{ "resourceType": "StructureDefinition", "id": "DetectedIssue", "meta": { "lastUpdated": "2017-04-18T21:44:43.294+00:00" }, "text": { "status": "generated", "div": "
NameFlagsCard.TypeDescription & Constraints\"doco\"
\".\"\".\"DetectedIssueDomainResourceClinical issue with action\n
Elements defined in Ancestors: \n id, \n meta, \n implicitRules, \n language, \n text, \n contained, \n extension, \n modifierExtension
\".\"\".\"\".\"identifierΣ0..1IdentifierUnique id for the detected issue
\".\"\".\"\".\"status?!Σ1..1coderegistered | preliminary | final | amended +\n
ObservationStatus (\n Required)\n
\".\"\".\"\".\"categoryΣ0..1CodeableConceptIssue Category, e.g. drug-drug, duplicate therapy, etc.\n
Detected Issue Category (\n Preferred)\n
\".\"\".\"\".\"severityΣ0..1codehigh | moderate | low\n
DetectedIssueSeverity (\n Required)\n
\".\"\".\"\".\"patientΣ0..1Reference(\n Patient)\n Associated patient
\".\"\".\"\".\"dateΣ0..1dateTimeWhen identified
\".\"\".\"\".\"authorΣ0..1Reference(\n Practitioner | \n Device)\n The provider or device that identified the issue
\".\"\".\"\".\"implicatedΣ0..*Reference(\n Any)\n Problem resource\n
\".\"\".\"\".\"detail0..1stringDescription and context
\".\"\".\"\".\"reference0..1uriAuthority for issue
\".\"\".\"\".\"mitigation0..*BackboneElementStep taken to address\n
\".\"\".\"\".\"\".\"action1..1CodeableConceptWhat mitigation?\n
Detected Issue Mitigation Action (\n Preferred)\n
\".\"\".\"\".\"\".\"date0..1dateTimeDate committed
\".\"\".\"\".\"\".\"author0..1Reference(\n Practitioner)\n Who is committing?

\"doco\" Documentation for this format\n
" }, "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "cds" } ], "url": "http://hl7.org/fhir/StructureDefinition/DetectedIssue", "name": "DetectedIssue", "status": "draft", "date": "2017-04-18T21:44:43+00:00", "publisher": "Health Level Seven International (Clinical Decision Support)", "contact": [ { "telecom": [ { "system": "url", "value": "http://hl7.org/fhir" } ] }, { "telecom": [ { "system": "url", "value": "http://www.hl7.org/Special/committees/dss/index.cfm" } ] } ], "description": "Base StructureDefinition for DetectedIssue Resource", "fhirVersion": "3.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/w5", "name": "W5 Mapping" } ], "kind": "resource", "abstract": false, "type": "DetectedIssue", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource", "derivation": "specialization", "snapshot": { "element": [ { "id": "DetectedIssue", "path": "DetectedIssue", "short": "Clinical issue with action", "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.", "alias": [ "DDI", "drug-drug interaction", "Contraindication", "Alert" ], "min": 0, "max": "*", "base": { "path": "Resource", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-1", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain any narrative", "expression": "contained.text.empty()", "xpath": "not(parent::f:contained and f:text)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource", "expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()", "xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "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)" }, { "identity": "w5", "map": "clinical.general" } ] }, { "id": "DetectedIssue.id", "path": "DetectedIssue.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DetectedIssue.meta", "path": "DetectedIssue.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "DetectedIssue.implicitRules", "path": "DetectedIssue.implicitRules", "short": "A set of rules under which this content was created", "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.", "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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DetectedIssue.language", "path": "DetectedIssue.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "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).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueReference": { "reference": "http://hl7.org/fhir/ValueSet/all-languages" } }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "extensible", "description": "A human language.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/languages" } }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DetectedIssue.text", "path": "DetectedIssue.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource, and may 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.", "comment": "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 in formation is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "ele-1", "dom-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "DetectedIssue.contained", "path": "DetectedIssue.contained", "short": "Contained, inline Resources", "definition": "These 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.", "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.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "DetectedIssue.extension", "path": "DetectedIssue.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order 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.", "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "DetectedIssue.modifierExtension", "path": "DetectedIssue.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "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. Usually modifier elements provide negation or qualification. In order 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.", "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "DetectedIssue.identifier", "path": "DetectedIssue.identifier", "short": "Unique id for the detected issue", "definition": "Business identifier associated with the detected issue record.", "requirements": "Allows linking instances of the same detected issue found on different servers.", "min": 0, "max": "1", "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "workflow", "map": "Event.identifier" }, { "identity": "v2", "map": "IAM-7" }, { "identity": "rim", "map": ".id" }, { "identity": "w5", "map": "id" } ] }, { "id": "DetectedIssue.status", "path": "DetectedIssue.status", "short": "registered | preliminary | final | amended +", "definition": "Indicates the status of the detected issue.", "comment": "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.", "alias": [ "status" ], "min": 1, "max": "1", "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueStatus" } ], "strength": "required", "description": "Indicates the status of the identified issue", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/observation-status" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "DetectedIssue.category", "path": "DetectedIssue.category", "short": "Issue Category, e.g. drug-drug, duplicate