StructureDefinition-UKCore-Flag

Canonical_URLStatusCurrent_VersionLast_UpdatedDescription
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Flagdraft1.2.02023-12-12

This profile defines the UK constraints and extensions on the International FHIR resource Flag.


Profile_Purpose

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)
identifierΣ0..*Identifier
statusS Σ ?!1..1codeBinding
categoryΣ0..*CodeableConcept
codeS Σ1..1CodeableConcept
subjectS Σ I1..1Reference(Patient | Location | Group | Organization | Practitioner | PlanDefinition | Medication | Procedure)
periodΣ I0..1Period
encounterΣ I0..1Reference(Encounter)
authorΣ I0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole)

Detailed Descriptions

Flag
DefinitionProspective warnings of potential issues when providing care to the patient.
Cardinality0...*
AliasBarriers to Care, Alert, Warning
Invariants
  • dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: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
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6:A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5:If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim:Entity. Role, or Act
  • rim:Observation[classCode=ISSUE, moodCode=EVN]
Flag.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
TypeSystem.String
SummaryTrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Flag.meta
DefinitionThe 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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
Flag.implicitRules
DefinitionA 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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

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 it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
Flag.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

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).

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
Flag.text
DefinitionA 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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

Contained resources do not have 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.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
  • rim:Act.text?
Flag.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

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.

Mappings
  • rim:Entity. Role, or Act
  • rim:N/A
Flag.extension
DefinitionMay 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 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.
Cardinality0...*
TypeExtension
Aliasextensions, 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.

SlicingUnordered, 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
Flag.modifierExtension
DefinitionMay 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 manageable, 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
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.

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.

SlicingUnordered, 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
Flag.identifier
DefinitionBusiness identifiers assigned to this flag by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Allows identification of the flag as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). 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.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd:Identifier
  • w5:FiveWs.identifier
  • rim:.id
Flag.status
DefinitionSupports basic workflow.
Cardinality1...1
Typecode
Binding

Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error.

FlagStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • w5:FiveWs.status
  • rim:.status
Flag.category
DefinitionAllows a 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 context.
Cardinality0...*
TypeCodeableConcept
Binding

A general category for flags for filtering/display purposes.

FlagCategory (example)
SummaryTrue
Comments

The value set will often need to be adjusted based on local business rules and usage context.

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
  • w5:FiveWs.class
  • rim:.code
Flag.code
DefinitionThe coded value or textual component of the flag to display to the user.
Cardinality1...1
TypeCodeableConcept
Binding

Detail codes identifying specific flagged issues.

FlagCode (example)
Must SupportTrue
SummaryTrue
Comments

If non-coded, use CodeableConcept.text. This element should always be included in the narrative.

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
  • w5:FiveWs.what[x]
  • rim:.value
Flag.subject
DefinitionThe patient, location, group, organization, or practitioner etc. this is about record this flag is associated with.
Cardinality1...1
TypeReference(Patient | Location | Group | Organization | Practitioner | PlanDefinition | Medication | Procedure)
Must SupportTrue
SummaryTrue
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)
  • w5:FiveWs.subject[x]
  • rim:.participation[typeCode=SBJ].role[classCode=PAT | LOCE | ASSIGNED]
  • w5:FiveWs.subject
Flag.period
DefinitionThe 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 unspecified.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1:If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim:n/a
  • v2:DR
  • rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • w5:FiveWs.context
Flag.encounter
DefinitionThis alert is only relevant during the encounter.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
Comments

If both Flag.encounter and Flag.period are valued, then Flag.period.start shall not be before Encounter.period.start and Flag.period.end shall not be after Encounter.period.end.

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)
  • w5:FiveWs.context
Flag.author
DefinitionThe person, organization or device that created the flag.
Cardinality0...1
TypeReference(Device | Organization | Patient | Practitioner | PractitionerRole)
SummaryTrue
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)
  • w5:FiveWs.author
  • rim:.participation[typeCode=AUT].role

Table View

Flag..
Flag.status..
Flag.code..
Flag.subject..


XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Flag" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Flag" />
    <version value="1.2.0" />
    <name value="UKCoreFlag" />
    <title value="UK Core Flag" />
    <status value="draft" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Flag](https://hl7.org/fhir/R4/Flag.html)." />
    <purpose value="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.   \n\nThis subject can be of different types, as described in the examples below:   \n\n- 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`)   \n- 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   \n- A particular provider is unavailable for referrals over a given period (`subject = Practitioner`)   \n- A patient who is enrolled in a clinical trial (`subject = Group`)   \n- Special guidance or caveats to be aware of when following a protocol (`subject = PlanDefinition`)   \n- Warnings about using a drug in a formulary requires special approval (`subject = Medication`)" />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Flag" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Flag" />
    <derivation value="constraint" />
    <differential>
        <element id="Flag.status">
            <path value="Flag.status" />
            <mustSupport value="true" />
        </element>
        <element id="Flag.code">
            <path value="Flag.code" />
            <mustSupport value="true" />
        </element>
        <element id="Flag.subject">
            <path value="Flag.subject" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Flag",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Flag",
    "version": "1.2.0",
    "name": "UKCoreFlag",
    "title": "UK Core Flag",
    "status": "draft",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Flag](https://hl7.org/fhir/R4/Flag.html).",
    "purpose": "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.   \n\nThis subject can be of different types, as described in the examples below:   \n\n- 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`)   \n- 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   \n- A particular provider is unavailable for referrals over a given period (`subject = Practitioner`)   \n- A patient who is enrolled in a clinical trial (`subject = Group`)   \n- Special guidance or caveats to be aware of when following a protocol (`subject = PlanDefinition`)   \n- Warnings about using a drug in a formulary requires special approval (`subject = Medication`)",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Flag",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Flag",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Flag.status",
                "path": "Flag.status",
                "mustSupport": true
            },
            {
                "id": "Flag.code",
                "path": "Flag.code",
                "mustSupport": true
            },
            {
                "id": "Flag.subject",
                "path": "Flag.subject",
                "mustSupport": true
            }
        ]
    }
}

Usage

This Profile has the following derived profiles:


This Profile is referenced in the following Extensions:


This Profile is referenced in the following Profiles:

Feedback

Click here to:

Report issue for UKCore-Flag

Examples

Food Allergy - An example to illustrate a flag regarding a food allergy.
Example UKCore-Flag-FoodAllergy

Example Usage Scenarios

The following are example usage scenarios for the UK Core Flag profile:

  • Query for flag information for a given Patient
  • Exchange flag information within a FHIR document or message.

Profile Specific Implementation Guidance:

Minimum Viable Content

A minimum viable content that all provider and consumer systems SHALL support are the following elements.

Element Reason
Flag.status Supports basic workflow.
Flag.code The coded value or textual component of the flag to display to the user.
Flag.subject The patient, location, group, organization, or practitioner etc. this is about record this flag is associated with.

subject

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:


encounter

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Encounter.


author

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles: