NexusHarnessClinicalIdentity Naming system

Status: draft · 1.26.0 · JSON

Identifies the clinical fact a machine-proposed chart resource asserts -- which problem, at which clinical status, for which patient -- so that approving the same proposal twice does not leave two copies of one problem on the problem list. It appears on Condition.identifier of a resource the clinical-extraction graph proposes for clinician approval, and as the conditional-create precondition on the transaction entry that creates it; because the proposal is carried inside the reviewing Task as a contained transaction Bundle, the precondition is evaluated at approval time against the chart as it then stands, which matters because a clinician may have entered the same problem by hand in the interval. This is deliberately NOT NamingSystem/nexus-harness-key, whose contract is that a producer searches its key and updates the resource it finds, and whose resources are ones the harness writes on its own behalf: an approved Condition is the patient's problem-list entry from the moment it is accepted, is edited by clinicians, and outlives the run and the graph that proposed it, so its identity must not be owned by a producer; and the operation here is a create precondition, where a match means do not write rather than write over what a clinician entered. Values are OPAQUE and MUST NOT be parsed. One property of the shape is stated because a consumer would otherwise assume its opposite: the value is derived from the subject, the code, the clinical status and the body site, so it is stable across re-extraction of the same problem from the same chart but NOT across that problem's own lifecycle -- the same problem at a different clinical status computes a different value. It is a create-time convergence key, never a durable handle on a chart record. Onset is deliberately excluded, because two extractions of one problem routinely disagree about when it began. Only Condition carries this identifier today; proposed AllergyIntolerance and MedicationRequest resources are created without a precondition, so its absence on a proposed resource means the type is not yet covered and never that the proposal is unidentified. MIGRATION: Nexus EMR writes this system today at ../nexus-harness/clinical-identity, which is this guide's own base with no artifact-type segment and is not an address this specification publishes; it is live in code and in the identifier.system values already stored, and is under migration to the URI declared here. Write the URI declared here; expect both until the migration completes.

Type	Value	Preferred
uri	../NamingSystem/nexus-harness-clinical-identity	true
uri	../nexus-harness/clinical-identity	false