{"abstract":false,"baseDefinition":"http://hl7.org/fhir/StructureDefinition/DomainResource","contact":[{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/fiwg"}]},{"telecom":[{"system":"url","value":"http://www.hl7.org/Special/committees/dss"}]}],"date":"2026-03-31T17:43:31+00:00","derivation":"specialization","description":"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.","differential":{"element":[{"alias":["DDI","drug-drug interaction","Contraindication","Alert"],"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.","id":"DetectedIssue","isModifier":false,"mapping":[{"identity":"workflow","map":"Event"},{"identity":"w5","map":"clinical.general"},{"identity":"v2","map":"Partial mapping from messages containing the AL1 or IAM segment, such as the ADT^A01, ADT^A08, and ADT^A60."},{"identity":"rim","map":"Observation[classCode=ALRT, moodCode=EVN)"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue","short":"Clinical issue with action"},{"comment":"Note: This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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.","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.","id":"DetectedIssue.identifier","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.identifier"},{"identity":"w5","map":"FiveWs.identifier"},{"identity":"v2","map":"IAM-7"},{"identity":"rim","map":".id"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.identifier","requirements":"Allows identification of the detected issue as it is known by various participating systems and in a way that remains consistent across servers.","short":"Business identifier for detected issue","type":[{"code":"Identifier"}]},{"alias":["status"],"binding":{"description":"Indicates the status of the identified issue.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueStatus"}],"strength":"required","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-status|6.0.0-ballot4"},"comment":"A nominal state-transition diagram can be found in the (Event pattern documentation\n\nUnknown 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.","definition":"The current state of the detected issue.","id":"DetectedIssue.status","isModifier":true,"isModifierReason":"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","isSummary":true,"mapping":[{"identity":"workflow","map":"Event.status"},{"identity":"w5","map":"FiveWs.status"},{"identity":"rim","map":".statusCode"}],"max":"1","min":1,"mustSupport":false,"path":"DetectedIssue.status","short":"preliminary | final | entered-in-error | unknown | mitigated | processing-error","type":[{"code":"code"}]},{"binding":{"description":"Codes for high level detected issue categories.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueCategory"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-category"},"comment":"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'.\nIn 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.","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.","id":"DetectedIssue.category","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.category"},{"identity":"w5","map":"FiveWs.class"},{"identity":"rim","map":".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.category","requirements":"Used for filtering what detected issues are retrieved and displayed.","short":"High level categorization of detected issue","type":[{"code":"CodeableConcept"}]},{"alias":["type"],"binding":{"description":"Codes identifying the type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueCode"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-code"},"definition":"A code that identifies the specific type of issue detected.","id":"DetectedIssue.code","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.code"},{"identity":"w5","map":"FiveWs.what[x]"},{"identity":"v2","map":"AL1-2 / IAM-9"},{"identity":"rim","map":".code"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.code","short":"Specific type of detected issue, e.g. drug-drug, duplicate therapy, etc","type":[{"code":"CodeableConcept"}]},{"alias":["severity"],"binding":{"description":"Indicates the potential degree of impact of the identified issue on the patient.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueSeverity"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-severity"},"definition":"Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.","id":"DetectedIssue.severity","isModifier":false,"isSummary":true,"mapping":[{"identity":"w5","map":"FiveWs.grade"},{"identity":"v2","map":"AL1-4/ IAR-2"},{"identity":"rim","map":".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.severity","short":"high | moderate | low","type":[{"code":"CodeableConcept"}]},{"definition":"Indicates the subject whose record the detected issue is associated with.","id":"DetectedIssue.subject","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.subject"},{"identity":"w5","map":"FiveWs.subject"},{"identity":"v2","map":"PID-3"},{"identity":"rim","map":".participation[typeCode=SBJ].role[classCode=PAT]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.subject","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.","short":"Associated subject","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/Group","http://hl7.org/fhir/StructureDefinition/Device","http://hl7.org/fhir/StructureDefinition/Location","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/Procedure","http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/Medication","http://hl7.org/fhir/StructureDefinition/Substance","http://hl7.org/fhir/StructureDefinition/BiologicallyDerivedProduct","http://hl7.org/fhir/StructureDefinition/NutritionProduct"]}]},{"alias":["context"],"comment":"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).","definition":"The Encounter during which this detected issue was created or to which the creation of this record is tightly associated.","id":"DetectedIssue.encounter","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.encounter"},{"identity":"w5","map":"FiveWs.context"},{"identity":"v2","map":"PV1-19 Visit Number"},{"identity":"rim","map":".