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8.13 Resource Flag - Content

Patient Care Work GroupMaturity Level: 1 Trial UseCompartments: Device, Patient, Practitioner

Prospective warnings of potential issues when providing care to the patient.

A flag is a warning or notification of some sort presented to the user - who may be a clinician or some other person involve in patient care. It usually represents something of sufficient significance to warrant a special display of some sort - rather than just a note in the resource. A flag has a subject representing the resource that will trigger its display. This subject can be of different types, as described in the examples below:

  • A note that a patient has an overdue account, which the provider may wish to discuss with them - in case of hardship for example (subject = Patient)
  • An outbreak of Ebola in a particular region (subject=Location) so that all patients from that region have a higher risk of having that condition
  • A particular provider is unavailable for referrals over a given period (subject = Practitioner)
  • A patient who is enrolled in a clinical trial (subject=Group)
  • Special guidance or caveats to be aware of when following a protocol (subject=PlanDefinition)
  • Warnings about using a drug in a formulary requires special approval (subject=Medication)
  • etc.

A flag is typically presented as a label in a prominent location in the record to notify the clinician of the potential issues, though it may also appear in other contexts; e.g. notes applicable to a radiology technician, or to a clinician performing a home visit. For patients, the information in the flag will often be derived from the record, and therefore, for a thorough and careful clinician, who has the time to review the notes will be redundant. However, given the volume of information frequently found in patients' records and the potentially serious consequences of losing sight of some facts, this redundancy is deemed appropriate. As well, some flags may reflect information not captured by any other resource in the record. (E.g. "Patient has large dog at home")

In line with its purpose, a flag is concise, highlighting a small set of high-priority issues among the much larger set of data in the chart. Readers who want more detail should consult the chart or other source of information. Caution should be exercised in creating Flag instances. If entries are created for information that could be gleaned in a sufficiently timely fashion by reviewing the patient record, the flag list will itself become overwhelming and will cease to serve its intended purpose.

Flags are expected to persist in a record for some period of time and are, at most, targeted to particular types of practitioners or to practitioners in particular system.

Examples of Patient related issues that might appear in flags:

  • Risks to the patient (functional risk of falls, spousal restraining order, latex allergy)
  • Patient's needs for special accommodations (hard of hearing, need for easy-open caps)
  • Risks to providers (dog in house, patient may bite, infection control precautions)
  • Administrative concerns (incomplete information, pre-payment required due to credit risk)

Examples of issues that should not appear only in flags:

Note that we include "latex allergy" in the "in scope" list, and "allergy" in the "not in scope" list. The Flag resource is not designed to replace the normal order checking process, and one should not expect to see all allergies in Flags. However, if there is an activity that might occur prior to careful evaluation of the record (e.g. donning of latex gloves) and that activity might pose a risk to the patient, that is the sort of eventuality the Flag is intended to support.

Specific guidelines about what type of information is appropriate to expose using Flag, as well as what categories of individuals should see particular flags, will vary by interoperability community.

Flags may highlight a highly condensed view of information found in the AllergyIntolerance, Condition, Observation, Procedure and possibly other resources. A common extension allows the linkage of a Flag to the supporting detail resource. The purpose of these other resources is to provide detailed clinical information. The purpose of a Flag is to alert practitioners to information that is important to influence their interaction with a Patient prior to detailed review of the record.

Flags are not used to convey information to a specific individual or organization (e.g. an abnormal lab result reported to the ordering clinician, reporting of an adverse reaction to a regulatory authority). These are handled using the CommunicationRequest and the Communication resources.

Flags are not raised as a result of a reported or proposed action (e.g. drug-drug interactions, duplicate therapy warnings). These would be handled using DetectedIssue.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Flag DomainResourceKey information to flag to healthcare providers
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness identifier
... status ?!Σ1..1codeactive | inactive | entered-in-error
FlagStatus (Required)
... category Σ0..*CodeableConceptClinical, administrative, etc.
Flag Category (Example)
... code Σ1..1CodeableConceptCoded or textual message to display to user
Flag Code (Example)
... subject Σ1..1Reference(Patient | Location | Group | Organization | Practitioner | PlanDefinition | Medication | Procedure)Who/What is flag about?
... period Σ0..1PeriodTime period when flag is active
... encounter Σ0..1Reference(Encounter)Alert relevant during encounter
... author Σ0..1Reference(Device | Organization | Patient | Practitioner)Flag creator

doco Documentation for this format

UML Diagram (Legend)

Flag (DomainResource)Identifier assigned to the flag for external use (outside the FHIR environment)identifier : Identifier [0..*]Supports basic workflow (this element modifies the meaning of other elements)status : code [1..1] « Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or entered in error. (Strength=Required)FlagStatus! »Allows an flag to be divided into different categories like clinical, administrative etc. Intended to be used as a means of filtering which flags are displayed to particular user or in a given contextcategory : CodeableConcept [0..*] « A general category for flags for filtering/display purposes. (Strength=Example)Flag Category?? »The coded value or textual component of the flag to display to the usercode : CodeableConcept [1..1] « Detail codes identifying specific flagged issues. (Strength=Example)Flag Code?? »The patient, location, group , organization , or practitioner, etc. this is about record this flag is associated withsubject : Reference [1..1] « Patient|Location|Group|Organization| Practitioner|PlanDefinition|Medication|Procedure »The period of time from the activation of the flag to inactivation of the flag. If the flag is active, the end of the period should be unspecifiedperiod : Period [0..1]This alert is only relevant during the encounterencounter : Reference [0..1] « Encounter »The person, organization or device that created the flagauthor : Reference [0..1] « Device|Organization|Patient|Practitioner »

