3.61.6 StructureDefinition: PrescribeIT® DUR - Detailed Descriptions
Definitions for the profile-detectedissue Profile.
1. DetectedIssue | |
Definition | 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. |
Control | 0..* |
Must Support | true |
Alternate Names | DDI, drug-drug interaction, Contraindication, Alert |
Comments | Usage Note: Detected Issue will be used to convey managed drug interactions. Conformance Rule: Detected issue can only be sent (with or without a mitigation) if it has been viewed and acknowledged by the prescriber. |
Max Length | 0 |
2. DetectedIssue.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Control | 1..1 |
Type | id |
Must Support | true |
Comments | 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. |
Max Length | 0 |
3. DetectedIssue.meta | |
Definition | 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. |
Control | 0..1 |
Type | Meta |
Max Length | 0 |
4. DetectedIssue.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. |
Control | 0..1 |
Type | uri |
Is Modifier | true |
Comments | 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. |
Max Length | 0 |
5. DetectedIssue.language | |
Definition | The base language in which the resource is written. |
Control | 0..1 |
Binding | The codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language. |
Type | code |
Comments | 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). |
Max Length | 0 |
6. DetectedIssue.text | |
Definition | 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. |
Control | 0..1 This element is affected by the following invariants: dom-1 |
Type | Narrative |
Alternate Names | narrative, html, xhtml, display |
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. |
Max Length | 0 |
7. DetectedIssue.contained | |
Definition | 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. |
Control | 0..* |
Type | Resource |
Alternate Names | inline resources, anonymous resources, contained resources |
Comments | 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. |
Max Length | 0 |
8. DetectedIssue.extension | |
Definition | 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. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | 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. |
Max Length | 0 |
9. DetectedIssue.modifierExtension | |
Definition | 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. |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Alternate Names | extensions, user content |
Comments | 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. |
Max Length | 0 |
10. DetectedIssue.patient | |
Definition | A reference from one resource to another. |
Control | 1..1 |
Type | Reference(Shared Health Reference)(Shared Health Patient) |
Must Support | true |
Requirements | 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. |
Max Length | 0 |
11. DetectedIssue.category | |
Definition | This is used to express the type of interaction |
Control | 0..1 |
Binding | The codes SHALL be taken from DetectedIssueCategory (20210501); other codes may be used where these codes are not suitable |
Type | CodeableConcept(Shared Health CodeableConcept) |
Must Support | true |
Comments | 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. |
Max Length | 0 |
Invariants | Defined on this element inv-1: Must have coding, text or both (: coding.exists() or text.exists()) |
12. DetectedIssue.severity | |
Definition | Indicates the degree of importance associated with the identified issue based on the potential impact on the patient. |
Control | 0..1 |
Binding | The codes SHALL be taken from DetectedIssueSeverity Indicates the potential degree of impact of the identified issue on the patient. |
Type | code |
Alternate Names | severity |
Max Length | 0 |
13. DetectedIssue.implicated | |
Definition | A reference from one resource to another. |
Control | 1..1 |
Type | Reference(Shared Health Reference)(PrescribeIT® Prescription) |
Must Support | true |
Comments | 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. |
Max Length | 0 |
14. DetectedIssue.detail | |
Definition | A textual explanation of the detected issue. |
Control | 0..1 |
Type | string |
Must Support | true |
Comments | 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. |
Max Length | 1000 |
15. DetectedIssue.date | |
Definition | The date or date-time when the detected issue was initially identified. |
Control | 0..1 |
Type | dateTime |
Requirements | No-one can be responsible for mitigation prior to the issue being identified. |
Max Length | 0 |
16. DetectedIssue.author | |
Definition | Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review. |
Control | 0..1 |
Type | Reference(Practitioner | Device) |
Max Length | 0 |
17. DetectedIssue.identifier | |
Definition | Business identifier associated with the detected issue record. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..1 |
Type | Identifier |
Requirements | Allows linking instances of the same detected issue found on different servers. |
Max Length | 0 |
18. DetectedIssue.reference | |
Definition | The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified. |
Control | 0..1 |
Type | uri |
Max Length | 0 |
19. DetectedIssue.mitigation | |
Definition | 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. |
Control | 0..* |
Type | BackboneElement |
Must Support | true |
Comments | 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 if available. Conformance Rule: The PMS must display all warnings with Managed Text. |
Max Length | 0 |
20. DetectedIssue.mitigation.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
21. DetectedIssue.mitigation.extension | |
Definition | 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. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | 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. |
Max Length | 0 |
22. DetectedIssue.mitigation.modifierExtension | |
Definition | 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. |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Alternate Names | extensions, user content, modifiers |
Comments | 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. |
Max Length | 0 |
23. DetectedIssue.mitigation.action | |
Definition | A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. |
Control | 1..1 |
Binding | The codes SHALL be taken from DetectedIssueMitigationAction (20210501); other codes may be used where these codes are not suitable |
Type | CodeableConcept(Shared Health CodeableConcept Required Text with optional code) |
Must Support | true |
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. |
Max Length | 0 |
24. DetectedIssue.mitigation.date | |
Definition | Indicates when the mitigating action was documented. |
Control | 0..1 |
Type | dateTime |
Comments | This may not be the same as when the mitigating step was actually taken. |
Max Length | 0 |
25. DetectedIssue.mitigation.author | |
Definition | Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring. |
Control | 0..1 |
Type | Reference(Practitioner) |
Max Length | 0 |