<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="DetectedIssue" />
  <meta>
    <lastUpdated value="2021-01-02T08:58:31.578+11:00" />
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-category">
    <valueString value="Clinical.Summary" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="1" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category">
    <valueCode value="patient" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cds" />
  </extension>
  <extension url="http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status">
    <valueCode value=".status = entered-in-error" />
  </extension>
  <url value="http://hl7.org/fhir/StructureDefinition/DetectedIssue" />
  <version value="4.6.0" />
  <name value="DetectedIssue" />
  <status value="draft" />
  <date value="2021-01-02T08:58:31+11:00" />
  <publisher value="Health Level Seven International (Clinical Decision Support)" />
  <contact>
    <telecom>
      <system value="url" />
      <value value="http://hl7.org/fhir" />
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="url" />
      <value value="http://www.hl7.org/Special/committees/dss/index.cfm" />
    </telecom>
  </contact>
  <description value="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 value="4.6.0" />
  <mapping>
    <identity value="workflow" />
    <uri value="http://hl7.org/fhir/workflow" />
    <name value="Workflow Pattern" />
  </mapping>
  <mapping>
    <identity value="v2" />
    <uri value="http://hl7.org/v2" />
    <name value="HL7 v2 Mapping" />
  </mapping>
  <mapping>
    <identity value="rim" />
    <uri value="http://hl7.org/v3" />
    <name value="RIM Mapping" />
  </mapping>
  <mapping>
    <identity value="w5" />
    <uri value="http://hl7.org/fhir/fivews" />
    <name value="FiveWs Pattern Mapping" />
  </mapping>
  <kind value="resource" />
  <abstract value="false" />
  <type value="DetectedIssue" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
  <derivation value="specialization" />
  <differential>
    <element id="DetectedIssue">
      <path value="DetectedIssue" />
      <short value="Clinical issue with action" />
      <definition value="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 value="DDI" />
      <alias value="drug-drug interaction" />
      <alias value="Contraindication" />
      <alias value="Alert" />
      <min value="0" />
      <max value="*" />
      <mapping>
        <identity value="workflow" />
        <map value="Event" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="Partial mapping from messages containing the AL1 or IAM segment, such as the ADT^A01, ADT^A08, and ADT^A60." />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Observation[classCode=ALRT, moodCode=EVN)" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="clinical.general" />
      </mapping>
    </element>
    <element id="DetectedIssue.identifier">
      <path value="DetectedIssue.identifier" />
      <short value="Unique id for the detected issue" />
      <definition value="Business identifier associated with the detected issue record." />
      <requirements value="Allows linking instances of the same detected issue found on different servers." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Identifier" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="workflow" />
        <map value="Event.identifier" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.identifier" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="IAM-7" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".id" />
      </mapping>
    </element>
    <element id="DetectedIssue.status">
      <path value="DetectedIssue.status" />
      <short value="registered | preliminary | final | amended +" />
      <definition value="Indicates the status of the detected issue." />
      <comment value="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 value="status" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <isModifier value="true" />
      <isModifierReason value="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 value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DetectedIssueStatus" />
        </extension>
        <strength value="required" />
        <description value="Indicates the status of the identified issue." />
        <valueSet value="http://hl7.org/fhir/ValueSet/observation-status" />
      </binding>
      <mapping>
        <identity value="workflow" />
        <map value="Event.status" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.status" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".statusCode" />
      </mapping>
    </element>
    <element id="DetectedIssue.code">
      <path value="DetectedIssue.code" />
      <short value="Issue Category, e.g. drug-drug, duplicate therapy, etc." />
      <definition value="Identifies the general type of issue identified." />
      <alias value="type" />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DetectedIssueCategory" />
        </extension>
        <strength value="preferred" />
        <description value="Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc." />
        <valueSet value="http://hl7.org/fhir/ValueSet/detectedissue-category" />
      </binding>
      <mapping>
        <identity value="workflow" />
        <map value="Event.code" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.class" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="AL1-2 / IAM-9" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".code" />
      </mapping>
    </element>
    <element id="DetectedIssue.severity">
      <path value="DetectedIssue.severity" />
      <short value="high | moderate | low" />
      <definition value="Indicates the degree of importance associated with the identified issue based on the potential impact on the patient." />
      <alias value="severity" />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DetectedIssueSeverity" />
        </extension>
        <extension url="http://hl7.org/fhir/build/StructureDefinition/v3-map">
          <valueString value="SeverityObservation" />
        </extension>
        <strength value="required" />
        <description value="Indicates the potential degree of impact of the identified issue on the patient." />
        <valueSet value="http://hl7.org/fhir/ValueSet/detectedissue-severity" />
      </binding>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.grade" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="AL1-4/ IAR-2" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV].value" />
      </mapping>
    </element>
    <element id="DetectedIssue.patient">
      <path value="DetectedIssue.patient" />
      <short value="Associated patient" />
      <definition value="Indicates the patient whose record the detected issue is associated with." />
      <requirements value="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 value="0" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="workflow" />
        <map value="Event.subject" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.subject[x]" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="PID-3" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=SBJ].role[classCode=PAT]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.subject" />
