Release 4 5 Preview #2
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Clinical Decision Support Work Group Maturity Level : 1   Trial Use Security Category : Patient Compartments : Device , Patient , Practitioner

Detailed Descriptions for the elements in the DetectedIssue resource.

DetectedIssue
Element Id 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.

Cardinality 0..*
Type DomainResource
Alternate Names DDI; drug-drug interaction; Contraindication; Alert
DetectedIssue.identifier
Element Id DetectedIssue.identifier
Definition

Business identifier associated with the detected issue record.

Note This is a business identifier, not a resource identifier (see discussion )
Cardinality 0..*
Type Identifier
Requirements

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

Summary true
DetectedIssue.status
Element Id DetectedIssue.status
Definition

Indicates the status of the detected issue.

Cardinality 1..1
Terminology Binding ObservationStatus ( Required )
Type code
Is Modifier true (Reason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Alternate Names status
Summary true
Comments

This element is labeled as a modifier because the status contains the codes cancelled and entered-in-error that mark the issue as not currently valid.

DetectedIssue.code
Element Id DetectedIssue.code
Definition

Identifies the general type of issue identified.

Cardinality 0..1
Terminology Binding Detected Issue Category ( Preferred )
Type CodeableConcept
Alternate Names type
Summary true
DetectedIssue.severity
Element Id DetectedIssue.severity
Definition

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

Cardinality 0..1
Terminology Binding DetectedIssueSeverity ( Required )
Type code
Alternate Names severity
Summary true
DetectedIssue.patient
Element Id DetectedIssue.patient
Definition

Indicates the patient whose record the detected issue is associated with.

Cardinality 0..1
Type Reference ( Patient )
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.

Summary true
DetectedIssue.identified[x]
Element Id DetectedIssue.identified[x]
Definition

The date or period when the detected issue was initially identified.

Cardinality 0..1
Type dateTime | Period
[x] Note See Choice of Data Types for further information about how to use [x]
Requirements

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

Summary true
DetectedIssue.author
Element Id 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.

Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole | Device )
Patterns Reference(Practitioner,PractitionerRole,Device): Common patterns = Participant
Summary true
DetectedIssue.implicated
Element Id DetectedIssue.implicated
Definition

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

Cardinality 0..*
Type Reference ( Any )
Alternate Names cause
Summary 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.

DetectedIssue.evidence
Element Id DetectedIssue.evidence
Definition

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

Cardinality 0..*
DetectedIssue.evidence.code
Element Id DetectedIssue.evidence.code
Definition

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

Cardinality 0..*
Terminology Binding Manifestation and Symptom Codes ( Example )
Type CodeableConcept
DetectedIssue.evidence.detail
Element Id DetectedIssue.evidence.detail
Definition

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

Cardinality 0..*
Type Reference ( Any )
DetectedIssue.detail
Element Id DetectedIssue.detail
Definition

A textual explanation of the detected issue.

Cardinality 0..1
Type string
Comments

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

DetectedIssue.reference
Element Id DetectedIssue.reference
Definition

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

Cardinality 0..1
Type uri
DetectedIssue.mitigation
Element Id DetectedIssue.mitigation
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..*
DetectedIssue.mitigation.action
Element Id DetectedIssue.mitigation.action
Definition

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

Cardinality 1..1
Terminology Binding Detected Issue Mitigation Action ( Preferred )
Type CodeableConcept
Comments

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

DetectedIssue.mitigation.date
Element Id DetectedIssue.mitigation.date
Definition

Indicates when the mitigating action was documented.

Cardinality 0..1
Type dateTime
Comments

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

DetectedIssue.mitigation.author
Element Id DetectedIssue.mitigation.author
Definition

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

Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole )
Patterns Reference(Practitioner,PractitionerRole): Common patterns = Participant