Data Exchange For Quality Measures Implementation Guide
1.0.0-ballot - STU 1 Ballot

Data Exchange For Quality Measures Implementation Guide - Downloaded Version 1.0.0-ballot See the Directory of published versions

## Resource Profile: DEQM Gaps In Care Detected Issue Profile

Official URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapsincaredetectedissue | Version: 1.0.0-ballot | Highlight text changes?
Standards status: Trial-use Active as of 2021-04-23 | Maturity Level: 4 | Computable Name: DEQMGapsInCareDetectedIssue

The DEQM Gaps In Care DetectedIssue Profile indicates that the measure reported has an open gap, prospective-gap or a closed gap as identified in the gapStatus modifier extension.

### Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present).

Each DetectedIssue Must Have:

1. modifierExtension: Gap Status
2. evidence: Supporting evidence
3. code: Issue Category, e.g. drug-drug, duplicate therapy, etc.
4. status: registered | preliminary | final | amended +
5. evidence.detail: This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
6. patient: Associated patient

Each DetectedIssue Must Support:

1. criteriaReference: Criteria reference

This profile builds on DetectedIssue.

Usages:

- Refer to this Profile: DEQM Gaps In Care Composition Profile
- Examples for this Profile: DetectedIssue/gaps-detectedissue01, DetectedIssue/gaps-detectedissue02, DetectedIssue/gaps-detectedissue03, DetectedIssue/gaps-detectedissue04 and DetectedIssue/gaps-detectedissue05

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DetectedIssue |  | 0..* | DetectedIssue | Clinical issue with action
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for modifierExtension | ?! | 1..* | Extension | Extension Slice: Unordered, Open by value:url
modifierExtension:gapStatus | ?!S | 1..1 | CodeableConcept | Gap Status URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
status | ?!Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Indicates the status of the identified issue.
code | S Σ | 1..1 | CodeableConcept | Issue Category, e.g. drug-drug, duplicate therapy, etc. Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: CAREGAP
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
patient | S Σ | 1..1 | Reference(Patient) | Associated patient
evidence | S | 1..* | BackboneElement | Supporting evidence
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
detail | S | 1..1 | Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) | This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
Slices for extension |  |  |  | Content/Rules for all slices
extension:criteriaReference | S | 0..1 | string | Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DetectedIssue.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
DetectedIssue.code | Base | preferred | Detected Issue Category | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DetectedIssue | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DetectedIssue | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DetectedIssue | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DetectedIssue |  | 0..* | DetectedIssue | Clinical issue with action
Slices for modifierExtension |  |  |  | Content/Rules for all slices
modifierExtension:gapStatus | ?!S | 1..1 | CodeableConcept | Gap Status URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
code | S | 1..1 | CodeableConcept | Issue Category, e.g. drug-drug, duplicate therapy, etc. Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: CAREGAP
patient | S | 1..1 | Reference(Patient) | Associated patient
evidence | S | 1..* | BackboneElement | Supporting evidence
detail | S | 1..1 | Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) | This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
Slices for extension |  |  |  | Content/Rules for all slices
extension:criteriaReference | S | 0..1 | string | Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DetectedIssue |  | 0..* | DetectedIssue | Clinical issue with action
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
Slices for modifierExtension | ?! | 1..* | Extension | Extension Slice: Unordered, Open by value:url
modifierExtension:gapStatus | ?!S | 1..1 | CodeableConcept | Gap Status URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
identifier | Σ | 0..* | Identifier | Unique id for the detected issue
status | ?!Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Indicates the status of the identified issue.
code | S Σ | 1..1 | CodeableConcept | Issue Category, e.g. drug-drug, duplicate therapy, etc. Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: CAREGAP
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
severity | Σ | 0..1 | code | high | moderate | low Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.
patient | S Σ | 1..1 | Reference(Patient) | Associated patient
identified[x] | Σ | 0..1 |  | When identified
identifiedDateTime |  |  | dateTime |
identifiedPeriod |  |  | Period |
author | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Device) | The provider or device that identified the issue
implicated | Σ | 0..* | Reference(Resource) | Problem resource
evidence | S | 1..* | BackboneElement | Supporting evidence
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 0..* | CodeableConcept | Manifestation Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.
detail | S | 1..1 | Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) | This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:criteriaReference | S | 0..1 | string | Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
detail |  | 0..1 | string | Description and context
reference |  | 0..1 | uri | Authority for issue
mitigation |  | 0..* | BackboneElement | Step taken to address
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
action |  | 1..1 | CodeableConcept | What mitigation? Binding: DetectedIssueMitigationAction (preferred): 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.
date |  | 0..1 | dateTime | Date committed
author |  | 0..1 | Reference(Practitioner | PractitionerRole) | Who is committing?
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DetectedIssue.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DetectedIssue.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
DetectedIssue.code | Base | preferred | Detected Issue Category | 📍4.0.1 | FHIR Std.
DetectedIssue.severity | Base | required | DetectedIssueSeverity | 📍4.0.1 | FHIR Std.
DetectedIssue.evidence.​code | Base | example | Manifestation and Symptom Codes | 📍4.0.1 | FHIR Std.
DetectedIssue.evidence.​detail.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
DetectedIssue.mitigation.​action | Base | preferred | Detected Issue Mitigation Action | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DetectedIssue | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DetectedIssue | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DetectedIssue | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Mandatory: 5 elements
Must-Support: 6 elements

