Category
Flag.status Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or entered in error.RequiredFlagStatus
Flag.code Detail codes identifying specific flagged issues.ExampleFlag Code

The Flag resource is sometimes known as "patient notes" and MAY be used to warn of issues such as:

  • Issues that impact on the patient's ability to receive/respond to care the care provision process itself (e.g., poor language comprehension, low compliance expected)
  • Issues that impact on the ability to provide care (e.g., patient has a big dog at home)
  • Financial matters (e.g., patient is a bad debtor)

5.20.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
authorreferenceFlag creatorFlag.author
(Device, Patient, Organization, Practitioner)
datedateTime period when flag is activeFlag.period
encounterreferenceAlert relevant during encounterFlag.encounter
(Encounter)
patientreferenceThe identity of a subject to list flags forFlag.subject
(Patient)
subjectreferenceThe identity of a subject to list flags forFlag.subject
(Organization, Location, Patient, Practitioner, Group)