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HdBe-Alert

WARNING This page contains a draft CBB, as raw output from the zib export and automatic conversion to CBB. It requires thorough review and adaption to the Belgian realm. This CBB is merely added for informative use.

CBB	Description	Status
HdBe-Alert	An alert describes a clinical or administrative fact brought to the attention of the users of the clinical systems to be taken into account when shaping diagnostic and therapeutic policy or in dealing with the patient, usually because of a safety risk. Disorders that describe the body’s sensitivity to a substance which results in a specific physiological reaction after being exposed to that substance are referred to as allergies. These are described in a separate information model. Warnings for non-allergic disorders can concern: A disorder, condition or diagnosis which can be considered as a contraindication for undergoing a certain type of therapy, such as pregnancy or long QT syndrome; Impaired functioning of an organ system (heart failure, impaired liver or kidney function, weakened immune system); Risk of spreading certain microorganisms (multi-resistant bacteria, tubercle bacilli, HIV, HBV, Ebola virus); Other risks Purpose Documenting and entering disorders or conditions that require attention is an important part of medical registration. It concerns the core of patient safety. In the execution of research and treatment, these patient characteristics - which are marked as a warning - constantly have to be taken into account. They provide information that is important for the patient’s condition and the options a healthcare professional has for therapy. Disorders that are registered or transferred as an Alert can also be described as a Problem. The difference is in the fact that the healthcare professional considers the problem as an Alert = warning. In many cases, transfer will be subject to strict privacy rules, as the warning will not always elicit an adequate reaction in the informed environment. Instructions If there is a contraindication which is also important for medication safety, it should also be registered via MedicationContraIndication.	active

CBB

Description

Status

HdBe-Alert

An alert describes a clinical or administrative fact brought to the attention of the users of the clinical systems to be taken into account when shaping diagnostic and therapeutic policy or in dealing with the patient, usually because of a safety risk. Disorders that describe the body’s sensitivity to a substance which results in a specific physiological reaction after being exposed to that substance are referred to as allergies. These are described in a separate information model. Warnings for non-allergic disorders can concern:

A disorder, condition or diagnosis which can be considered as a contraindication for undergoing a certain type of therapy, such as pregnancy or long QT syndrome;
Impaired functioning of an organ system (heart failure, impaired liver or kidney function, weakened immune system);
Risk of spreading certain microorganisms (multi-resistant bacteria, tubercle bacilli, HIV, HBV, Ebola virus);
Other risks

Purpose

Documenting and entering disorders or conditions that require attention is an important part of medical registration. It concerns the core of patient safety. In the execution of research and treatment, these patient characteristics - which are marked as a warning - constantly have to be taken into account. They provide information that is important for the patient’s condition and the options a healthcare professional has for therapy. Disorders that are registered or transferred as an Alert can also be described as a Problem. The difference is in the fact that the healthcare professional considers the problem as an Alert = warning. In many cases, transfer will be subject to strict privacy rules, as the warning will not always elicit an adequate reaction in the informed environment.

Instructions

If there is a contraindication which is also important for medication safety, it should also be registered via MedicationContraIndication.

active

Alert	I		Alert	Element id Alert Short description Alert Definition Root concept of the Alert information model. This root concept contains all data elements of the Alert information model. Data type Alert Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` HdBe-Alert-1: One concept from Condition and AlertName must be selected. `Condition.exists() xor AlertName.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Alert.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Alert.extension Short description Additional content defined by implementations Alternate names extensions, user content 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 manageable, 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
EndDateTime		0..1	dateTime	Element id Alert.EndDateTime Short description EndDateTime Definition The date and time at which the described condition was retracted as a warning. This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year). Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Condition	I	0..1	Reference(HdBe-Problem)	Element id Alert.Condition Short description Condition Definition The patient’s health problem or condition that is the subject of the alert. This could involve a patient’s problem, condition or diagnosis that is seen as a contraindication in prescribing medication or which has to be taken into account when shaping diagnostic and therapeutic policy. This can be in the patient’s own interest, or it can involve a problem or disorder that can make the patient a risk to their surroundings, such as an infection hazard. These are references to conditions included on the patient’s problem list. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-Problem) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
AlertName	I	0..1	CodeableConceptBinding	Element id Alert.AlertName Short description AlertName Definition A warning, other than a condition or problem. For example, a patient can be given an ‘Aggressive patient' alert. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding AlertName codes AlertName (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
StartDateTime		0..1	dateTime	Element id Alert.StartDateTime Short description StartDateTime Definition The date and time at which the described condition was entered as a warning. This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year). Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
AlertType		0..1	CodeableConceptBinding	Element id Alert.AlertType Short description AlertType Definition Indicates the type of alert, meaning a rough description of the cause or origin of the warning. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding AlertType codes AlertType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Comment		0..1	string	Element id Alert.Comment Short description Comment Definition Explanatory comments to the alert that cannot be expressed in any of the other elements. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a

Alert		0..*
Alert.EndDateTime	dateTime	0..1
Alert.Condition	Reference(HdBe-Problem)	0..1
Alert.AlertName	CodeableConcept	0..1
Alert.StartDateTime	dateTime	0..1
Alert.AlertType	CodeableConcept	0..1
Alert.Comment	string	0..1

Alert
Definition	Root concept of the Alert information model. This root concept contains all data elements of the Alert information model.
Cardinality	0...*
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` HdBe-Alert-1: One concept from Condition and AlertName must be selected. `Condition.exists() xor AlertName.exists()`
Mappings	rim: n/a
Alert.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Alert.extension
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 manageable, 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Alert.EndDateTime
Definition	The date and time at which the described condition was retracted as a warning. This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Alert.Condition
Definition	The patient’s health problem or condition that is the subject of the alert. This could involve a patient’s problem, condition or diagnosis that is seen as a contraindication in prescribing medication or which has to be taken into account when shaping diagnostic and therapeutic policy. This can be in the patient’s own interest, or it can involve a problem or disorder that can make the patient a risk to their surroundings, such as an infection hazard. These are references to conditions included on the patient’s problem list.
Cardinality	0...1
Type	Reference(HdBe-Problem)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Alert.AlertName
Definition	A warning, other than a condition or problem. For example, a patient can be given an ‘Aggressive patient' alert.
Cardinality	0...1
Type	CodeableConcept
Binding	AlertName codes AlertName (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Alert.StartDateTime
Definition	The date and time at which the described condition was entered as a warning. This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Alert.AlertType
Definition	Indicates the type of alert, meaning a rough description of the cause or origin of the warning.
Cardinality	0...1
Type	CodeableConcept
Binding	AlertType codes AlertType (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Alert.Comment
Definition	Explanatory comments to the alert that cannot be expressed in any of the other elements.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a

Example instances

alert
EndDateTime	2012-12-30
condition.Problem	Listeriosis
AlertName
StartDateTime	2012-09-15
AlertType	75323-6 - Condition (code by LOINC)
Comment

zib Alert-v4.1 difference

Concept	Category	Description
`AlertName`	textual	Removed the notion of allowing free text in the definition because this is confusing and we want to stimulate the use of codes. The ValueSet binding is extensible, meaning that other codes or a text as fall back can be used.
`AlertName`	terminology	Replaced NullFlavor Other and Unkown with SNOMED equivelant codes.

Terminology Bindings

Path	Name	Strength	URL
AlertName	AlertName	extensible	https://fhir.healthdata.be/ValueSet/AlertName
AlertType	AlertType	required	https://fhir.healthdata.be/ValueSet/AlertType