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Clinical Decision Support Work GroupMaturity Level: 1 Trial UseSecurity Category: Patient Compartments: Device, Patient, Practitioner

Detailed Descriptions for the elements in the DetectedIssue resource.

DetectedIssue
Element IdDetectedIssue
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.

Cardinality0..*
TypeDomainResource
Alternate NamesDDI; drug-drug interaction; Contraindication; Alert
DetectedIssue.identifier
Element IdDetectedIssue.identifier
Definition

Business identifier associated with the detected issue record.

NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..*
TypeIdentifier
Requirements

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

Summarytrue
DetectedIssue.status
Element IdDetectedIssue.status
Definition

Indicates the status of the detected issue.

Cardinality1..1
Terminology BindingObservationStatus (Required)
Typecode
Is Modifiertrue (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 Namesstatus
Summarytrue
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 IdDetectedIssue.code
Definition

Identifies the general type of issue identified.

Cardinality0..1
Terminology BindingDetected Issue Category (Preferred)
TypeCodeableConcept
Alternate Namestype
Summarytrue
DetectedIssue.severity
Element IdDetectedIssue.severity
Definition

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

Cardinality0..1
Terminology BindingDetectedIssueSeverity (Required)
Typecode
Alternate Namesseverity
Summarytrue
DetectedIssue.patient
Element IdDetectedIssue.patient
Definition

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

Cardinality0..1
TypeReference(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.

Summarytrue
DetectedIssue.identified[x]
Element IdDetectedIssue.identified[x]
Definition

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

Cardinality0..1
TypedateTime|Period
[x] NoteSee 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.

Summarytrue
DetectedIssue.author
Element IdDetectedIssue.author
Definition

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

Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Device)
PatternsReference(Practitioner,PractitionerRole,Device): Common patterns = Participant
Summarytrue
DetectedIssue.implicated
Element IdDetectedIssue.implicated
Definition

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

Cardinality0..*
TypeReference(Any)
Alternate Namescause
Summarytrue
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 IdDetectedIssue.evidence
Definition

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

Cardinality0..*
DetectedIssue.evidence.code
Element IdDetectedIssue.evidence.code
Definition

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

Cardinality0..*
Terminology BindingManifestation and Symptom Codes (Example)
TypeCodeableConcept
DetectedIssue.evidence.detail
Element IdDetectedIssue.evidence.detail
Definition

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

Cardinality0..*
TypeReference(Any)
DetectedIssue.detail
Element IdDetectedIssue.detail
Definition

A textual explanation of the detected issue.

Cardinality0..1
Typestring
Comments

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

DetectedIssue.reference
Element IdDetectedIssue.reference
Definition

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

Cardinality0..1
Typeuri
DetectedIssue.mitigation
Element IdDetectedIssue.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.

Cardinality0..*
DetectedIssue.mitigation.action
Element IdDetectedIssue.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.

Cardinality1..1
Terminology BindingDetected Issue Mitigation Action (Preferred)
TypeCodeableConcept
Comments

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

DetectedIssue.mitigation.date
Element IdDetectedIssue.mitigation.date
Definition

Indicates when the mitigating action was documented.

Cardinality0..1
TypedateTime
Comments

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

DetectedIssue.mitigation.author
Element IdDetectedIssue.mitigation.author
Definition

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

Cardinality0..1
TypeReference(Practitioner | PractitionerRole)
PatternsReference(Practitioner,PractitionerRole): Common patterns = Participant