5.20 Resource Flag - Content

5.20.1 Scope and Usage

A flag is typically presented as a label in a prominent location in a patient chart to notify the clinician of potential issues, though it may also appear in other contexts. E.g. instructions to a radiology technician. The information in the flag will usually be derived from the record, and therefore, for a thorough and careful clinician, 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. 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 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 in flags:

• Potential allergy or drug interaction to planned therapy (use Contraindication)
• Known adverse reaction to a substance (use AllergyIntolerance)

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 Contraindication.

• Structure
• UML
• XML
• JSON
• All

Structure

Name	Flags	Card.	Type	Description & Constraints
Flag			DomainResource	Key information to flag to healthcare providers
identifier	Σ	0..*	Identifier	Business identifier
category	Σ	0..1	CodeableConcept	Clinical, administrative, etc.
status	?! Σ	1..1	code	active | inactive | entered-in-error FlagStatus (Required)
period	Σ	0..1	Period	Time period when flag is active
patient	Σ	1..1	Patient	Who is flag about?
author	Σ	0..1	Practitioner | Patient | Device	Flag creator
code	Σ	1..1	CodeableConcept	Partially deaf, Requires easy open caps, No permanent address, etc.

<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>
 <category><!-- 0..1 CodeableConcept Clinical, administrative, etc. --></category>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error -->
 <period><!-- 0..1 Period Time period when flag is active --></period>
 <patient><!-- 1..1 Reference(Patient) Who is flag about? --></patient>
 <author><!-- 0..1 Reference(Practitioner|Patient|Device) Flag creator --></author>
 <code><!-- 1..1 CodeableConcept 
     Partially deaf, Requires easy open caps, No permanent address, etc. --></code>
</Flag>

{
  "resourceType" : "Flag",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "category" : { CodeableConcept }, // Clinical, administrative, etc.
  "status" : "<code>", // R!  active | inactive | entered-in-error
  "period" : { Period }, // Time period when flag is active
  "patient" : { Reference(Patient) }, // R!  Who is flag about?
  "author" : { Reference(Practitioner|Patient|Device) }, // Flag creator
  "code" : { CodeableConcept } // R!  
     Partially deaf, Requires easy open caps, No permanent address, etc.
}

Structure

Name	Flags	Card.	Type	Description & Constraints
Flag			DomainResource	Key information to flag to healthcare providers
identifier	Σ	0..*	Identifier	Business identifier
category	Σ	0..1	CodeableConcept	Clinical, administrative, etc.
status	?! Σ	1..1	code	active | inactive | entered-in-error FlagStatus (Required)
period	Σ	0..1	Period	Time period when flag is active
patient	Σ	1..1	Patient	Who is flag about?
author	Σ	0..1	Practitioner | Patient | Device	Flag creator
code	Σ	1..1	CodeableConcept	Partially deaf, Requires easy open caps, No permanent address, etc.

UML Diagram

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>
 <category><!-- 0..1 CodeableConcept Clinical, administrative, etc. --></category>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error -->
 <period><!-- 0..1 Period Time period when flag is active --></period>
 <patient><!-- 1..1 Reference(Patient) Who is flag about? --></patient>
 <author><!-- 0..1 Reference(Practitioner|Patient|Device) Flag creator --></author>
 <code><!-- 1..1 CodeableConcept 
     Partially deaf, Requires easy open caps, No permanent address, etc. --></code>
</Flag>

JSON Template

{
  "resourceType" : "Flag",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "category" : { CodeableConcept }, // Clinical, administrative, etc.
  "status" : "<code>", // R!  active | inactive | entered-in-error
  "period" : { Period }, // Time period when flag is active
  "patient" : { Reference(Patient) }, // R!  Who is flag about?
  "author" : { Reference(Practitioner|Patient|Device) }, // Flag creator
  "code" : { CodeableConcept } // R!  
     Partially deaf, Requires easy open caps, No permanent address, etc.
}