PrescribeIT® Specification and Guide Version 5.0

 

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.

Control0..*
Must Supporttrue
Alternate NamesDDI, 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 Length0
2. DetectedIssue.id
Definition

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

Control1..1
Typeid
Must Supporttrue
Comments

Usage Note: This will usually be a GUID and is assigned by the sending application.

Max Length0
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.

Control0..1
TypeMeta
Max Length0
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.

Control0..1
Typeuri
Is Modifiertrue
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 Length0
5. DetectedIssue.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language.

Typecode
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 Length0
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.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Max Length0
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.

Control0..*
TypeResource
Alternate Namesinline 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 Length0
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.

Control0..*
TypeExtension
Alternate Namesextensions, 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 Length0
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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, 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 Length0
10. DetectedIssue.patient
Definition

A reference from one resource to another.

Control1..1
TypeReference(Shared Health Reference)(Shared Health Patient)
Must Supporttrue
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 Length0
11. DetectedIssue.category
Definition

This is used to express the type of interaction

Control0..1
BindingThe codes SHALL be taken from DetectedIssueCategory (20220615); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept)
Must Supporttrue
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 Length0
InvariantsDefined 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.

Control0..1
BindingThe codes SHALL be taken from DetectedIssueSeverity Indicates the potential degree of impact of the identified issue on the patient.

Typecode
Alternate Namesseverity
Max Length0
13. DetectedIssue.implicated
Definition

A reference from one resource to another.

Control1..1
TypeReference(Shared Health Reference)(PrescribeIT® Prescription)
Must Supporttrue
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 Length0
14. DetectedIssue.detail
Definition

A textual explanation of the detected issue.

Control0..1
Typestring
Must Supporttrue
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 Length1000
15. DetectedIssue.date
Definition

The date or date-time when the detected issue was initially identified.

Control0..1
TypedateTime
Requirements

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

Max Length0
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.

Control0..1
TypeReference(Practitioner | Device)
Max Length0
17. DetectedIssue.identifier
Definition

Business identifier associated with the detected issue record.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Requirements

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

Max Length0
18. DetectedIssue.reference
Definition

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

Control0..1
Typeuri
Max Length0
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.

Control0..*
TypeBackboneElement
Must Supporttrue
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 Length0
20. DetectedIssue.mitigation.id
Definition

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

Control0..1
Typeid
Max Length0
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.

Control0..*
TypeExtension
Alternate Namesextensions, 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 Length0
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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, 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 Length0
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.

Control1..1
BindingThe codes SHALL be taken from DetectedIssueMitigationAction (20210501); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
Must Supporttrue
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 Length0
24. DetectedIssue.mitigation.date
Definition

Indicates when the mitigating action was documented.

Control0..1
TypedateTime
Comments

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

Max Length0
25. DetectedIssue.mitigation.author
Definition

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

Control0..1
TypeReference(Practitioner)
Max Length0