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"
}