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code=\"type of encounter or episode\"]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.encounter","requirements":"Links the detected issue to the Encounter context. May also affect access control.","short":"Encounter the detected issue is part of","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Encounter"]}]},{"comment":"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.\n.","definition":"The date, period or timing when the detected issue did occur or is occurring.","id":"DetectedIssue.identified[x]","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.occurrence[x]"},{"identity":"w5","map":"FiveWs.done[x]"},{"identity":"v2","map":"ALI-6 / IAM-11"},{"identity":"rim","map":".effectiveTime"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.identified[x]","requirements":"No-one can be responsible for mitigation prior to the issue being identified.","short":"When detected issue occurred/is occurring","type":[{"code":"dateTime"},{"code":"Period"},{"code":"Timing"}]},{"definition":"Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.","id":"DetectedIssue.author","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.performer.actor"},{"identity":"w5","map":"FiveWs.author"},{"identity":"v2","map":"IAM-14 / IAM-16"},{"identity":"rim","map":".participation[typeCode=AUT].role[classCode=ASSIGNED]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.author","short":"The provider or device that identified the issue","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson","http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Device"]}]},{"alias":["cause"],"comment":"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.","definition":"Indicates the resource representing the current activity or proposed activity that is potentially problematic.","id":"DetectedIssue.implicated","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.reason"},{"identity":"rim","map":".outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.implicated","short":"Problem resource","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Resource"]}]},{"definition":"Supporting evidence or manifestations that provide the basis for identifying the detected issue such as a GuidanceResponse or MeasureReport.","id":"DetectedIssue.evidence","isModifier":false,"isSummary":false,"mapping":[{"identity":"w5","map":"FiveWs.why[x]"},{"identity":"rim","map":".outboundRelationship[typeCode=EVID].target[classCode=ACT, moodCode=EVN]"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.evidence","short":"Supporting evidence","type":[{"code":"BackboneElement"}]},{"binding":{"description":"Codes that describes the types of evidence for a detected issue.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueEvidenceCode"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/manifestation-or-symptom"},"definition":"A manifestation that led to the recording of this detected issue.","id":"DetectedIssue.evidence.code","isModifier":false,"isSummary":false,"mapping":[{"identity":"w5","map":"FiveWs.why[x]"},{"identity":"rim","map":".code"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.evidence.code","short":"Manifestation","type":[{"code":"CodeableConcept"}]},{"definition":"Links to resources that constitute evidence for the detected issue such as a GuidanceResponse or MeasureReport.","id":"DetectedIssue.evidence.detail","isModifier":false,"isSummary":false,"mapping":[{"identity":"w5","map":"FiveWs.why[x]"},{"identity":"rim","map":".text"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.evidence.detail","short":"Supporting information","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Resource"]}]},{"comment":"Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.","definition":"A textual explanation of the detected issue.","id":"DetectedIssue.detail","isModifier":false,"isSummary":false,"mapping":[{"identity":"workflow","map":"Event.note"},{"identity":"v2","map":"AL1-5 / IAM-8"},{"identity":"rim","map":".text"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.detail","short":"Description and context","type":[{"code":"markdown"}]},{"definition":"The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.","id":"DetectedIssue.reference","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.reference","short":"Authority for issue","type":[{"code":"uri"}]},{"binding":{"description":"A rating system that describes the quality of evidence such as the GRADE, DynaMed, or Oxford CEBM systems.