type: resource-definitionsresource: DetectedIssue

DetectedIssue Definitions

DetectedIssue

Clinical issue with action

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, gaps in care, etc.

Aliases: DDI, drug-drug interaction, Contraindication, Alert

Cardinality: 0..*

Mappings: workflow=Event; v2=Partial mapping from messages containing the AL1 or IAM segment, such as the ADT^A01, ADT^A08, and ADT^A60.; rim=Observation[classCode=ALRT, moodCode=EVN); w5=clinical.general

DetectedIssue.identifier

Business identifier for detected issue

Definition: Business identifiers assigned to this detected issue by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server.

Comments: Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

Requirements: Allows identification of the detected issue as it is known by various participating systems and in a way that remains consistent across servers.

Cardinality: 0..*

Type: Identifier

Summary: true

Mappings: workflow=Event.identifier; w5=FiveWs.identifier; v2=IAM-7; rim=.id

DetectedIssue.status

Definition: The current state of the detected issue.

Comments: A nominal state-transition diagram can be found in the (Event pattern documentation

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. Processing error is used to indicate that an error occurred attempting to evaluate a detected issue. For example, a DetectedIssue with a code of drug-drug interaction could have a status of processing-error to indicate that an error was encountered attempting to determine whether there was a drug-drug interaction.

Aliases: status

Cardinality: 1..1

Type: code

Binding: required:detectedissue-status

Summary: true

Is Modifier: true (Reason: This element is labeled as a modifier because it is a status element that contains the code entered-in-error which means that the resource should not be treated as valid)

Mappings: workflow=Event.status; w5=FiveWs.status; rim=.statusCode

DetectedIssue.category

High level categorization of detected issue

Definition: Partitions the detected issue into one or more categories that can be used to filter searching, to govern access control and/or to guide system behavior.

Comments: Categorization might be done automatically (inferred by code) or manually by user assertion. The absence of a category may limit the ability to determine when the element should be handled, so strong consideration should be given to how systems will be able to determine category values for legacy data and how data that cannot be categorized will be handled. As well, some categories might not be mutually exclusive, so systems should prepare for multiple declared categories - even within a single category 'axis'. In general, there should not be a 'strong' binding ('required' or 'extensible') on the category element overall. Instead, the element can be sliced and bindings can be asserted that apply to particular repetitions.

Requirements: Used for filtering what detected issues are retrieved and displayed.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:detectedissue-category

Summary: true

Mappings: workflow=Event.category; w5=FiveWs.class; rim=.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code

DetectedIssue.code

Specific type of detected issue, e.g. drug-drug, duplicate therapy, etc

Definition: A code that identifies the specific type of issue detected.

Aliases: type

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:detectedissue-code

Summary: true

Mappings: workflow=Event.code; w5=FiveWs.what[x]; v2=AL1-2 / IAM-9; rim=.code

DetectedIssue.severity

high | moderate | low

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

Aliases: severity

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:detectedissue-severity

Summary: true

Mappings: w5=FiveWs.grade; v2=AL1-4/ IAR-2; rim=.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value

DetectedIssue.subject

Associated subject

Definition: Indicates the subject whose record the detected issue is associated with.

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.

Cardinality: 0..1

Type: Reference(Patient, Group, Device, Location, Organization, Procedure, Practitioner, Medication, Substance, BiologicallyDerivedProduct, NutritionProduct)

Summary: true

Mappings: workflow=Event.subject; w5=FiveWs.subject; v2=PID-3; rim=.participation[typeCode=SBJ].role[classCode=PAT]

DetectedIssue.encounter

Encounter the detected issue is part of

Definition: The Encounter during which this detected issue was created or to which the creation of this record is tightly associated.

Comments: This will typically be the encounter the detected issue was created during, but some detected issues may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).

Requirements: Links the detected issue to the Encounter context. May also affect access control.

Aliases: context

Cardinality: 0..1

Type: Reference(Encounter)

Summary: true

Mappings: workflow=Event.encounter; w5=FiveWs.context; v2=PV1-19 Visit Number; rim=.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]

DetectedIssue.identified[x]

When detected issue occurred/is occurring

Definition: The date, period or timing when the detected issue did occur or is occurring.

Comments: This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. .