therapy, etc.", "definition": "Identifies the general type of issue identified.", "comment": "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.", "alias": [ "type" ], "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueCategory" } ], "strength": "preferred", "description": "Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/detectedissue-category" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "workflow", "map": "Event.code" }, { "identity": "v2", "map": "AL1-2 / IAM-9" }, { "identity": "rim", "map": ".code" }, { "identity": "w5", "map": "class" } ] }, { "id": "DetectedIssue.severity", "path": "DetectedIssue.severity", "short": "high | moderate | low", "definition": "Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.", "comment": "Note that FHIR strings may not exceed 1MB in size", "alias": [ "severity" ], "min": 0, "max": "1", "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueSeverity" } ], "strength": "required", "description": "Indicates the potential degree of impact of the identified issue on the patient.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/detectedissue-severity" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "AL1-4/ IAR-2" }, { "identity": "rim", "map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value" }, { "identity": "w5", "map": "grade" } ] }, { "id": "DetectedIssue.patient", "path": "DetectedIssue.patient", "short": "Associated patient", "definition": "Indicates the patient whose record the detected issue is associated with.", "comment": "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.", "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.subject" }, { "identity": "v2", "map": "PID-3" }, { "identity": "rim", "map": ".participation[typeCode=SBJ].role[classCode=PAT]" }, { "identity": "w5", "map": "who.focus" } ] }, { "id": "DetectedIssue.date", "path": "DetectedIssue.date", "short": "When identified", "definition": "The date or date-time when the detected issue was initially identified.", "requirements": "No-one can be responsible for mitigation prior to the issue being identified.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.occurrence" }, { "identity": "v2", "map": "ALI-6 / IAM-11" }, { "identity": "rim", "map": ".effectiveTime" }, { "identity": "w5", "map": "when.recorded" } ] }, { "id": "DetectedIssue.author", "path": "DetectedIssue.author", "short": "The provider or device that identified the issue", "definition": "Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "v2", "map": "IAM-14 / IAM-16" }, { "identity": "rim", "map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]" }, { "identity": "w5", "map": "who.author" } ] }, { "id": "DetectedIssue.implicated", "path": "DetectedIssue.implicated", "short": "Problem resource", "definition": "Indicates the resource representing the current activity or proposed activity that is potentially problematic.", "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.", "alias": [ "cause" ], "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.reasonReference" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]" } ] }, { "id": "DetectedIssue.detail", "path": "DetectedIssue.detail", "short": "Description and context", "definition": "A textual explanation of the detected issue.", "comment": "Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.note" }, { "identity": "v2", "map": "AL1-5 / IAM-8" }, { "identity": "rim", "map": ".text" } ] }, { "id": "DetectedIssue.reference", "path": "DetectedIssue.reference", "short": "Authority for issue", "definition": "The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.", "comment": "see http://en.wikipedia.org/wiki/Uniform_resource_identifier", "min": 0, "max": "1", "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri" } ] }, { "id": "DetectedIssue.mitigation", "path": "DetectedIssue.mitigation", "short": "Step taken to address", "definition": "Indicates an action that has been taken or is committed to 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.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]" } ] }, { "id": "DetectedIssue.mitigation.id", "path": "DetectedIssue.mitigation.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "DetectedIssue.mitigation.extension", "path": "DetectedIssue.mitigation.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional Content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.", "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "DetectedIssue.mitigation.modifierExtension", "path": "DetectedIssue.mitigation.modifierExtension", "short": "Extensions that cannot be ignored", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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.", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "DetectedIssue.mitigation.action", "path": "DetectedIssue.mitigation.action", "short": "What mitigation?", "definition": "Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.", "comment": "The \"text\" component can be used for detail or when no appropriate code exists.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueMitigationAction" } ], "strength": "preferred", "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.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": ".code" } ] }, { "id": "DetectedIssue.mitigation.date", "path": "DetectedIssue.mitigation.date", "short": "Date committed", "definition": "Indicates when the mitigating action was documented.", "comment": "This may not be the same as when the mitigating step was actually taken.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": ".effectiveTime" } ] }, { "id": "DetectedIssue.mitigation.author", "path": "DetectedIssue.mitigation.author", "short": "Who is committing?", "definition": "Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.", "comment": "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "rim", "map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]" } ] } ] }, "differential": { "element": [ { "id": "DetectedIssue", "path": "DetectedIssue", "short": "Clinical issue with action", "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.", "alias": [ "DDI", "drug-drug interaction", "Contraindication", "Alert" ], "min": 0, "max": "*", "mapping": [ { "identity": "workflow", "map": "Event" }, { "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)" }, { "identity": "w5", "map": "clinical.general" } ] }, { "id": "DetectedIssue.identifier", "path": "DetectedIssue.identifier", "short": "Unique id for the detected issue", "definition": "Business identifier associated with the detected issue record.", "requirements": "Allows linking instances of the same detected issue found on different servers.", "min": 