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueQualityOfEvidence"}],"strength":"example","valueSet":"http://terminology.hl7.org/ValueSet/evidence-quality"},"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.","id":"DetectedIssue.qualityOfEvidence","isModifier":false,"isSummary":false,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.qualityOfEvidence","short":"The quality of the evidence supporting the detected issue","type":[{"code":"CodeableConcept"}]},{"binding":{"description":"Example codes illustrating expected onset type","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueExpectedOnsetType"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-expected-onset-type"},"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.","id":"DetectedIssue.expectedOnsetType","isModifier":false,"isSummary":false,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.expectedOnsetType","short":"Time frame of clinical effect","type":[{"code":"CodeableConcept"}]},{"binding":{"description":"Example codes illustrating example medication classes","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueExampleMedicationClass"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-example-medication-class"},"comment":"For example, for a duplicate therapy or an alergy alert, this class would represent the medication class to which the medications belong.","definition":"Represents the medication class that is responsible for the detected issue.","id":"DetectedIssue.medicationClass","isModifier":false,"isSummary":false,"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.medicationClass","short":"What medication class","type":[{"code":"CodeableConcept"}]},{"binding":{"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueManagementCode"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-management-code"},"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.","id":"DetectedIssue.managementCode","isModifier":false,"isSummary":false,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.managementCode","short":"Importance of taking action on the issue","type":[{"code":"CodeableConcept"}]},{"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.","id":"DetectedIssue.mitigation","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation","short":"Step taken to address","type":[{"code":"BackboneElement"}]},{"binding":{"description":"Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueMitigationAction"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action"},"comment":"The \"text\" component can be used for detail or when no appropriate code exists.","definition":"Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.","id":"DetectedIssue.mitigation.action","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".code"}],"max":"1","min":1,"mustSupport":false,"path":"DetectedIssue.mitigation.action","short":"What mitigation?","type":[{"code":"CodeableConcept"}]},{"comment":"This might not be the same as when the mitigating step was actually taken.","definition":"Indicates when the mitigating action was documented.","id":"DetectedIssue.mitigation.date","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".effectiveTime"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation.date","short":"Date committed","type":[{"code":"dateTime"}]},{"definition":"Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.","id":"DetectedIssue.mitigation.author","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".participation[typeCode=AUT].role[classCode=ASSIGNED]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation.author","short":"Who is committing?","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole"]}]},{"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.","id":"DetectedIssue.mitigation.note","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".participation[typeCode=AUT].role[classCode=ASSIGNED].note"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation.note","short":"Additional notes about the mitigation","type":[{"code":"Annotation"}]}]},"experimental":false,"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status","valueCode":"normative"},{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"cds"},{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm","valueInteger":3},{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category","valueCode":"patient"}],"fhirVersion":"6.0.0-ballot4","id":"DetectedIssue","jurisdiction":[{"coding":[{"code":"001","display":"World","system":"http://unstats.un.org/unsd/methods/m49/m49.htm"}]}],"kind":"resource","mapping":[{"identity":"workflow","name":"Workflow Pattern","uri":"http://hl7.org/fhir/workflow"},{"identity":"w5","name":"FiveWs Pattern Mapping","uri":"http://hl7.org/fhir/fivews"},{"identity":"v2","name":"HL7 V2 Mapping","uri":"http://hl7.org/v2"},{"identity":"rim","name":"RIM Mapping","uri":"http://hl7.org/v3"}],"meta":{"lastUpdated":"2026-03-31T17:43:31.836+00:00"},"name":"DetectedIssue","publisher":"HL7 International / Clinical Decision Support","resourceType":"StructureDefinition","snapshot":{"element":[{"alias":["DDI","drug-drug interaction","Contraindication","Alert"],"base":{"max":"*","min":0,"path":"DetectedIssue"},"constraint":[{"expression":"contained.contained.empty()","human":"If the resource is contained in another resource, it SHALL NOT contain nested Resources","key":"dom-2","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/DomainResource"},{"expression":"contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()","human":"If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource","key":"dom-3","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/DomainResource"},{"expression":"contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()","human":"If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated","key":"dom-4","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/DomainResource"},{"expression":"contained.meta.security.empty()","human":"If a resource is contained in another resource, it SHALL NOT have a security label","key":"dom-5","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/DomainResource"},{"expression":"text.`div`.exists()","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice","valueBoolean":true},{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation","valueMarkdown":"When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."