DetectedIssue

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.

Columns

Header row
# path type required description
0 resourceType string * Resource type identifier. Must be string "DetectedIssue"
1 integer * Number of subrows
2 id string * Logical id of this artifact
3 status code registered | preliminary | final | amended +
code CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
code.coding Coding Code defined by a terminology system
4 code.coding.system uri Identity of the terminology system
5 code.coding.version string Version of the system - if relevant
6 code.coding.code code Symbol in syntax defined by the system
7 code.coding.display string Representation defined by the system
8 code.coding.userSelected boolean If this coding was chosen directly by the user
9 code.text string Plain text representation of the concept
10 severity code high | moderate | low
patient Reference Associated patient
11 patient.reference string Literal reference, Relative, internal or absolute URL
12 patient.type uri Type the reference refers to (e.g. "Patient")
patient.identifier Identifier Logical reference, when literal reference is not known
13 patient.identifier.use code usual | official | temp | secondary | old (If known)
patient.identifier.type CodeableConcept Description of identifier
patient.identifier.type.coding Coding Code defined by a terminology system
14 patient.identifier.type.coding.system uri Identity of the terminology system
15 patient.identifier.type.coding.version string Version of the system - if relevant
16 patient.identifier.type.coding.code code Symbol in syntax defined by the system
17 patient.identifier.type.coding.display string Representation defined by the system
18 patient.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
19 patient.identifier.type.text string Plain text representation of the concept
20 patient.identifier.system uri The namespace for the identifier value
21 patient.identifier.value string The value that is unique
patient.identifier.period Period Time period when id is/was valid for use
22 patient.identifier.period.start dateTime Starting time with inclusive boundary
23 patient.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
24 patient.display string Text alternative for the resource
identified[x] When identified
25 identifiedDateTime dateTime
identifiedPeriod Period
26 identifiedPeriod.start dateTime Starting time with inclusive boundary
27 identifiedPeriod.end dateTime End time with inclusive boundary, if not ongoing
author Reference The provider or device that identified the issue
28 author.reference string Literal reference, Relative, internal or absolute URL
29 author.type uri Type the reference refers to (e.g. "Patient")
author.identifier Identifier Logical reference, when literal reference is not known
30 author.identifier.use code usual | official | temp | secondary | old (If known)
author.identifier.type CodeableConcept Description of identifier
author.identifier.type.coding Coding Code defined by a terminology system
31 author.identifier.type.coding.system uri Identity of the terminology system
32 author.identifier.type.coding.version string Version of the system - if relevant
33 author.identifier.type.coding.code code Symbol in syntax defined by the system
34 author.identifier.type.coding.display string Representation defined by the system
35 author.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
36 author.identifier.type.text string Plain text representation of the concept
37 author.identifier.system uri The namespace for the identifier value
38 author.identifier.value string The value that is unique
author.identifier.period Period Time period when id is/was valid for use
39 author.identifier.period.start dateTime Starting time with inclusive boundary
40 author.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
41 author.display string Text alternative for the resource
42 detail string Description and context
43 reference uri Authority for issue
Row identifier
# path type required description
0 string * Subrow identifier. Must be string "identifier"
identifier Identifier Unique id for the detected issue
1 identifier.use code usual | official | temp | secondary | old (If known)
identifier.type CodeableConcept Description of identifier
identifier.type.coding Coding Code defined by a terminology system
2 identifier.type.coding.system uri Identity of the terminology system
3 identifier.type.coding.version string Version of the system - if relevant
4 identifier.type.coding.code code Symbol in syntax defined by the system
5 identifier.type.coding.display string Representation defined by the system
6 identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
7 identifier.type.text string Plain text representation of the concept
8 identifier.system uri The namespace for the identifier value
9 identifier.value string The value that is unique
identifier.period Period Time period when id is/was valid for use
10 identifier.period.start dateTime Starting time with inclusive boundary
11 identifier.period.end dateTime End time with inclusive boundary, if not ongoing
Row implicated
# path type required description
0 string * Subrow identifier. Must be string "implicated"
implicated Reference Problem resource
1 implicated.reference string Literal reference, Relative, internal or absolute URL
2 implicated.type uri Type the reference refers to (e.g. "Patient")
implicated.identifier Identifier Logical reference, when literal reference is not known
3 implicated.identifier.use code usual | official | temp | secondary | old (If known)
