3.92 StructureDefinition: PrescribeIT® DUR
The official URL for this profile is:
http://prescribeit.ca/fhir/StructureDefinition/profile-detectedissue
3.92.2 Formal Views of Profile Content
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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
| Name | Card. | Type | Constraints and Usage |
|---|---|---|---|
 DetectedIssue | 0..* | 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. 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..1 | id | Definition: 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..1 | Reference(Shared Health Patient) {b} | Definition: A reference from one resource to another. |
| category | 0..1 | Shared Health CodeableConcept | Binding: DetectedIssueCategory (20220615) (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..1 | Reference(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..1 | string | Max 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..* | BackboneElement | 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. 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..1 | Shared Health CodeableConcept Required Text with optional code | Binding: 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
Summary
Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 7 elements
Structures
This structure refers to these other structures:
- http://sharedhealth.exchange/fhir/StructureDefinition/dtprofile-reference
- http://sharedhealth.exchange/fhir/StructureDefinition/profile-patient
- http://sharedhealth.exchange/fhir/StructureDefinition/dtprofile-codeableconcept
- http://prescribeit.ca/fhir/StructureDefinition/profile-medicationorder
- http://sharedhealth.exchange/fhir/StructureDefinition/dtprofile-codeableconcept-text-required-with-code
This structure is derived from DetectedIssue
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
 DetectedIssue | S | 0..* | DetectedIssue | Clinical issue with action |
 id | S | 1..1 | id | Logical id of this artifact |
 patient | S | 1..1 | Reference(Shared Health Patient) {b} | A reference from one resource to another |
 category | S | 0..1 | Shared Health CodeableConcept | Concept - reference to a terminology or just text Binding: DetectedIssueCategory (20220615) (extensible) |
| implicated | S | 1..1 | Reference(PrescribeIT® Prescription) {b} | A reference from one resource to another |
| detail | S | 0..1 | string | Description and context Max Length: 1000 |
| mitigation | S | 0..* | BackboneElement | Step taken to address |
| action | S | 1..1 | Shared Health CodeableConcept Required Text with optional code | Concept - reference to a terminology or just text Binding: DetectedIssueMitigationAction (20210501) (extensible) |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DetectedIssue | S | 0..* | DetectedIssue | Clinical issue with action |
 id | SΣ | 1..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: http://tools.ietf.org/html/bcp47 (required): A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
 extension | 0..* | Extension | Additional Content defined by implementations | |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| patient | SΣ | 1..1 | Reference(Shared Health Patient) {b} | A reference from one resource to another |
| category | SI | 0..1 | Shared Health CodeableConcept | Concept - reference to a terminology or just text Binding: DetectedIssueCategory (20220615) (extensible) |
| severity | Σ | 0..1 | code | high | moderate | low Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient. |
| implicated | SΣ | 1..1 | Reference(PrescribeIT® Prescription) {b} | A reference from one resource to another |
| detail | S | 0..1 | string | Description and context Max Length: 1000 |
| date | Σ | 0..1 | dateTime | When identified |
| author | Σ | 0..1 | Reference(Practitioner | Device) | The provider or device that identified the issue |
| identifier | Σ | 0..1 | Identifier | Unique id for the detected issue |
| reference | 0..1 | uri | Authority for issue | |
| mitigation | S | 0..* | BackboneElement | Step taken to address |
| id | 0..1 | id | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Additional Content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| action | S | 1..1 | Shared Health CodeableConcept Required Text with optional code | Concept - reference to a terminology or just text Binding: DetectedIssueMitigationAction (20210501) (extensible) |
| date | 0..1 | dateTime | Date committed | |
| author | 0..1 | Reference(Practitioner) | Who is committing? | |
| Documentation for this format | ||||
Grid View
This structure is derived from DetectedIssue
| Name | Card. | Type | Constraints and Usage |
|---|---|---|---|