}],"human":"A resource should have narrative for robust management","key":"dom-6","severity":"warning","source":"http://hl7.org/fhir/StructureDefinition/DomainResource"}],"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.","id":"DetectedIssue","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"Entity, Role, or Act,Observation[classCode=ALRT, moodCode=EVN)"},{"identity":"workflow","map":"Event"},{"identity":"w5","map":"clinical.general"},{"identity":"v2","map":"Partial mapping from messages containing the AL1 or IAM segment, such as the ADT^A01, ADT^A08, and ADT^A60."}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue","short":"Clinical issue with action"},{"base":{"max":"1","min":0,"path":"Resource.id"},"comment":"Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.","definition":"The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.","id":"DetectedIssue.id","isModifier":false,"isSummary":true,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.id","short":"Logical id of this artifact","type":[{"code":"http://hl7.org/fhirpath/System.String","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type","valueUrl":"string"}]}]},{"base":{"max":"1","min":0,"path":"Resource.meta"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.","id":"DetectedIssue.meta","isModifier":false,"isSummary":true,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.meta","short":"Metadata about the resource","type":[{"code":"Meta"}]},{"base":{"max":"1","min":0,"path":"Resource.implicitRules"},"comment":"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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the [additionalImplicitRules](https://build.fhir.org/ig/HL7/fhir-extensions/StructureDefinition-additionalImplicitRules.html) extension.","id":"DetectedIssue.implicitRules","isModifier":true,"isModifierReason":"This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation","isSummary":true,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.implicitRules","short":"A set of rules under which this content was created","type":[{"code":"uri"}]},{"base":{"max":"1","min":0,"path":"Resource.language"},"binding":{"additional":[{"purpose":"starter","valueSet":"http://hl7.org/fhir/ValueSet/languages"}],"description":"IETF language tag for a human language","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"Language"},{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding","valueBoolean":true}],"strength":"required","valueSet":"http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot4"},"comment":"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).","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"The base language in which the resource is written.","id":"DetectedIssue.language","isModifier":false,"isSummary":false,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.language","short":"Language of the resource content","type":[{"code":"code"}]},{"alias":["narrative","html","xhtml","display"],"base":{"max":"1","min":0,"path":"DomainResource.text"},"comment":"Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.","condition":["dom-6"],"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"A human-readable narrative that contains a summary of the resource and can 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.","id":"DetectedIssue.text","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"Act.text?"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.text","short":"Text summary of the resource, for human interpretation","type":[{"code":"Narrative"}]},{"alias":["inline resources","anonymous resources","contained resources"],"base":{"max":"*","min":0,"path":"DomainResource.contained"},"comment":"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. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. Contained resources may be a resource type defined in the FHIR specification, or an [additional resource](resource.html#additional).","condition":["dom-2","dom-4","dom-3","dom-5"],"definition":"These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.","id":"DetectedIssue.contained","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"N/A"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.contained","short":"Contained, inline Resources","type":[{"code":"Resource"}]},{"alias":["extensions","user content"],"base":{"max":"*","min":0,"path":"DomainResource.extension"},"comment":"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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.","id":"DetectedIssue.extension","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"N/A"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.extension","short":"Additional content defined by implementations","type":[{"code":"Extension"}]},{"alias":["extensions","user content"],"base":{"max":"*","min":0,"path":"DomainResource.modifierExtension"},"comment":"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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).","id":"DetectedIssue.modifierExtension","isModifier":true,"isModifierReason":"Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them","isSummary":true,"mapping":[{"identity":"rim","map":"N/A"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.modifierExtension","requirements":"Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).","short":"Extensions that cannot be ignored","type":[{"code":"Extension"}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.identifier"},"comment":"Note: This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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.","id":"DetectedIssue.identifier","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.identifier"},{"identity":"w5","map":"FiveWs.identifier"},{"identity":"v2","map":"IAM-7"},{"identity":"rim","map":".id"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.identifier","requirements":"Allows identification of the detected issue as it is known by various participating systems and in a way that remains consistent across servers.","short":"Business identifier for detected issue","type":[{"code":"Identifier"}]},{"alias":["status"],"base":{"max":"1","min":1,"path":"DetectedIssue.status"},"binding":{"description":"Indicates the status of the identified issue.