Example
CodeSystem/reaction-event-severity
(Turtle)
Prospective
warnings
of
potential
issues
when
providing
care
to
the
patient.
8.13.1
Scope
and
Usage
A
flag
is
a
warning
or
notification
of
some
sort
presented
to
the
user
-
who
may
be
a
clinician
or
some
other
person
involve
in
patient
care.
It
usually
represents
something
of
sufficient
significance
to
be
warrant
a
special
display
of
some
sort
-
rather
than
just
a
note
in
the
resource.
A
flag
has
a
subject
representing
the
resource
that
will
trigger
its
display.
This
subject
can
be
of
different
types,
as
described
in
the
examples
below:
A
note
that
a
patient
has
an
overdue
account,
which
the
provider
may
wish
to
discuss
with
them
-
in
case
of
hardship
for
example
(subject
=
Patient)
An
outbreak
of
Ebola
in
a
particular
region
(subject=Location)
so
that
all
patients
from
that
region
have
a
higher
risk
of
having
that
condition
A
particular
provider
is
unavailable
for
referrals
over
a
given
period
(subject
=
Practitioner)
A
patient
who
is
enrolled
in
a
clinical
trial
(subject=Group)
Special
guidance
or
caveats
to
be
aware
of
when
following
a
protocol
(subject=PlanDefinition)
Warnings
about
using
a
drug
in
a
formulary
requires
special
approval
(subject=Medication)
etc.
A
flag
is
typically
presented
as
a
label
in
a
prominent
location
in
the
record
to
notify
the
clinician
of
the
potential
issues,
though
it
may
also
appear
in
other
contexts;
e.g.
notes
applicable
to
a
radiology
technician,
or
to
a
clinician
performing
a
home
visit.
For
patients,
the
information
in
the
flag
will
often
be
derived
from
the
record,
and
therefore,
for
a
thorough
and
careful
clinician,
who
has
the
time
to
review
the
notes
will
be
redundant.
However,
given
the
volume
of
information
frequently
found
in
patients'
records
and
the
potentially
serious
consequences
of
losing
sight
of
some
facts,
this
redundancy
is
deemed
appropriate.
As
well,
some
flags
may
reflect
information
not
captured
by
any
other
resource
in
the
record.
(E.g.
"Patient
has
large
dog
at
home")
In
line
with
its
purpose,
a
flag
is
concise,
highlighting
a
small
set
of
high-priority
issues
among
the
much
larger
set
of
data
in
the
chart.
Readers
who
want
more
detail
should
consult
the
chart
or
other
source
of
information.
Caution
should
be
exercised
in
creating
Flag
instances.
If
entries
are
created
for
information
that
could
be
gleaned
in
a
sufficiently
timely
fashion
by
reviewing
the
patient
record,
the
flag
list
will
itself
become
overwhelming
and
will
cease
to
serve
its
intended
purpose.
Flags
are
expected
to
persist
in
a
record
for
some
period
of
time
and
are,
at
most,
targeted
to
particular
types
of
practitioners
or
to
practitioners
in
particular
system.
Examples
of
Patient
related
issues
that
might
appear
in
flags:
Risks
to
the
patient
(functional
risk
of
falls,
spousal
restraining
order,
latex
allergy)
Patient's
needs
for
special
accommodations
(hard
of
hearing,
need
for
easy-open
caps)
Risks
to
providers
(dog
in
house,
patient
may
bite,
infection
control
precautions)
Administrative
concerns
(incomplete
information,
pre-payment
required
due
to
credit
risk)
Examples
of
issues
that
should
not
appear
only
in
flags:
Potential
allergy
or
drug
interaction
to
planned
therapy
(use
DetectedIssue
)
Known
adverse
reaction
to
a
substance
(use
AllergyIntolerance
)
Note
that
we
include
"latex
allergy"
in
the
"in
scope"
list,
and
"allergy"
in
the
"not
in
scope"
list.