implicated.identifier.type CodeableConcept Description of identifier
implicated.identifier.type.coding Coding Code defined by a terminology system
4 implicated.identifier.type.coding.system uri Identity of the terminology system
5 implicated.identifier.type.coding.version string Version of the system - if relevant
6 implicated.identifier.type.coding.code code Symbol in syntax defined by the system
7 implicated.identifier.type.coding.display string Representation defined by the system
8 implicated.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
9 implicated.identifier.type.text string Plain text representation of the concept
10 implicated.identifier.system uri The namespace for the identifier value
11 implicated.identifier.value string The value that is unique
implicated.identifier.period Period Time period when id is/was valid for use
12 implicated.identifier.period.start dateTime Starting time with inclusive boundary
13 implicated.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
14 implicated.display string Text alternative for the resource
Row evidence
# path type required description
0 string * Subrow identifier. Must be string "evidence"
evidence Supporting evidence
evidence.code CodeableConcept Manifestation
evidence.code.coding Coding Code defined by a terminology system
1 evidence.code.coding.system uri Identity of the terminology system
2 evidence.code.coding.version string Version of the system - if relevant
3 evidence.code.coding.code code Symbol in syntax defined by the system
4 evidence.code.coding.display string Representation defined by the system
5 evidence.code.coding.userSelected boolean If this coding was chosen directly by the user
6 evidence.code.text string Plain text representation of the concept
evidence.detail Reference Supporting information
7 evidence.detail.reference string Literal reference, Relative, internal or absolute URL
8 evidence.detail.type uri Type the reference refers to (e.g. "Patient")
evidence.detail.identifier Identifier Logical reference, when literal reference is not known
9 evidence.detail.identifier.use code usual | official | temp | secondary | old (If known)
evidence.detail.identifier.type CodeableConcept Description of identifier
evidence.detail.identifier.type.coding Coding Code defined by a terminology system
10 evidence.detail.identifier.type.coding.system uri Identity of the terminology system
11 evidence.detail.identifier.type.coding.version string Version of the system - if relevant
12 evidence.detail.identifier.type.coding.code code Symbol in syntax defined by the system
13 evidence.detail.identifier.type.coding.display string Representation defined by the system
14 evidence.detail.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
15 evidence.detail.identifier.type.text string Plain text representation of the concept
16 evidence.detail.identifier.system uri The namespace for the identifier value
17 evidence.detail.identifier.value string The value that is unique
evidence.detail.identifier.period Period Time period when id is/was valid for use
18 evidence.detail.identifier.period.start dateTime Starting time with inclusive boundary
19 evidence.detail.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
20 evidence.detail.display string Text alternative for the resource
Row mitigation
# path type required description
0 string * Subrow identifier. Must be string "mitigation"
mitigation Step taken to address
mitigation.action CodeableConcept What mitigation?
mitigation.action.coding Coding Code defined by a terminology system
1 mitigation.action.coding.system uri Identity of the terminology system
2 mitigation.action.coding.version string Version of the system - if relevant
3 mitigation.action.coding.code code Symbol in syntax defined by the system
4 mitigation.action.coding.display string Representation defined by the system
5 mitigation.action.coding.userSelected boolean If this coding was chosen directly by the user
6 mitigation.action.text string Plain text representation of the concept
7 mitigation.date dateTime Date committed
mitigation.author Reference Who is committing?
8 mitigation.author.reference string Literal reference, Relative, internal or absolute URL
9 mitigation.author.type uri Type the reference refers to (e.g. "Patient")
mitigation.author.identifier Identifier Logical reference, when literal reference is not known
10 mitigation.author.identifier.use code usual | official | temp | secondary | old (If known)
mitigation.author.identifier.type CodeableConcept Description of identifier
mitigation.author.identifier.type.coding Coding Code defined by a terminology system
11 mitigation.author.identifier.type.coding.system uri Identity of the terminology system
12 mitigation.author.identifier.type.coding.version string Version of the system - if relevant
13 mitigation.author.identifier.type.coding.code code Symbol in syntax defined by the system
14 mitigation.author.identifier.type.coding.display string Representation defined by the system
15 mitigation.author.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
16 mitigation.author.identifier.type.text string Plain text representation of the concept
17 mitigation.author.identifier.system uri The namespace for the identifier value
18 mitigation.author.identifier.value string The value that is unique
mitigation.author.identifier.period Period Time period when id is/was valid for use
19 mitigation.author.identifier.period.start dateTime Starting time with inclusive boundary
20 mitigation.author.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
21 mitigation.author.display string Text alternative for the resource

