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.

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.

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.

An Extension

R5: DetectedIssue.category (new:CodeableConcept)

Element DetectedIssue.category has a context of DetectedIssue based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.category has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

R5: DetectedIssue.encounter (new:Reference(Encounter))

Element DetectedIssue.encounter has a context of DetectedIssue based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.encounter has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This will typically be the encounter the DetectedIssue was created during, but some DetectedIssues may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).

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 and/or the understanding of the containing element's descendants. 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Indicates the status of the detected issue.

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.

Indicates the status of the identified issue.

An Extension

R5: DetectedIssue.status additional codes

Element DetectedIssue.status is mapped to FHIR R4 element DetectedIssue.status as RelatedTo. The mappings for DetectedIssue.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context DetectedIssue.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains the code entered-in-error that marks the issue as not currently valid.

R5: DetectedIssue.category (new:CodeableConcept)

Element DetectedIssue.category has a context of DetectedIssue based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.category has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

R5: DetectedIssue.encounter (new:Reference(Encounter))

Element DetectedIssue.encounter has a context of DetectedIssue based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.encounter has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This will typically be the encounter the DetectedIssue was created during, but some DetectedIssues may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).

R5: DetectedIssue.status additional codes

Element DetectedIssue.status is mapped to FHIR R4 element DetectedIssue.status as RelatedTo. The mappings for DetectedIssue.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context DetectedIssue.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains the code entered-in-error that marks the issue as not currently valid.

R5: DetectedIssue.subject

Element DetectedIssue.subject is mapped to FHIR R4 element DetectedIssue.patient as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element DetectedIssue.subject with unmapped reference targets: BiologicallyDerivedProduct, Device, Group, Location, Medication, NutritionProduct, Organization, Practitioner, Procedure, Substance.

R5: DetectedIssue.author

Element DetectedIssue.author is mapped to FHIR R4 element DetectedIssue.author as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element DetectedIssue.author with unmapped reference targets: Patient, RelatedPerson.

R5: DetectedIssue.mitigation.note (new:Annotation)

Element DetectedIssue.mitigation.note has a context of DetectedIssue.mitigation based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.mitigation.note has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

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.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

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.

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.

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.

The base language in which the resource is written.

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).

The codes SHOULD be taken from CommonLanguages
(preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

A human language.

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.

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 information is added later.

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.

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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

R5: DetectedIssue.category (new:CodeableConcept)

Element DetectedIssue.category has a context of DetectedIssue based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.category has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

R5: DetectedIssue.encounter (new:Reference(Encounter))

Element DetectedIssue.encounter has a context of DetectedIssue based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.encounter has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This will typically be the encounter the DetectedIssue was created during, but some DetectedIssues may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).

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 and/or the understanding of the containing element's descendants. 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Business identifier associated with the detected issue record.

Allows linking instances of the same detected issue found on different servers.

Indicates the status of the detected issue.

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.

Indicates the status of the identified issue.

unique id for the element within a resource (for internal references)

An Extension

R5: DetectedIssue.status additional codes

Element DetectedIssue.status is mapped to FHIR R4 element DetectedIssue.status as RelatedTo. The mappings for DetectedIssue.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context DetectedIssue.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains the code entered-in-error that marks the issue as not currently valid.

Primitive value for code

Identifies the general type of issue identified.

Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.

Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.

Indicates the potential degree of impact of the identified issue on the patient.

Indicates the patient whose record the detected issue is associated with.

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.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R5: DetectedIssue.subject

Element DetectedIssue.subject is mapped to FHIR R4 element DetectedIssue.patient as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element DetectedIssue.subject with unmapped reference targets: BiologicallyDerivedProduct, Device, Group, Location, Medication, NutritionProduct, Organization, Practitioner, Procedure, Substance.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The date or period when the detected issue was initially identified.

No-one can be responsible for mitigation prior to the issue being identified.

Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R5: DetectedIssue.author

Element DetectedIssue.author is mapped to FHIR R4 element DetectedIssue.author as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element DetectedIssue.author with unmapped reference targets: Patient, RelatedPerson.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Indicates the resource representing the current activity or proposed activity that is potentially problematic.

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.

Supporting evidence or manifestations that provide the basis for identifying the detected issue such as a GuidanceResponse or MeasureReport.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

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.

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.

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 and/or the understanding of the containing element's descendants. 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

A manifestation that led to the recording of this detected issue.

Codes that describes the types of evidence for a detected issue.

Links to resources that constitute evidence for the detected issue such as a GuidanceResponse or MeasureReport.

A textual explanation of the detected issue.

Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.

The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.

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.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R5: DetectedIssue.mitigation.note (new:Annotation)

Element DetectedIssue.mitigation.note has a context of DetectedIssue.mitigation based on following the parent source element upwards and mapping to DetectedIssue. Element DetectedIssue.mitigation.note has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

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 and/or the understanding of the containing element's descendants. 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.

The "text" component can be used for detail or when no appropriate code exists.

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.

Indicates when the mitigating action was documented.

This might not be the same as when the mitigating step was actually taken.

Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.