      </mapping>
    </element>
    <element id="DetectedIssue.identified[x]">
      <path value="DetectedIssue.identified[x]" />
      <short value="When identified" />
      <definition value="The date or period when the detected issue was initially identified." />
      <requirements value="No-one can be responsible for mitigation prior to the issue being identified." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="dateTime" />
      </type>
      <type>
        <code value="Period" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="workflow" />
        <map value="Event.occurrence[x]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.recorded" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="ALI-6 / IAM-11" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".effectiveTime" />
      </mapping>
    </element>
    <element id="DetectedIssue.author">
      <path value="DetectedIssue.author" />
      <short value="The provider or device that identified the issue" />
      <definition value="Individual or device responsible for the issue being raised.  For example, a decision support application or a pharmacist conducting a medication review." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="workflow" />
        <map value="Event.performer.actor" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.author" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="IAM-14 / IAM-16" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=AUT].role[classCode=ASSIGNED]" />
      </mapping>
    </element>
    <element id="DetectedIssue.implicated">
      <path value="DetectedIssue.implicated" />
      <short value="Problem resource" />
      <definition value="Indicates the resource representing the current activity or proposed activity that is potentially problematic." />
      <comment value="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 value="cause" />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="workflow" />
        <map value="Event.reasonReference" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=SUBJ].target[moodCode=EVN, INT]" />
      </mapping>
    </element>
    <element id="DetectedIssue.evidence">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/committee-notes">
        <valueString value="This element is modeled the same as the evidence element of a Condition resource." />
      </extension>
      <path value="DetectedIssue.evidence" />
      <short value="Supporting evidence" />
      <definition value="Supporting evidence or manifestations that provide the basis for identifying the detected issue such as a GuidanceResponse or MeasureReport." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.why[x]" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=EVID].target[classCode=ACT, moodCode=EVN]" />
      </mapping>
    </element>
    <element id="DetectedIssue.evidence.code">
      <path value="DetectedIssue.evidence.code" />
      <short value="Manifestation" />
      <definition value="A manifestation that led to the recording of this detected issue." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DetectedIssueEvidenceCode" />
        </extension>
        <strength value="example" />
        <description value="Codes that describes the types of evidence for a detected issue." />
        <valueSet value="http://hl7.org/fhir/ValueSet/manifestation-or-symptom" />
      </binding>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.why[x]" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".code" />
      </mapping>
    </element>
    <element id="DetectedIssue.evidence.detail">
      <path value="DetectedIssue.evidence.detail" />
      <short value="Supporting information" />
      <definition value="Links to resources that constitute evidence for the detected issue such as a GuidanceResponse or MeasureReport." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
      </type>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.why[x]" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".text" />
      </mapping>
    </element>
    <element id="DetectedIssue.detail">
      <path value="DetectedIssue.detail" />
      <short value="Description and context" />
      <definition value="A textual explanation of the detected issue." />
      <comment value="Should focus on information not covered elsewhere as discrete data - no need to duplicate the narrative." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
      <mapping>
        <identity value="workflow" />
        <map value="Event.note" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="AL1-5 / IAM-8" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".text" />
      </mapping>
    </element>
    <element id="DetectedIssue.reference">
      <path value="DetectedIssue.reference" />
      <short value="Authority for issue" />
      <definition value="The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="uri" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=INST].target[classCode=ALRT, moodCode=DEFN].text.uri" />
      </mapping>
    </element>
    <element id="DetectedIssue.mitigation">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="350,0" />
      </extension>
      <path value="DetectedIssue.mitigation" />
      <short value="Step taken to address" />
      <definition value="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 value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=MITG].target[classCode=ACT, moodCode=EVN]" />
      </mapping>
    </element>
    <element id="DetectedIssue.mitigation.action">
      <path value="DetectedIssue.mitigation.action" />
      <short value="What mitigation?" />
      <definition value="Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue." />
      <comment value="The &quot;text&quot; component can be used for detail or when no appropriate code exists." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DetectedIssueMitigationAction" />
        </extension>
        <strength value="preferred" />
        <description value="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 value="http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action" />
      </binding>
      <mapping>
        <identity value="rim" />
        <map value=".code" />
      </mapping>
    </element>
    <element id="DetectedIssue.mitigation.date">
      <path value="DetectedIssue.mitigation.date" />
      <short value="Date committed" />
      <definition value="Indicates when the mitigating action was documented." />
      <comment value="This might not be the same as when the mitigating step was actually taken." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="dateTime" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value=".effectiveTime" />
      </mapping>
    </element>
    <element id="DetectedIssue.mitigation.author">
      <path value="DetectedIssue.mitigation.author" />
      <short value="Who is committing?" />
      <definition value="Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=AUT].role[classCode=ASSIGNED]" />
      </mapping>
    </element>
  </differential>
</StructureDefinition>