Examples

Example #1
Input CSV
DetectedIssue,0,"allergy","final",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Resulting resource
{
  "resourceType": "DetectedIssue",
  "id": "allergy",
  "status": "final"
}
Example #2
Input CSV
DetectedIssue,3,"duplicate","final","http://terminology.hl7.org/CodeSystem/v3-ActCode",,"DUPTHPY","Duplicate Therapy Alert",,,,"Patient/dicom",,,,,,,,,,,,,,"2013-05-08",,,"Device/software",,,,,,,,,,,,,,"Similar test was performed within the past 14 days","http://www.tmhp.com/RadiologyClinicalDecisionSupport/2011/CHEST%20IMAGING%20GUIDELINES%202011.pdf"
identifier,"official",,,,,,,"http://example.org","12345",,
implicated,"ServiceRequest/di",,,,,,,,,,,,,"Chest CT - ordered May 8, 2013 by Dr. Adam Careful"
implicated,"ImagingStudy/example",,,,,,,,,,,,,"Image 1 from Series 3: CT Images on Patient MINT (MINT1234) taken at 1-Jan 2011 01:20 AM"
Resulting resource
{
  "resourceType": "DetectedIssue",
  "id": "duplicate",
  "identifier": [
    {
      "use": "official",
      "system": "http://example.org",
      "value": "12345"
    }
  ],
  "status": "final",
  "code": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "DUPTHPY",
        "display": "Duplicate Therapy Alert"
      }
    ]
  },
  "patient": {
    "reference": "Patient/dicom"
  },
  "identifiedDateTime": "2013-05-08",
  "author": {
    "reference": "Device/software"
  },
  "implicated": [
    {
      "reference": "ServiceRequest/di",
      "display": "Chest CT - ordered May 8, 2013 by Dr. Adam Careful"
    },
    {
      "reference": "ImagingStudy/example",
      "display": "Image 1 from Series 3: CT Images on Patient MINT (MINT1234) taken at 1-Jan 2011 01:20 AM"
    }
  ],
  "detail": "Similar test was performed within the past 14 days",
  "reference": "http://www.tmhp.com/RadiologyClinicalDecisionSupport/2011/CHEST%20IMAGING%20GUIDELINES%202011.pdf"
}
Example #3
Input CSV
DetectedIssue,3,"ddi","final","http://terminology.hl7.org/CodeSystem/v3-ActCode",,"DRG","Drug Interaction Alert",,,"high",,,,,,,,,,,,,,,"2014-01-05",,,"Device/software",,,,,,,,,,,,,,"Risk of internal bleeding.  Those who take acetaminophen along with the widely used blood-thinning drug warfarin may face the risk of serious internal bleeding. People on warfarin who take acetaminophen for at least seven days in a row should be closely watched for bleeding.",
implicated,"MedicationStatement/example001",,,,,,,,,,,,,"500 mg Acetaminophen tablet 1/day, PRN since 2010"
implicated,"MedicationRequest/medrx0331",,,,,,,,,,,,,"Warfarin 1 MG TAB prescribed Jan. 15, 2015"
mitigation,"http://terminology.hl7.org/CodeSystem/v3-ActCode",,"13","Stopped Concurrent Therapy",,"Asked patient to discontinue regular use of Tylenol and to consult with clinician if they need to resume to allow appropriate INR monitoring","2014-01-05","Practitioner/example",,,,,,,,,,,,,"Dr. Adam Careful"
Resulting resource
{
  "resourceType": "DetectedIssue",
  "id": "ddi",
  "status": "final",
  "code": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "DRG",
        "display": "Drug Interaction Alert"
      }
    ]
  },
  "severity": "high",
  "identifiedDateTime": "2014-01-05",
  "author": {
    "reference": "Device/software"
  },
  "implicated": [
    {
      "reference": "MedicationStatement/example001",
      "display": "500 mg Acetaminophen tablet 1/day, PRN since 2010"
    },
    {
      "reference": "MedicationRequest/medrx0331",
      "display": "Warfarin 1 MG TAB prescribed Jan. 15, 2015"
    }
  ],
  "detail": "Risk of internal bleeding.  Those who take acetaminophen along with the widely used blood-thinning drug warfarin may face the risk of serious internal bleeding. People on warfarin who take acetaminophen for at least seven days in a row should be closely watched for bleeding.",
  "mitigation": [
    {
      "action": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code": "13",
            "display": "Stopped Concurrent Therapy"
          }
        ],
        "text": "Asked patient to discontinue regular use of Tylenol and to consult with clinician if they need to resume to allow appropriate INR monitoring"
      },
      "date": "2014-01-05",
      "author": {
        "reference": "Practitioner/example",
        "display": "Dr. Adam Careful"
      }
    }
  ]
}
Example #4
Input CSV
DetectedIssue,0,"lab","final",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Resulting resource
{
  "resourceType": "DetectedIssue",
  "id": "lab",
  "status": "final"
}