DetectedIssue Profile

Canonical	../StructureDefinition/nexus-emr-core-detectedissue
Status	draft (experimental) · 1.26.0
Base	DetectedIssue (constraint)
Source	FSH · JSON

Nexus EMR profile for DetectedIssue -- drug-drug and drug-allergy interaction findings raised during prescribing, and the prescriber's recorded override of them. First pass: models the override audit trail; the severity mapping is not yet settled.

Examples

Warfarin/NSAID Interaction with Prescriber Override

Drug-drug interaction detected during prescribing for Avery Linwood, overridden by Dr. Navarro with recorded rationale. Demonstrates the medico-legal override trail -- status stays final and the presence of the mitigation is what marks the issue accepted

DetectedIssue/di-avery-warfarin-nsaid-override — claims conformance to DetectedIssue Profile

{
  "resourceType": "DetectedIssue",
  "id": "di-avery-warfarin-nsaid-override",
  "meta": {
    "profile": [
      "../StructureDefinition/nexus-emr-core-detectedissue"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns='http://www.w3.org/1999/xhtml'><p>Drug-drug interaction detected for Avery Linwood: warfarin and naproxen, increased bleeding risk. Dr. Emil Navarro overrode the warning and proceeded, recording the rationale: short course, INR being monitored weekly, patient counselled on bleeding signs.</p><p>Note the shape: the issue remains status=final after the override. The presence of the mitigation is what marks it accepted -- the status does NOT change.</p></div>"
  },
  "identifier": [
    {
      "use": "secondary",
      "system": "../NamingSystem/cedarbrook-clinic-detectedissue-raw-code",
      "value": "SCREEN-DDI-88412"
    }
  ],
  "status": "final",
  "code": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "DRG",
        "display": "Drug Interaction Alert"
      }
    ],
    "text": "Drug-drug interaction: warfarin + naproxen (increased bleeding risk)"
  },
  "severity": "high",
  "patient": {
    "reference": "Patient/avery-linwood",
    "display": "Avery Linwood"
  },
  "identifiedDateTime": "2025-04-08T09:22:00-06:00",
  "implicated": [
    {
      "reference": "MedicationRequest/rx-avery-warfarin",
      "display": "Warfarin 5mg daily (existing)"
    },
    {
      "reference": "MedicationRequest/rx-avery-naproxen",
      "display": "Naproxen 500mg BID (proposed)"
    }
  ],
  "detail": "Concurrent warfarin and non-selective NSAID therapy increases the risk of gastrointestinal and other bleeding through additive antiplatelet effect and direct mucosal injury.",
  "mitigation": [
    {
      "action": {
        "text": "Proceeding despite interaction: 5-day course only, INR monitoring weekly, patient counselled on bleeding signs and advised to take with food. Acetaminophen trialled first without adequate effect."
      },
      "date": "2025-04-08T09:24:00-06:00",
      "author": {
        "reference": "Practitioner/dr-emil-navarro",
        "display": "Dr. Emil Navarro"
      }
    }
  ]
}

Referenced by: AI-Drafted Note Accepted by a Clinician