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

Cardinality: 0..1

Type: dateTime, Period, Timing

Summary: true

Mappings: workflow=Event.occurrence[x]; w5=FiveWs.done[x]; v2=ALI-6 / IAM-11; rim=.effectiveTime

DetectedIssue.author

The provider or device that identified the issue

Definition: Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.

Cardinality: 0..1

Type: Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Device)

Summary: true

Mappings: workflow=Event.performer.actor; w5=FiveWs.author; v2=IAM-14 / IAM-16; rim=.participation[typeCode=AUT].role[classCode=ASSIGNED]

DetectedIssue.implicated

Problem resource

Definition: Indicates the resource representing the current activity or proposed activity that is potentially problematic.

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.

Aliases: cause

Cardinality: 0..*

Type: Reference(Resource)

Summary: true

Mappings: workflow=Event.reason; rim=.outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]

DetectedIssue.evidence

Supporting evidence

Definition: Supporting evidence or manifestations that provide the basis for identifying the detected issue such as a GuidanceResponse or MeasureReport.

Cardinality: 0..*

Type: BackboneElement

Mappings: w5=FiveWs.why[x]; rim=.outboundRelationship[typeCode=EVID].target[classCode=ACT, moodCode=EVN]

DetectedIssue.evidence.code

Manifestation

Definition: A manifestation that led to the recording of this detected issue.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:manifestation-or-symptom

Mappings: w5=FiveWs.why[x]; rim=.code

DetectedIssue.evidence.detail

Supporting information

Definition: Links to resources that constitute evidence for the detected issue such as a GuidanceResponse or MeasureReport.

Cardinality: 0..*

Type: Reference(Resource)

Mappings: w5=FiveWs.why[x]; rim=.text

DetectedIssue.detail

Description and context

Definition: A textual explanation of the detected issue.

Comments: Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.

Cardinality: 0..1

Type: markdown

Mappings: workflow=Event.note; v2=AL1-5 / IAM-8; rim=.text

DetectedIssue.reference

Authority for issue

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

Cardinality: 0..1

Type: uri

Mappings: rim=.outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri

DetectedIssue.qualityOfEvidence

The quality of the evidence supporting the detected issue

Definition: The quality of the evidence supporting identification of the detected issue. The code system used specifies the quality scale used to grade this evidence source while the code specifies the actual quality score (represented as a coded value) associated with the evidence.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:evidence-quality

DetectedIssue.expectedOnsetType

Time frame of clinical effect

Definition: The time frame in which the clinical effects of the detected issue may be expected to occur. Rapid refers to an expected onset within 24 hours. Delayed refers to an expected onset in more than 24 hours.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:detectedissue-expected-onset-type

DetectedIssue.medicationClass

What medication class

Definition: Represents the medication class that is responsible for the detected issue.

Comments: For example, for a duplicate therapy or an alergy alert, this class would represent the medication class to which the medications belong.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:detectedissue-example-medication-class

DetectedIssue.managementCode

Importance of taking action on the issue

Definition: An indication of the importance or type of step that should or may be taken in order to address the detected issue. This is different than mitigation in that it is not specifically providing actions to be taken, rather general suggestions about approach.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:detectedissue-management-code

DetectedIssue.mitigation

Step taken to address

Definition: Indicates an action that has been taken or is committed 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.

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]

DetectedIssue.mitigation.action

What mitigation?

Definition: Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.

Comments: The "text" component can be used for detail or when no appropriate code exists.

Cardinality: 1..1

Type: CodeableConcept

Binding: preferred:detectedissue-mitigation-action

Mappings: rim=.code

DetectedIssue.mitigation.date

Date committed

Definition: Indicates when the mitigating action was documented.

Comments: This might not be the same as when the mitigating step was actually taken.

Cardinality: 0..1

Type: dateTime

Mappings: rim=.effectiveTime

DetectedIssue.mitigation.author

Who is committing?

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

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole)

Mappings: rim=.participation[typeCode=AUT].role[classCode=ASSIGNED]

DetectedIssue.mitigation.note

Additional notes about the mitigation

Definition: Clinicians may add additional notes or justifications about the mitigation action. For example, patient can have this drug because they have had it before without any issues. Multiple justifications may be provided.

Cardinality: 0..*

Type: Annotation

Mappings: rim=.participation[typeCode=AUT].role[classCode=ASSIGNED].note