{
  "resourceType": "StructureDefinition",
  "id": "DetectedIssue",
  "meta": {
    "lastUpdated": "2021-01-01T21:58:31.578+00:00"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
      "valueString": "Clinical.Summary"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 1
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category",
      "valueCode": "patient"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "cds"
    },
    {
      "url": "http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status",
      "valueCode": ".status = entered-in-error"
    }
  ],
  "url": "http://hl7.org/fhir/StructureDefinition/DetectedIssue",
  "version": "4.6.0",
  "name": "DetectedIssue",
  "status": "draft",
  "date": "2021-01-01T21:58:31+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": "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.",
  "fhirVersion": "4.6.0",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "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/fivews",
      "name": "FiveWs Pattern Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "DetectedIssue",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
  "derivation": "specialization",
  "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": "*",
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.identifier"
          },
          {
            "identity": "w5",
            "map": "FiveWs.identifier"
          },
          {
            "identity": "v2",
            "map": "IAM-7"
          },
          {
            "identity": "rim",
            "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,
        "isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "DetectedIssueStatus"
            }
          ],
          "strength": "required",
          "description": "Indicates the status of the identified issue.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-status"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.status"
          },
          {
            "identity": "w5",
            "map": "FiveWs.status"
          },
          {
            "identity": "rim",
            "map": ".statusCode"
          }
        ]
      },
      {
        "id": "DetectedIssue.code",
        "path": "DetectedIssue.code",
        "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.",
          "valueSet": "http://hl7.org/fhir/ValueSet/detectedissue-category"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.code"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "v2",
            "map": "AL1-2 / IAM-9"
          },
          {
            "identity": "rim",
            "map": ".code"
          }
        ]
      },
      {
        "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"
            },
            {
              "url": "http://hl7.org/fhir/build/StructureDefinition/v3-map",
              "valueString": "SeverityObservation"
            }
          ],
          "strength": "required",
          "description": "Indicates the potential degree of impact of the identified issue on the patient.",
          "valueSet": "http://hl7.org/fhir/ValueSet/detectedissue-severity"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.grade"
          },
          {
            "identity": "v2",
            "map": "AL1-4/ IAR-2"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value"
          }
        ]
      },
      {
        "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": "w5",
            "map": "FiveWs.subject[x]"
          },
          {
            "identity": "v2",
            "map": "PID-3"
          },
          {
            "identity": "rim",
            "map": ".participation[typeCode=SBJ].role[classCode=PAT]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          }
        ]
      },
      {
        "id": "DetectedIssue.identified[x]",
        "path": "DetectedIssue.identified[x]",
        "short": "When identified",
        "definition": "The date or period 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"
          },
          {
            "code": "Period"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.occurrence[x]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.recorded"
          },
          {
            "identity": "v2",
            "map": "ALI-6 / IAM-11"
          },
          {
            "identity": "rim",
            "map": ".effectiveTime"
          }
        ]
      },
      {
        "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",
              "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
              "http://hl7.org/fhir/StructureDefinition/Device"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.performer.actor"
          },
          {
            "identity": "w5",
            "map": "FiveWs.author"
          },
          {
            "identity": "v2",
            "map": "IAM-14 / IAM-16"
          },
          {
            "identity": "rim",
            "map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]"
          }
        ]
      },
      {
        "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.evidence",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "This element is modeled the same as the evidence element of a Condition resource."
          }
        ],
        "path": "DetectedIssue.evidence",
        "short": "Supporting evidence",
        "definition": "Supporting evidence or manifestations that provide the basis for identifying the detected issue such as a GuidanceResponse or MeasureReport.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.why[x]"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=EVID].target[classCode=ACT, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "DetectedIssue.evidence.code",
        "path": "DetectedIssue.evidence.code",
        "short": "Manifestation",
        "definition": "A manifestation that led to the recording of this detected issue.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "DetectedIssueEvidenceCode"
            }
          ],
          "strength": "example",
          "description": "Codes that describes the types of evidence for a detected issue.",
          "valueSet": "http://hl7.org/fhir/ValueSet/manifestation-or-symptom"
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.why[x]"
          },
          {
            "identity": "rim",
            "map": ".code"
          }
        ]
      },
      {
        "id": "DetectedIssue.evidence.detail",
        "path": "DetectedIssue.evidence.detail",
        "short": "Supporting information",
        "definition": "Links to resources that constitute evidence for the detected issue such as a GuidanceResponse or MeasureReport.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.why[x]"
          },
          {
            "identity": "rim",
            "map": ".text"
          }
        ]
      },
      {
        "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",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "350,0"
          }
        ],
        "path": "DetectedIssue.mitigation",
        "short": "Step taken to address",
        "definition": "Indicates an action that has been taken or is committed to reduce or eliminate the likelihood of the risk identified by the detected issue from manifesting.  Can also reflect an observation of known mitigating factors that may reduce/eliminate the need for any action.",
        "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.",
          "valueSet": "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 might 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",
              "http://hl7.org/fhir/StructureDefinition/PractitionerRole"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".participation[typeCode=AUT].role[classCode=ASSIGNED]"
          }
        ]
      }
    ]
  }
}