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Flag;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Flag.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:Flag.status [ code ]; # 1..1 active | inactive | entered-in-error
  fhir:Flag.category [ CodeableConcept ], ... ; # 0..* Clinical, administrative, etc.
  fhir:Flag.code [ CodeableConcept ]; # 1..1 Coded or textual message to display to user
  fhir:Flag.subject [ Reference(Patient|Location|Group|Organization|Practitioner|PlanDefinition|Medication|
  Procedure) ]; # 1..1 Who/What is flag about?
  fhir:Flag.period [ Period ]; # 0..1 Time period when flag is active
  fhir:Flag.encounter [ Reference(Encounter) ]; # 0..1 Alert relevant during encounter
  fhir:Flag.author [ Reference(Device|Organization|Patient|Practitioner) ]; # 0..1 Flag creator
]

Changes since DSTU2

Flag
Flag.category
  • Max Cardinality changed from 1 to *
Flag.subject
  • Add Reference(PlanDefinition), Add Reference(Medication), Add Reference(Procedure)

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Flag DomainResourceKey information to flag to healthcare providers
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness identifier
... status ?!Σ1..1codeactive | inactive | entered-in-error
FlagStatus (Required)
... category Σ0..*CodeableConceptClinical, administrative, etc.
Flag Category (Example)
... code Σ1..1CodeableConceptCoded or textual message to display to user
Flag Code (Example)
... subject Σ1..1Reference(Patient | Location | Group | Organization | Practitioner | PlanDefinition | Medication | Procedure)Who/What is flag about?
... period Σ0..1PeriodTime period when flag is active
... encounter Σ0..1Reference(Encounter)Alert relevant during encounter
... author Σ0..1Reference(Device | Organization | Patient | Practitioner)Flag creator

doco Documentation for this format

UML Diagram (Legend)

Flag (DomainResource)Identifier assigned to the flag for external use (outside the FHIR environment)identifier : Identifier [0..*]Supports basic workflow (this element modifies the meaning of other elements)status : code [1..1] « Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or entered in error. (Strength=Required)FlagStatus! »Allows an flag to be divided into different categories like clinical, administrative etc. Intended to be used as a means of filtering which flags are displayed to particular user or in a given contextcategory : CodeableConcept [0..*] « A general category for flags for filtering/display purposes. (Strength=Example)Flag Category?? »The coded value or textual component of the flag to display to the usercode : CodeableConcept [1..1] « Detail codes identifying specific flagged issues. (Strength=Example)Flag Code?? »The patient, location, group , organization , or practitioner, etc. this is about record this flag is associated withsubject : Reference [1..1] « Patient|Location|Group|Organization| Practitioner|PlanDefinition|Medication|Procedure »The period of time from the activation of the flag to inactivation of the flag. If the flag is active, the end of the period should be unspecifiedperiod : Period [0..1]This alert is only relevant during the encounterencounter : Reference [0..1] « Encounter »The person, organization or device that created the flagauthor : Reference [0..1] « Device|Organization|Patient|Practitioner »

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Flag;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Flag.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:Flag.status [ code ]; # 1..1 active | inactive | entered-in-error
  fhir:Flag.category [ CodeableConcept ], ... ; # 0..* Clinical, administrative, etc.
  fhir:Flag.code [ CodeableConcept ]; # 1..1 Coded or textual message to display to user
  fhir:Flag.subject [ Reference(Patient|Location|Group|Organization|Practitioner|PlanDefinition|Medication|
  Procedure) ]; # 1..1 Who/What is flag about?
  fhir:Flag.period [ Period ]; # 0..1 Time period when flag is active
  fhir:Flag.encounter [ Reference(Encounter) ]; # 0..1 Alert relevant during encounter
  fhir:Flag.author [ Reference(Device|Organization|Patient|Practitioner) ]; # 0..1 Flag creator
]

Changes since DSTU2

Flag
Flag.category
  • Max Cardinality changed from 1 to *
Flag.subject
  • Add Reference(PlanDefinition), Add Reference(Medication), Add Reference(Procedure)

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron + JSON Schema, ShEx (for Turtle)

PathDefinitionTypeReference
Flag.status Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or entered in error.RequiredFlagStatus
Flag.category A general category for flags for filtering/display purposes.ExampleFlag Category
Flag.code Detail codes identifying specific flagged issues.ExampleFlag Code

The Flag resource is sometimes used as "patient notes" and MAY be used to warn of issues such as:

  • Issues that impact on the patient's ability to receive/respond to care the care provision process itself (e.g., poor language comprehension, low compliance expected)
  • Issues that impact on the ability to provide care (e.g., patient has a big dog at home)
  • Financial matters (e.g., patient is a bad debtor)

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
authorreferenceFlag creatorFlag.author
(Practitioner, Organization, Device, Patient)
datedateTime period when flag is activeFlag.period17 Resources
encounterreferenceAlert relevant during encounterFlag.encounter
(Encounter)
12 Resources
identifiertokenBusiness identifierFlag.identifier
patientreferenceThe identity of a subject to list flags forFlag.subject
(Patient)
30 Resources
subjectreferenceThe identity of a subject to list flags forFlag.subject
(Practitioner, Group, Organization, Medication, Patient, PlanDefinition, Procedure, Location)