The
Flag
resource
is
not
designed
to
replace
the
normal
order
checking
process,
and
one
should
not
expect
to
see
all
allergies
in
Flags.
However,
if
there
is
an
activity
that
might
occur
prior
to
careful
evaluation
of
the
record
(e.g.
donning
of
latex
gloves)
and
that
activity
might
pose
a
risk
to
the
patient,
that
is
the
sort
of
eventuality
the
Flag
is
intended
to
support.
Specific
guidelines
about
what
type
of
information
is
appropriate
to
expose
using
Flag,
as
well
as
what
categories
of
individuals
should
see
particular
flags,
will
vary
by
interoperability
community.
8.13.2
Boundaries
and
Relationships
Flags
may
highlight
a
highly
condensed
view
of
information
found
in
the
AllergyIntolerance
,
Condition
,
Observation
,
Procedure
and
possibly
other
resources.
A
common
extension
allows
the
linkage
of
a
Flag
to
the
supporting
detail
resource.
The
purpose
of
these
other
resources
is
to
provide
detailed
clinical
information.
The
purpose
of
a
Flag
is
to
alert
practitioners
to
information
that
is
important
to
influence
their
interaction
with
a
Patient
prior
to
detailed
review
of
the
record.
Flags
are
not
used
to
convey
information
to
a
specific
individual
or
organization
(e.g.
an
abnormal
lab
result
reported
to
the
ordering
clinician,
reporting
of
an
adverse
reaction
to
a
regulatory
authority).
These
are
handled
using
the
CommunicationRequest
and
the
Communication
resources.
Flags
are
not
raised
as
a
result
of
a
reported
or
proposed
action
(e.g.
drug-drug
interactions,
duplicate
therapy
warnings).
These
would
be
handled
using
DetectedIssue
.
8.13.3
Resource
Content
Structure
Name
Flags
Card.
Type
Description
&
Constraints
Flag
DomainResource
Key
information
to
flag
to
healthcare
providers
Elements
defined
in
Ancestors:
id
,
meta
,
implicitRules
,
language
,
text
,
contained
,
extension
,
modifierExtension
identifier
Σ
0..*
Identifier
Business
identifier
status
?!
Σ
1..1
code
active
|
inactive
|
entered-in-error
FlagStatus
(
Required
)
category
Σ
0..1
CodeableConcept
Clinical,
administrative,
etc.
Flag
Category
(
Example
)
code
Σ
1..1
CodeableConcept
Coded
or
textual
message
to
display
to
user
Flag
Code
(
Example
)
subject
Σ
1..1
Reference
(
Patient
|
Location
|
Group
|
Organization
|
Practitioner
|
PlanDefinition
|
Medication
|
Procedure
)
Who/What
is
flag
about?
period
Σ
0..1
Period
Time
period
when
flag
is
active
encounter
Σ
0..1
Reference
(
Encounter
)
Alert
relevant
during
encounter
author
Σ
0..1
Reference
(
Device
|
Organization
|
Patient
|
Practitioner
)
Flag
creator
Documentation
for
this
format
Raw
Turtle
UML
Diagram
(
Legend
(+
also
see
Turtle/RDF
Format
Specification
)
Flag
(
DomainResource
)
Identifier
assigned
to
the
flag
for
external
use
(outside
the
FHIR
environment)
identifier
:
Identifier
[0..*]
Supports
basic
workflow
(this
element
modifies
the
meaning
of
other
elements)
status
:
code
[1..1]
Indicates
whether
this
flag
is
active
and
needs
to
be
displayed
to
a
user,
or
whether
it
is
no
longer
needed
or
entered
in
error.
(Strength=Required)
FlagStatus
!
Allows
an
flag
to
be
divided
into
different
categories
like
clinical,
administrative
etc.
Intended
to
be
used
as
a
means
of
filtering
which
flags
are
displayed
to
particular
user
or
in
a
given
context
category
:
CodeableConcept
[0..1]
A
general
category
for
flags
Definition
for
filtering/display
purposes.