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueStatus"}],"strength":"required","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-status|6.0.0-ballot4"},"comment":"A nominal state-transition diagram can be found in the (Event pattern documentation\n\nUnknown 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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"The current state of the detected issue.","id":"DetectedIssue.status","isModifier":true,"isModifierReason":"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","isSummary":true,"mapping":[{"identity":"workflow","map":"Event.status"},{"identity":"w5","map":"FiveWs.status"},{"identity":"rim","map":".statusCode"}],"max":"1","min":1,"mustSupport":false,"path":"DetectedIssue.status","short":"preliminary | final | entered-in-error | unknown | mitigated | processing-error","type":[{"code":"code"}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.category"},"binding":{"description":"Codes for high level detected issue categories.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueCategory"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-category"},"comment":"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'.\nIn 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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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.","id":"DetectedIssue.category","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.category"},{"identity":"w5","map":"FiveWs.class"},{"identity":"rim","map":".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.category","requirements":"Used for filtering what detected issues are retrieved and displayed.","short":"High level categorization of detected issue","type":[{"code":"CodeableConcept"}]},{"alias":["type"],"base":{"max":"1","min":0,"path":"DetectedIssue.code"},"binding":{"description":"Codes identifying the type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueCode"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-code"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"A code that identifies the specific type of issue detected.","id":"DetectedIssue.code","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.code"},{"identity":"w5","map":"FiveWs.what[x]"},{"identity":"v2","map":"AL1-2 / IAM-9"},{"identity":"rim","map":".code"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.code","short":"Specific type of detected issue, e.g. drug-drug, duplicate therapy, etc","type":[{"code":"CodeableConcept"}]},{"alias":["severity"],"base":{"max":"1","min":0,"path":"DetectedIssue.severity"},"binding":{"description":"Indicates the potential degree of impact of the identified issue on the patient.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueSeverity"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-severity"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.","id":"DetectedIssue.severity","isModifier":false,"isSummary":true,"mapping":[{"identity":"w5","map":"FiveWs.grade"},{"identity":"v2","map":"AL1-4/ IAR-2"},{"identity":"rim","map":".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.severity","short":"high | moderate | low","type":[{"code":"CodeableConcept"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.subject"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Indicates the subject whose record the detected issue is associated with.","id":"DetectedIssue.subject","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.subject"},{"identity":"w5","map":"FiveWs.subject"},{"identity":"v2","map":"PID-3"},{"identity":"rim","map":".participation[typeCode=SBJ].role[classCode=PAT]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.subject","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.","short":"Associated subject","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/Group","http://hl7.org/fhir/StructureDefinition/Device","http://hl7.org/fhir/StructureDefinition/Location","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/Procedure","http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/Medication","http://hl7.org/fhir/StructureDefinition/Substance","http://hl7.org/fhir/StructureDefinition/BiologicallyDerivedProduct","http://hl7.org/fhir/StructureDefinition/NutritionProduct"]}]},{"alias":["context"],"base":{"max":"1","min":0,"path":"DetectedIssue.encounter"},"comment":"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).","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"The Encounter during which this detected issue was created or to which the creation of this record is tightly associated.","id":"DetectedIssue.encounter","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.encounter"},{"identity":"w5","map":"FiveWs.context"},{"identity":"v2","map":"PV1-19 Visit Number"},{"identity":"rim","map":".