Structures

This structure refers to these other structures:

- DEQM Individual MeasureReport Profile (http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-individualmeasurereport)
- DEQM Detailed Care Gap Guidance Response (http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-detailedcaregapguidanceresponse)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus (Modifier)
- http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DetectedIssue |  | 0..* | DetectedIssue | Clinical issue with action
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for modifierExtension | ?! | 1..* | Extension | Extension Slice: Unordered, Open by value:url
modifierExtension:gapStatus | ?!S | 1..1 | CodeableConcept | Gap Status URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
status | ?!Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Indicates the status of the identified issue.
code | S Σ | 1..1 | CodeableConcept | Issue Category, e.g. drug-drug, duplicate therapy, etc. Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: CAREGAP
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
patient | S Σ | 1..1 | Reference(Patient) | Associated patient
evidence | S | 1..* | BackboneElement | Supporting evidence
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
detail | S | 1..1 | Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) | This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
Slices for extension |  |  |  | Content/Rules for all slices
extension:criteriaReference | S | 0..1 | string | Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DetectedIssue.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
DetectedIssue.code | Base | preferred | Detected Issue Category | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DetectedIssue | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DetectedIssue | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DetectedIssue | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DetectedIssue |  | 0..* | DetectedIssue | Clinical issue with action
Slices for modifierExtension |  |  |  | Content/Rules for all slices
modifierExtension:gapStatus | ?!S | 1..1 | CodeableConcept | Gap Status URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
code | S | 1..1 | CodeableConcept | Issue Category, e.g. drug-drug, duplicate therapy, etc. Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: CAREGAP
patient | S | 1..1 | Reference(Patient) | Associated patient
evidence | S | 1..* | BackboneElement | Supporting evidence
detail | S | 1..1 | Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) | This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
Slices for extension |  |  |  | Content/Rules for all slices
extension:criteriaReference | S | 0..1 | string | Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
Documentation for this format

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
DetectedIssue |  | 0..* | DetectedIssue | Clinical issue with action
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
Slices for modifierExtension | ?! | 1..* | Extension | Extension Slice: Unordered, Open by value:url
modifierExtension:gapStatus | ?!S | 1..1 | CodeableConcept | Gap Status URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
identifier | Σ | 0..* | Identifier | Unique id for the detected issue
status | ?!Σ | 1..1 | code | registered | preliminary | final | amended + Binding: ObservationStatus (required): Indicates the status of the identified issue.
code | S Σ | 1..1 | CodeableConcept | Issue Category, e.g. drug-drug, duplicate therapy, etc. Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: CAREGAP
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
severity | Σ | 0..1 | code | high | moderate | low Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.
patient | S Σ | 1..1 | Reference(Patient) | Associated patient
identified[x] | Σ | 0..1 |  | When identified
identifiedDateTime |  |  | dateTime |
identifiedPeriod |  |  | Period |
author | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Device) | The provider or device that identified the issue
implicated | Σ | 0..* | Reference(Resource) | Problem resource
evidence | S | 1..* | BackboneElement | Supporting evidence
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 0..* | CodeableConcept | Manifestation Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.
detail | S | 1..1 | Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) | This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:criteriaReference | S | 0..1 | string | Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
detail |  | 0..1 | string | Description and context
reference |  | 0..1 | uri | Authority for issue
mitigation |  | 0..* | BackboneElement | Step taken to address
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
action |  | 1..1 | CodeableConcept | What mitigation? Binding: DetectedIssueMitigationAction (preferred): 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.
date |  | 0..1 | dateTime | Date committed
author |  | 0..1 | Reference(Practitioner | PractitionerRole) | Who is committing?
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
DetectedIssue.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
DetectedIssue.status | Base | required | ObservationStatus | 📍4.0.1 | FHIR Std.
DetectedIssue.code | Base | preferred | Detected Issue Category | 📍4.0.1 | FHIR Std.
DetectedIssue.severity | Base | required | DetectedIssueSeverity | 📍4.0.1 | FHIR Std.
DetectedIssue.evidence.​code | Base | example | Manifestation and Symptom Codes | 📍4.0.1 | FHIR Std.
DetectedIssue.evidence.​detail.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
DetectedIssue.mitigation.​action | Base | preferred | Detected Issue Mitigation Action | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | DetectedIssue | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | DetectedIssue | 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 | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | DetectedIssue | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | DetectedIssue | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Mandatory: 5 elements
Must-Support: 6 elements

Structures

This structure refers to these other structures:

- DEQM Individual MeasureReport Profile (http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-individualmeasurereport)
- DEQM Detailed Care Gap Guidance Response (http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-detailedcaregapguidanceresponse)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus (Modifier)
- http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference

Maturity: 4

Other representations of profile: CSV, Excel, Schematron