PrescribeIT™ Specification and Guide Version 2.0 Revision F

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.

Usage Note: Detected Issue will be used to convey managed drug interactions.

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

Usage Note: This will usually be a GUID and is assigned by the sending application. Ideally it should be consistent for all messages referencing this issue instance.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may 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.

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 as much as possible.

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).

A human-readable narrative that contains a summary of the resource, and may 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.

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.

May be used to represent additional information that is not part of the basic definition of the resource. In order 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.

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 resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

A reference from one resource to another.

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.

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

This is used to express the type of interaction and is supported with a binding value set. As a data type of codeable concept, coding and text are both available, optionally to express.

Conformance Rule: Drug Interactions should be populated when available.

Usage Note: PMS systems who are using the same DUR database could make use of this code for linking and presentation purposes

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

A reference from one resource to another.

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.

A textual explanation of the detected issue.

Conformance Rule: The EMR can determine which warnings should be sent, with a caution that too many warnings may not be useful. For example: Instead of sending all warnings, the Prescriber or EMR could be only the severe warnings and/or any warnings that the Prescriber specifically handled. Refer to rules in 'mitigation.action'. If an issue is provided, there is the expectation that a mitigation is also stated.

Conformance Rule: Maximum character length set to ‘1000’.

The date or date-time 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.

Business identifier associated with the detected issue record.

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

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 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.

Mitigation is used to express the steps taken to 'mitigate' the impact of the DUR issue. If used, 'action' is mandatory, of which only the child element of 'text' must be valued.

Conformance Rule: Must be provided as available. Expected to be available for each DUR code as only those that have been managed will be submitted in the message

Conformance Rule: The PMS MUST display all warnings with Managed Text.

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

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Usage Note: Text is mandatory. Coding is optional. If a code is available, it must be sent in Coding. Code + System are mandatory if coding is present.

Indicates when the mitigating action was documented.

This may 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.