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code=\"type of encounter or episode\"]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.encounter","requirements":"Links the detected issue to the Encounter context. May also affect access control.","short":"Encounter the detected issue is part of","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Encounter"]}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.identified[x]"},"comment":"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.\n.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"The date, period or timing when the detected issue did occur or is occurring.","id":"DetectedIssue.identified[x]","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.occurrence[x]"},{"identity":"w5","map":"FiveWs.done[x]"},{"identity":"v2","map":"ALI-6 / IAM-11"},{"identity":"rim","map":".effectiveTime"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.identified[x]","requirements":"No-one can be responsible for mitigation prior to the issue being identified.","short":"When detected issue occurred/is occurring","type":[{"code":"dateTime"},{"code":"Period"},{"code":"Timing"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.author"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.","id":"DetectedIssue.author","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.performer.actor"},{"identity":"w5","map":"FiveWs.author"},{"identity":"v2","map":"IAM-14 / IAM-16"},{"identity":"rim","map":".participation[typeCode=AUT].role[classCode=ASSIGNED]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.author","short":"The provider or device that identified the issue","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson","http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Device"]}]},{"alias":["cause"],"base":{"max":"*","min":0,"path":"DetectedIssue.implicated"},"comment":"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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Indicates the resource representing the current activity or proposed activity that is potentially problematic.","id":"DetectedIssue.implicated","isModifier":false,"isSummary":true,"mapping":[{"identity":"workflow","map":"Event.reason"},{"identity":"rim","map":".outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.implicated","short":"Problem resource","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Resource"]}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.evidence"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children or both","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Supporting evidence or manifestations that provide the basis for identifying the detected issue such as a GuidanceResponse or MeasureReport.","id":"DetectedIssue.evidence","isModifier":false,"isSummary":false,"mapping":[{"identity":"w5","map":"FiveWs.why[x]"},{"identity":"rim","map":".outboundRelationship[typeCode=EVID].target[classCode=ACT, moodCode=EVN]"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.evidence","short":"Supporting evidence","type":[{"code":"BackboneElement"}]},{"base":{"max":"1","min":0,"path":"Element.id"},"condition":["ele-1"],"definition":"Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.","id":"DetectedIssue.evidence.id","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"n/a"}],"max":"1","min":0,"path":"DetectedIssue.evidence.id","representation":["xmlAttr"],"short":"Unique id for inter-element referencing","type":[{"code":"http://hl7.org/fhirpath/System.String","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type","valueUrl":"string"}]}]},{"alias":["extensions","user content"],"base":{"max":"*","min":0,"path":"Element.extension"},"comment":"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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.","id":"DetectedIssue.evidence.extension","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"n/a"}],"max":"*","min":0,"path":"DetectedIssue.evidence.extension","short":"Additional content defined by implementations","type":[{"code":"Extension"}]},{"alias":["extensions","user content","modifiers"],"base":{"max":"*","min":0,"path":"BackboneElement.modifierExtension"},"comment":"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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).","id":"DetectedIssue.evidence.modifierExtension","isModifier":true,"isModifierReason":"Modifier extensions are expected to modify the meaning or interpretation of the element that contains them","isSummary":true,"mapping":[{"identity":"rim","map":"N/A"}],"max":"*","min":0,"path":"DetectedIssue.evidence.modifierExtension","requirements":"Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).","short":"Extensions that cannot be ignored even if unrecognized","type":[{"code":"Extension"}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.evidence.code"},"binding":{"description":"Codes that describes the types of evidence for a detected issue.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueEvidenceCode"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/manifestation-or-symptom"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"A manifestation that led to the recording of this detected issue.","id":"DetectedIssue.evidence.code","isModifier":false,"isSummary":false,"mapping":[{"identity":"w5","map":"FiveWs.why[x]"},{"identity":"rim","map":".code"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.evidence.code","short":"Manifestation","type":[{"code":"CodeableConcept"}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.evidence.detail"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Links to resources that constitute evidence for the detected issue such as a GuidanceResponse or MeasureReport.","id":"DetectedIssue.evidence.detail","isModifier":false,"isSummary":false,"mapping":[{"identity":"w5","map":"FiveWs.why[x]"},{"identity":"rim","map":".text"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.evidence.detail","short":"Supporting