(Strength=Example)
Flag
Category
??
The
coded
value
or
textual
component
of
the
flag
to
display
to
the
user
code
:
CodeableConcept
[1..1]
Detail
codes
identifying
specific
flagged
issues.
(Strength=Example)
Flag
Code
??
The
patient,
location,
group
,
organization
,
or
practitioner,
etc.
this
is
about
record
this
flag
is
associated
with
subject
:
Reference
[1..1]
Patient
|
Location
|
Group
|
Organization
|
Practitioner
|
PlanDefinition
|
Medication
|
Procedure
The
period
of
time
from
the
activation
of
the
flag
to
inactivation
of
the
flag.
If
the
flag
is
active,
the
end
of
the
period
should
be
unspecified
period
:
Period
[0..1]
This
alert
is
only
relevant
during
the
encounter
encounter
:
Reference
[0..1]
Encounter
The
person,
organization
or
device
that
created
the
flag
author
:
Reference
[0..1]
Device
|
Organization
|
Patient
|
Practitioner
XML
Template
<
<!-- from -->
<!-- from -->
<</identifier>
<
<</category>
<</code>
<|
</subject>
<</period>
<</encounter>
<</author>
</Flag>
JSON
Template
{
"resourceType" : "",
// from
// from
"
"
"
"
"|
"
"
"
}
Turtle
Template
SystemAllergyIntoleranceSeverity
@prefix fhir: <http://hl7.org/fhir/> .
@prefix fhir: <http://hl7.org/fhir/> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
[ a fhir:;
fhir:nodeRole fhir:treeRoot; # if this is the parser root
# - resource -------------------------------------------------------------------
# from
# from
fhir:
fhir:
fhir:
fhir:
fhir:|
fhir:
fhir:
fhir:
]
Changes
since
DSTU2
Flag
Flag.subject
Add
Reference(PlanDefinition),
Add
Reference(Medication),
Add
Reference(Procedure)
See
the
Full
Difference
for
further
information
This
analysis
is
available
as
XML
or
JSON
.
See
R2
<-->
R3
Conversion
Maps
(status
=
3
tests
that
all
execute
ok.
All
tests
pass
round-trip
testing
and
all
r3
resources
are
valid.).
Structure
Name
Flags
Card.
Type
Description
&
Constraints
Flag
DomainResource
Key
information
to
flag
to
healthcare
providers
Elements
defined
in
Ancestors:
id
,
meta
,
implicitRules
,
language
,
text
,
contained
,
extension
,
modifierExtension
identifier
Σ
0..*
Identifier
Business
identifier
status
?!
Σ
1..1
code
active
|
inactive
|
entered-in-error
FlagStatus
(
Required
)
category
Σ
0..1
CodeableConcept
Clinical,
administrative,
etc.
Flag
Category
(
Example
)
code
Σ
1..1
CodeableConcept
Coded
or
textual
message
to
display
to
user
Flag
Code
(
Example
)
subject
Σ
1..1
Reference
(
Patient
|
Location
|
Group
|
Organization
|
Practitioner
|
PlanDefinition
|
Medication
|
Procedure
)
Who/What
is
flag
about?
period
Σ
0..1
Period
Time
period
when
flag
is
active
encounter
Σ
0..1
Reference
(
Encounter
)
Alert
relevant
during
encounter
author
Σ
0..1
Reference
(
Device
|
Organization
|
Patient
|
Practitioner
)
Flag
creator
Documentation
for
this
format
UML
Diagram
(
Legend
)
Flag
(
DomainResource
)
Identifier
assigned
to
the
flag
for
external
use
(outside
the
FHIR
environment)
identifier
:
Identifier
[0..*]
Supports
basic
workflow
(this
element
modifies
the
meaning
of
other
elements)
status
:
code
[1..1]
Indicates
whether
this
flag
is
active
and
needs
to
be
displayed
to
a
user,
or
whether
it
is
no
longer
needed
or
entered
in
error.