0, "max": "1", "type": [ { "code": "Identifier" } ], "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "v2", "map": "IAM-7" }, { "identity": "rim", "map": ".id" }, { "identity": "w5", "map": "id" } ] }, { "id": "DetectedIssue.status", "path": "DetectedIssue.status", "short": "registered | preliminary | final | amended +", "definition": "Indicates the status of the detected issue.", "comment": "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.", "alias": [ "status" ], "min": 1, "max": "1", "type": [ { "code": "code" } ], "isModifier": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueStatus" } ], "strength": "required", "description": "Indicates the status of the identified issue", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/observation-status" } }, "mapping": [ { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "DetectedIssue.category", "path": "DetectedIssue.category", "short": "Issue Category, e.g. drug-drug, duplicate therapy, etc.", "definition": "Identifies the general type of issue identified.", "alias": [ "type" ], "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueCategory" } ], "strength": "preferred", "description": "Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/detectedissue-category" } }, "mapping": [ { "identity": "workflow", "map": "Event.code" }, { "identity": "v2", "map": "AL1-2 / IAM-9" }, { "identity": "rim", "map": ".code" }, { "identity": "w5", "map": "class" } ] }, { "id": "DetectedIssue.severity", "path": "DetectedIssue.severity", "short": "high | moderate | low", "definition": "Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.", "alias": [ "severity" ], "min": 0, "max": "1", "type": [ { "code": "code" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueSeverity" } ], "strength": "required", "description": "Indicates the potential degree of impact of the identified issue on the patient.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/detectedissue-severity" } }, "mapping": [ { "identity": "v2", "map": "AL1-4/ IAR-2" }, { "identity": "rim", "map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value" }, { "identity": "w5", "map": "grade" } ] }, { "id": "DetectedIssue.patient", "path": "DetectedIssue.patient", "short": "Associated patient", "definition": "Indicates the patient whose record the detected issue is associated with.", "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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient" } ], "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.subject" }, { "identity": "v2", "map": "PID-3" }, { "identity": "rim", "map": ".participation[typeCode=SBJ].role[classCode=PAT]" }, { "identity": "w5", "map": "who.focus" } ] }, { "id": "DetectedIssue.date", "path": "DetectedIssue.date", "short": "When identified", "definition": "The date or date-time when the detected issue was initially identified.", "requirements": "No-one can be responsible for mitigation prior to the issue being identified.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.occurrence" }, { "identity": "v2", "map": "ALI-6 / IAM-11" }, { "identity": "rim", "map": ".effectiveTime" }, { "identity": "w5", "map": "when.recorded" } ] }, { "id": "DetectedIssue.author", "path": "DetectedIssue.author", "short": "The provider or device that identified the issue", "definition": "Individual or device responsible for the issue being raised. For example, a decision support application or a pharmacist conducting a medication review.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" }, { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device" } ], "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "v2", "map": "IAM-14 / IAM-16" }, { "identity": "rim", "map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]" }, { "identity": "w5", "map": "who.author" } ] }, { "id": "DetectedIssue.implicated", "path": "DetectedIssue.implicated", "short": "Problem resource", "definition": "Indicates the resource representing the current activity or proposed activity that is potentially problematic.", "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.", "alias": [ "cause" ], "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource" } ], "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.reasonReference" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]" } ] }, { "id": "DetectedIssue.detail", "path": "DetectedIssue.detail", "short": "Description and context", "definition": "A textual explanation of the detected issue.", "comment": "Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mapping": [ { "identity": "workflow", "map": "Event.note" }, { "identity": "v2", "map": "AL1-5 / IAM-8" }, { "identity": "rim", "map": ".text" } ] }, { "id": "DetectedIssue.reference", "path": "DetectedIssue.reference", "short": "Authority for issue", "definition": "The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.", "min": 0, "max": "1", "type": [ { "code": "uri" } ], "mapping": [ { "identity": "rim", "map": ".outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri" } ] }, { "id": "DetectedIssue.mitigation", "path": "DetectedIssue.mitigation", "short": "Step taken to address", "definition": "Indicates an action that has been taken or is committed to 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.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mapping": [ { "identity": "rim", "map": ".outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]" } ] }, { "id": "DetectedIssue.mitigation.action", "path": "DetectedIssue.mitigation.action", "short": "What mitigation?", "definition": "Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.", "comment": "The \"text\" component can be used for detail or when no appropriate code exists.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DetectedIssueMitigationAction" } ], "strength": "preferred", "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.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action" } }, "mapping": [ { "identity": "rim", "map": ".code" } ] }, { "id": "DetectedIssue.mitigation.date", "path": "DetectedIssue.mitigation.date", "short": "Date committed", "definition": "Indicates when the mitigating action was documented.", "comment": "This may not be the same as when the mitigating step was actually taken.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "mapping": [ { "identity": "rim", "map": ".effectiveTime" } ] }, { "id": "DetectedIssue.mitigation.author", "path": "DetectedIssue.mitigation.author", "short": "Who is committing?", "definition": "Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "mapping": [ { "identity": "rim", "map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]" } ] } ] } }