information","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Resource"]}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.detail"},"comment":"Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"A textual explanation of the detected issue.","id":"DetectedIssue.detail","isModifier":false,"isSummary":false,"mapping":[{"identity":"workflow","map":"Event.note"},{"identity":"v2","map":"AL1-5 / IAM-8"},{"identity":"rim","map":".text"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.detail","short":"Description and context","type":[{"code":"markdown"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.reference"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.","id":"DetectedIssue.reference","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.reference","short":"Authority for issue","type":[{"code":"uri"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.qualityOfEvidence"},"binding":{"description":"A rating system that describes the quality of evidence such as the GRADE, DynaMed, or Oxford CEBM systems.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueQualityOfEvidence"}],"strength":"example","valueSet":"http://terminology.hl7.org/ValueSet/evidence-quality"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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.","id":"DetectedIssue.qualityOfEvidence","isModifier":false,"isSummary":false,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.qualityOfEvidence","short":"The quality of the evidence supporting the detected issue","type":[{"code":"CodeableConcept"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.expectedOnsetType"},"binding":{"description":"Example codes illustrating expected onset type","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueExpectedOnsetType"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-expected-onset-type"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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.","id":"DetectedIssue.expectedOnsetType","isModifier":false,"isSummary":false,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.expectedOnsetType","short":"Time frame of clinical effect","type":[{"code":"CodeableConcept"}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.medicationClass"},"binding":{"description":"Example codes illustrating example medication classes","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueExampleMedicationClass"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-example-medication-class"},"comment":"For example, for a duplicate therapy or an alergy alert, this class would represent the medication class to which the medications belong.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Represents the medication class that is responsible for the detected issue.","id":"DetectedIssue.medicationClass","isModifier":false,"isSummary":false,"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.medicationClass","short":"What medication class","type":[{"code":"CodeableConcept"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.managementCode"},"binding":{"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueManagementCode"}],"strength":"example","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-management-code"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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.","id":"DetectedIssue.managementCode","isModifier":false,"isSummary":false,"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.managementCode","short":"Importance of taking action on the issue","type":[{"code":"CodeableConcept"}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.mitigation"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children or both","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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.","id":"DetectedIssue.mitigation","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation","short":"Step taken to address","type":[{"code":"BackboneElement"}]},{"base":{"max":"1","min":0,"path":"Element.id"},"condition":["ele-1"],"definition":"Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.","id":"DetectedIssue.mitigation.id","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"n/a"}],"max":"1","min":0,"path":"DetectedIssue.mitigation.id","representation":["xmlAttr"],"short":"Unique id for inter-element referencing","type":[{"code":"http://hl7.org/fhirpath/System.String","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type","valueUrl":"string"}]}]},{"alias":["extensions","user content"],"base":{"max":"*","min":0,"path":"Element.extension"},"comment":"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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.","id":"DetectedIssue.mitigation.extension","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":"n/a"}],"max":"*","min":0,"path":"DetectedIssue.mitigation.extension","short":"Additional content defined by implementations","type":[{"code":"Extension"}]},{"alias":["extensions","user content","modifiers"],"base":{"max":"*","min":0,"path":"BackboneElement.modifierExtension"},"comment":"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.