(Strength=Required)
FlagStatus
!
Allows
an
flag
to
be
divided
into
different
categories
like
clinical,
administrative
etc.
Intended
to
be
used
as
a
means
of
filtering
which
flags
are
displayed
to
particular
user
or
in
a
given
context
category
:
CodeableConcept
[0..1]
A
general
category
for
flags
for
filtering/display
purposes.
(Strength=Example)
Flag
Category
??
The
coded
value
or
textual
component
of
the
flag
to
display
to
the
user
code
:
CodeableConcept
[1..1]
Detail
codes
identifying
specific
flagged
issues.
(Strength=Example)
Flag
Code
??
The
patient,
location,
group
,
organization
,
or
practitioner,
etc.
this
is
about
record
this
flag
is
associated
with
subject
:
Reference
[1..1]
Patient
|
Location
|
Group
|
Organization
|
Practitioner
|
PlanDefinition
|
Medication
|
Procedure
The
period
of
time
from
the
activation
of
the
flag
to
inactivation
of
the
flag.
If
the
flag
is
active,
the
end
of
the
period
should
be
unspecified
period
:
Period
[0..1]
This
alert
is
only
relevant
during
the
encounter
encounter
:
Reference
[0..1]
Encounter
The
person,
organization
or
device
that
created
the
flag
author
:
Reference
[0..1]
Device
|
Organization
|
Patient
|
Practitioner
XML
Template
<
<!-- from -->
<!-- from -->
<</identifier>
<
<</category>
<</code>
<|
</subject>
<</period>
<</encounter>
<</author>
</Flag>
JSON
Template
{
"resourceType" : "",
// from
// from
"
"
"
"
"|
"
"
"
}
Turtle
Template
@prefix fhir: <http://hl7.org/fhir/> .
[] a fhir:CodeSystem ;
fhir:id [ fhir:v "reaction-event-severity"] ;
fhir:meta [
fhir:lastUpdated [ fhir:v "2023-03-01T23:03:57.298+11:00" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/shareablecodesystem" ] )
] ;
fhir:text [
fhir:status [ fhir:v "generated" ]
] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:value [ fhir:v "pc" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
fhir:value [ fhir:v "trial-use" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm" ] ;
fhir:value [ fhir:v "3" ]
] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/reaction-event-severity"], [ fhir:v "http://hl7.org/fhir/reaction-event-severity"] ;
fhir:identifier ( [
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.4.136" ]
] [
fhir:use [ fhir:v "old" ] ;
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.1.126" ]
] [
fhir:use [ fhir:v "old" ] ;
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.2.56" ]
] [
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.4.136" ]
] [
fhir:use [ fhir:v "old" ] ;
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.1.126" ]
] [
fhir:use [ fhir:v "old" ] ;
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.2.56" ]
] ) ;
fhir:version [ fhir:v "5.0.0-draft-final"], [ fhir:v "5.0.0-draft-final"] ;
fhir:name [ fhir:v "AllergyIntoleranceSeverity"], [ fhir:v "AllergyIntoleranceSeverity"] ;
fhir:title [ fhir:v "Allergy Intolerance Severity"], [ fhir:v "Allergy Intolerance Severity"] ;
fhir:status [ fhir:v "active"], [ fhir:v "active"] ;
fhir:experimental [ fhir:v "false"], [ fhir:v "false"] ;
fhir:date [ fhir:v "2021-01-05T10:01:24+11:00"], [ fhir:v "2021-01-05T10:01:24+11:00"] ;
fhir:publisher [ fhir:v "HL7 (FHIR Project)"], [ fhir:v "HL7 (FHIR Project)"] ;
fhir:contact ( [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hl7.org/fhir" ]
] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "fhir@lists.hl7.org" ]
] )
] [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hl7.org/fhir" ]
] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "fhir@lists.hl7.org" ]
] )
] ) ;
fhir:description [ fhir:v "Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations."], [ fhir:v "Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations."] ;
fhir:jurisdiction ( [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] ) ;
fhir:caseSensitive [ fhir:v "true"] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/reaction-event-severity"] ;
fhir:content [ fhir:v "complete"] ;
fhir:concept ( [
fhir:code [ fhir:v "mild" ] ;
fhir:display [ fhir:v "Mild" ] ;
fhir:definition [ fhir:v "Causes mild physiological effects." ]
] [
fhir:code [ fhir:v "moderate" ] ;
fhir:display [ fhir:v "Moderate" ] ;
fhir:definition [ fhir:v "Causes moderate physiological effects." ]
] [
fhir:code [ fhir:v "severe" ] ;
fhir:display [ fhir:v "Severe" ] ;
fhir:definition [ fhir:v "Causes severe physiological effects." ]
] ) .
