PrescribeIT® Specification and Guide Version 5.0

 

The official URL for this profile is:

http://prescribeit.ca/fhir/StructureDefinition/profile-detectedissue

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Description of Profiles, Differentials, Snapshots and how the different presentations work.

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This structure is derived from DetectedIssue

NameCard.TypeConstraints and Usage
.  DetectedIssue 0..*DetectedIssueDefinition:
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.


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.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


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

..  patient 1..1Reference(Shared Health Patient) {b}Definition:
A reference from one resource to another.

..  category 0..1Shared Health CodeableConceptBinding: DetectedIssueCategory (20210501) (extensible)
inv-1: Must have coding, text or both
Definition:
This is used to express the type of interaction


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.

..  implicated 1..1Reference(PrescribeIT® Prescription) {b}Definition:
A reference from one resource to another.


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.

..  detail 0..1stringMax Length: 1000
Definition:
A textual explanation of the detected issue.


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.

..  mitigation 0..*BackboneElementDefinition:
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.


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.

...  action 1..1Shared Health CodeableConcept Required Text with optional codeBinding: DetectedIssueMitigationAction (20210501) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


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.

This structure is derived from DetectedIssue

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue S0..*DetectedIssueClinical issue with action
... id S1..1idLogical id of this artifact
... patient S1..1Reference(Shared Health Patient) {b}A reference from one resource to another
... category S0..1Shared Health CodeableConceptConcept - reference to a terminology or just text
Binding: DetectedIssueCategory (20210501) (extensible)
... implicated S1..1Reference(PrescribeIT® Prescription) {b}A reference from one resource to another
... detail S0..1stringDescription and context
Max Length: 1000
... mitigation S0..*BackboneElementStep taken to address
.... action S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: DetectedIssueMitigationAction (20210501) (extensible)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue S0..*DetectedIssueClinical issue with action
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required): A human language.


... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... patient SΣ1..1Reference(Shared Health Patient) {b}A reference from one resource to another
... category SI0..1Shared Health CodeableConceptConcept - reference to a terminology or just text
Binding: DetectedIssueCategory (20210501) (extensible)
... severity Σ0..1codehigh | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.

... implicated SΣ1..1Reference(PrescribeIT® Prescription) {b}A reference from one resource to another
... detail S0..1stringDescription and context
Max Length: 1000
... date Σ0..1dateTimeWhen identified
... author Σ0..1Reference(Practitioner | Device)The provider or device that identified the issue
... identifier Σ0..1IdentifierUnique id for the detected issue
... reference 0..1uriAuthority for issue
... mitigation S0..*BackboneElementStep taken to address
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... action S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: DetectedIssueMitigationAction (20210501) (extensible)
.... date 0..1dateTimeDate committed
.... author 0..1Reference(Practitioner)Who is committing?

doco Documentation for this format

Grid View

This structure is derived from DetectedIssue

NameCard.TypeConstraints and Usage
.  DetectedIssue 0..*DetectedIssueDefinition:
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.


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.

..  id 1..1idDefinition:
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.


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

..  patient 1..1Reference(Shared Health Patient) {b}Definition:
A reference from one resource to another.

..  category 0..1Shared Health CodeableConceptBinding: DetectedIssueCategory (20210501) (extensible)
inv-1: Must have coding, text or both
Definition:
This is used to express the type of interaction


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.

..  implicated 1..1Reference(PrescribeIT® Prescription) {b}Definition:
A reference from one resource to another.


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.

..  detail 0..1stringMax Length: 1000
Definition:
A textual explanation of the detected issue.


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.

..  mitigation 0..*BackboneElementDefinition:
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.


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.

...  action 1..1Shared Health CodeableConcept Required Text with optional codeBinding: DetectedIssueMitigationAction (20210501) (extensible)
Definition:
A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


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.

Differential View

This structure is derived from DetectedIssue

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue S0..*DetectedIssueClinical issue with action
... id S1..1idLogical id of this artifact
... patient S1..1Reference(Shared Health Patient) {b}A reference from one resource to another
... category S0..1Shared Health CodeableConceptConcept - reference to a terminology or just text
Binding: DetectedIssueCategory (20210501) (extensible)
... implicated S1..1Reference(PrescribeIT® Prescription) {b}A reference from one resource to another
... detail S0..1stringDescription and context
Max Length: 1000
... mitigation S0..*BackboneElementStep taken to address
.... action S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: DetectedIssueMitigationAction (20210501) (extensible)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue S0..*DetectedIssueClinical issue with action
... id SΣ1..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: http://tools.ietf.org/html/bcp47 (required): A human language.


... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... patient SΣ1..1Reference(Shared Health Patient) {b}A reference from one resource to another
... category SI0..1Shared Health CodeableConceptConcept - reference to a terminology or just text
Binding: DetectedIssueCategory (20210501) (extensible)
... severity Σ0..1codehigh | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.

... implicated SΣ1..1Reference(PrescribeIT® Prescription) {b}A reference from one resource to another
... detail S0..1stringDescription and context
Max Length: 1000
... date Σ0..1dateTimeWhen identified
... author Σ0..1Reference(Practitioner | Device)The provider or device that identified the issue
... identifier Σ0..1IdentifierUnique id for the detected issue
... reference 0..1uriAuthority for issue
... mitigation S0..*BackboneElementStep taken to address
.... id 0..1idxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... action S1..1Shared Health CodeableConcept Required Text with optional codeConcept - reference to a terminology or just text
Binding: DetectedIssueMitigationAction (20210501) (extensible)
.... date 0..1dateTimeDate committed
.... author 0..1Reference(Practitioner)Who is committing?

doco Documentation for this format

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet
DetectedIssue.languagerequiredhttp://tools.ietf.org/html/bcp47
DetectedIssue.categoryextensibleDetectedIssueCategory
DetectedIssue.severityrequiredDetectedIssueSeverity
DetectedIssue.mitigation.actionextensibleDetectedIssueMitigationAction

Constraints

IdPathDetailsRequirements
inv-1DetectedIssue.categoryMust have coding, text or both
: coding.exists() or text.exists()