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).","id":"DetectedIssue.mitigation.modifierExtension","isModifier":true,"isModifierReason":"Modifier extensions are expected to modify the meaning or interpretation of the element that contains them","isSummary":true,"mapping":[{"identity":"rim","map":"N/A"}],"max":"*","min":0,"path":"DetectedIssue.mitigation.modifierExtension","requirements":"Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).","short":"Extensions that cannot be ignored even if unrecognized","type":[{"code":"Extension"}]},{"base":{"max":"1","min":1,"path":"DetectedIssue.mitigation.action"},"binding":{"description":"Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.","extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"DetectedIssueMitigationAction"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action"},"comment":"The \"text\" component can be used for detail or when no appropriate code exists.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.","id":"DetectedIssue.mitigation.action","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".code"}],"max":"1","min":1,"mustSupport":false,"path":"DetectedIssue.mitigation.action","short":"What mitigation?","type":[{"code":"CodeableConcept"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.mitigation.date"},"comment":"This might not be the same as when the mitigating step was actually taken.","constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Indicates when the mitigating action was documented.","id":"DetectedIssue.mitigation.date","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".effectiveTime"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation.date","short":"Date committed","type":[{"code":"dateTime"}]},{"base":{"max":"1","min":0,"path":"DetectedIssue.mitigation.author"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"definition":"Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.","id":"DetectedIssue.mitigation.author","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".participation[typeCode=AUT].role[classCode=ASSIGNED]"}],"max":"1","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation.author","short":"Who is committing?","type":[{"code":"Reference","targetProfile":["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole"]}]},{"base":{"max":"*","min":0,"path":"DetectedIssue.mitigation.note"},"constraint":[{"expression":"hasValue() or (children().count() > id.count())","human":"All FHIR elements must have a @value or children","key":"ele-1","severity":"error","source":"http://hl7.org/fhir/StructureDefinition/Element"}],"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.","id":"DetectedIssue.mitigation.note","isModifier":false,"isSummary":false,"mapping":[{"identity":"rim","map":".participation[typeCode=AUT].role[classCode=ASSIGNED].note"}],"max":"*","min":0,"mustSupport":false,"path":"DetectedIssue.mitigation.note","short":"Additional notes about the mitigation","type":[{"code":"Annotation"}]}]},"status":"active","text":{"div":"
\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
NameFlagsCard.TypeDescription & Constraints\"doco\"
\".\"\".\" DetectedIssue NDomainResourceClinical issue with action

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
\".\"\".\"\".\" identifier Σ0..*IdentifierBusiness identifier for detected issue

\".\"\".\"\".\" status ?!Σ1..1codepreliminary | final | entered-in-error | unknown | mitigated | processing-error
Binding: Detected Issue Status (Required)
\".\"\".\"\".\" category Σ0..*CodeableConceptHigh level categorization of detected issue
Binding: Detected Issue Category (Preferred)

\".\"\".\"\".\" code Σ0..1CodeableConceptSpecific type of detected issue, e.g. drug-drug, duplicate therapy, etc
Binding: Detected Issue Code (Preferred)
\".\"\".\"\".\" severity Σ0..1CodeableConcepthigh | moderate | low
Binding: Detected Issue Severity (Preferred)
\".\"\".\"\".\" subject Σ0..1Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | BiologicallyDerivedProduct | NutritionProduct)Associated subject
\".\"\".\"\".\" encounter Σ0..1Reference(Encounter)Encounter the detected issue is part of
\".\"\".\"\".\" identified[x] Σ0..1When detected issue occurred/is occurring
\".\"\".\"\".\"\".\" identifiedDateTimedateTime
\".\"\".\"\".\"\".\" identifiedPeriodPeriod
\".\"\".\"\".\"\".\" identifiedTimingTiming
\".\"\".\"\".\" author Σ0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Device)The provider or device that identified the issue
\".\"\".\"\".\" implicated Σ0..*Reference(Any)Problem resource

\".\"\".\"\".\" evidence 0..*BackboneElementSupporting evidence

\".\"\".\"\".\"\".\" code 0..*CodeableConceptManifestation
Binding: Manifestation and Symptom Codes (Example)

\".\"\".\"\".\"\".\" detail 0..*Reference(Any)Supporting information

\".\"\".\"\".\" detail 0..1markdownDescription and context
\".\"\".\"\".\" reference 0..1uriAuthority for issue
\".\"\".\"\".\" qualityOfEvidence 0..1CodeableConceptThe quality of the evidence supporting the detected issue
Binding: QualityOfEvidenceRating (Example)
\".\"\".\"\".\" expectedOnsetType 0..1CodeableConceptTime frame of clinical effect
Binding: Detected Issue Expected Onset Type (Example)
\".\"\".\"\".\" medicationClass 0..*CodeableConceptWhat medication class
Binding: Detected Issue Example Medication Class (Example)

\".\"\".\"\".\" managementCode 0..1CodeableConceptImportance of taking action on the issue
Binding: Detected Issue Management Code (Example)
\".\"\".\"\".\" mitigation 0..*BackboneElementStep taken to address

\".\"\".\"\".\"\".\" action 1..1CodeableConceptWhat mitigation?
Binding: Detected Issue Mitigation Action (Preferred)
\".\"\".\"\".\"\".\" date 0..1dateTimeDate committed
\".\"\".\"\".\"\".\" author 0..1Reference(Practitioner | PractitionerRole)Who is committing?
\".\"\".\"\".\"\".\" note 0..*AnnotationAdditional notes about the mitigation


\"doco\" Documentation for this format
","status":"generated"},"type":"DetectedIssue","url":"http://hl7.org/fhir/StructureDefinition/DetectedIssue","version":"6.0.0-ballot4"}