| DetectedIssue | 0..* | 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. 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..1 | id | Definition: 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..1 | Reference(Shared Health Patient) {b} | Definition: A reference from one resource to another. |
| category | 0..1 | Shared Health CodeableConcept | Binding: DetectedIssueCategory (20220615) (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..1 | Reference(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..1 | string | Max 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..* | BackboneElement | 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. 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..1 | Shared Health CodeableConcept Required Text with optional code | Binding: 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
Summary
Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 7 elements
Structures
This structure refers to these other structures:
- http://sharedhealth.exchange/fhir/StructureDefinition/dtprofile-reference
- http://sharedhealth.exchange/fhir/StructureDefinition/profile-patient
- http://sharedhealth.exchange/fhir/StructureDefinition/dtprofile-codeableconcept
- http://prescribeit.ca/fhir/StructureDefinition/profile-medicationorder
- http://sharedhealth.exchange/fhir/StructureDefinition/dtprofile-codeableconcept-text-required-with-code
Differential View
This structure is derived from DetectedIssue
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DetectedIssue | S | 0..* | DetectedIssue | Clinical issue with action |
| id | S | 1..1 | id | Logical id of this artifact |
| patient | S | 1..1 | Reference(Shared Health Patient) {b} | A reference from one resource to another |
| category | S | 0..1 | Shared Health CodeableConcept | Concept - reference to a terminology or just text Binding: DetectedIssueCategory (20220615) (extensible) |
| implicated | S | 1..1 | Reference(PrescribeIT® Prescription) {b} | A reference from one resource to another |
| detail | S | 0..1 | string | Description and context Max Length: 1000 |
| mitigation | S | 0..* | BackboneElement | Step taken to address |
| action | S | 1..1 | Shared Health CodeableConcept Required Text with optional code | Concept - reference to a terminology or just text Binding: DetectedIssueMitigationAction (20210501) (extensible) |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DetectedIssue | S | 0..* | DetectedIssue | Clinical issue with action |
| id | SΣ | 1..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: http://tools.ietf.org/html/bcp47 (required): A human language. | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Additional Content defined by implementations | |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| patient | SΣ | 1..1 | Reference(Shared Health Patient) {b} | A reference from one resource to another |
| category | SI | 0..1 | Shared Health CodeableConcept | Concept - reference to a terminology or just text Binding: DetectedIssueCategory (20220615) (extensible) |
| severity | Σ | 0..1 | code | high | moderate | low Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient. |
| implicated | SΣ | 1..1 | Reference(PrescribeIT® Prescription) {b} | A reference from one resource to another |
| detail | S | 0..1 | string | Description and context Max Length: 1000 |
| date | Σ | 0..1 | dateTime | When identified |
| author | Σ | 0..1 | Reference(Practitioner | Device) | The provider or device that identified the issue |
| identifier | Σ | 0..1 | Identifier | Unique id for the detected issue |
| reference | 0..1 | uri | Authority for issue | |
| mitigation | S | 0..* | BackboneElement | Step taken to address |
| id | 0..1 | id | xml:id (or equivalent in JSON) | |
| extension | 0..* | Extension | Additional Content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored |
| action | S | 1..1 | Shared Health CodeableConcept Required Text with optional code | Concept - reference to a terminology or just text Binding: DetectedIssueMitigationAction (20210501) (extensible) |
| date | 0..1 | dateTime | Date committed | |
| author | 0..1 | Reference(Practitioner) | Who is committing? | |
| Documentation for this format | ||||
Other representations of profile: Schematron
3.92.3 Terminology Bindings
Terminology Bindings
| Path | Conformance | ValueSet |
| DetectedIssue.language | required | http://tools.ietf.org/html/bcp47 |
| DetectedIssue.category | extensible | DetectedIssueCategory |
| DetectedIssue.severity | required | DetectedIssueSeverity |
| DetectedIssue.mitigation.action | extensible | DetectedIssueMitigationAction |
3.92.4 Constraints
Constraints
| Id | Path | Details | Requirements |
| inv-1 | DetectedIssue.category | Must have coding, text or both : coding.exists() or text.exists() |