# -------------------------------------------------------------------------------------
[ a fhir:;
fhir:nodeRole fhir:treeRoot; # if this is the parser root
# from
# from
fhir:
fhir:
fhir:
fhir:
fhir:|
fhir:
fhir:
fhir:
]
Changes
since
DSTU2
Flag
Flag.subject
Add
Reference(PlanDefinition),
Add
Reference(Medication),
Add
Reference(Procedure)
See
the
Full
Difference
for
further
information
This
analysis
is
available
as
XML
or
JSON
.
See
R2
<-->
R3
Conversion
Maps
(status
=
3
tests
Usage
note:
every
effort
has
been
made
to
ensure
that
all
execute
ok.
All
tests
pass
round-trip
testing
and
all
r3
resources
the
examples
are
valid.).
Alternate
definitions:
Master
Definition
(
XML
,
JSON
),
XML
Schema
/
Schematron
(for
)
+
JSON
Schema
,
ShEx
(for
Turtle
)
8.13.3.1
Terminology
Bindings
Path
Definition
Type
Reference
Flag.status
Indicates
whether
this
flag
is
active
correct
and
needs
to
be
displayed
to
useful,
but
they
are
not
a
user,
or
whether
it
is
no
longer
needed
or
entered
in
error.
Required
FlagStatus
Flag.category
A
general
category
for
flags
for
filtering/display
purposes.
Example
Flag
Category
Flag.code
Detail
codes
identifying
specific
flagged
issues.
Example
Flag
Code
8.13.4
Notes
The
Flag
resource
is
sometimes
used
as
"patient
notes"
and
MAY
be
used
to
warn
normative
part
of
issues
such
as:
Issues
that
impact
on
the
patient's
ability
to
receive/respond
to
care
the
care
provision
process
itself
(e.g.,
poor
language
comprehension,
low
compliance
expected)
Issues
that
impact
on
the
ability
to
provide
care
(e.g.,
patient
has
a
big
dog
at
home)
Financial
matters
(e.g.,
patient
is
a
bad
debtor)
8.13.5
Search
Parameters
Search
parameters
for
this
resource.
The
common
parameters
also
apply.
See
Searching
for
more
information
about
searching
in
REST,
messaging,
and
services.
specification.
Name
Type
Description
Expression
In
Common
author
reference
Flag
creator
Flag.author
(
Practitioner
,
Organization
,
Device
,
Patient
)
date
date
Time
period
when
flag
is
active
Flag.period
18
Resources
encounter
reference
Alert
relevant
during
encounter
Flag.encounter
(
Encounter
)
12
Resources
identifier
token
Business
identifier
Flag.identifier
patient
reference
The
identity
of
a
subject
to
list
flags
for
Flag.subject
(
Patient
)
31
Resources
subject
reference
The
identity
of
a
subject
to
list
flags
for
Flag.subject
(
Practitioner
,
Group
,
Organization
,
Medication
,
Patient
,
PlanDefinition
,
Procedure
,
Location
)
Terminology
.
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versions:
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