{ "resourceType": "StructureDefinition", "id": "action-on-abnormal", "url": "https://fhir.apps.health/StructureDefinition/action-on-abnormal", "name": "ServiceRequestActionOnAbnormal", "title": "Action on Abnormal Extension", "status": "draft", "description": "Records that the requester wants this order brought back to them if what it produces is abnormal.\n\n**An instruction recorded on the order, not a finding about a result.** It is set when the order is\nplaced and applies to whatever the order eventually yields. Nothing about a value of `true` says any\nresult was abnormal, and a consumer must not read it as an abnormality marker -- `Observation`\ninterpretation codes are where that question is answered.\n\n**Whether the instruction fires is decided elsewhere**, by a periodic review of what the order\nproduced. This element is the preference alone: it changes nothing by itself, and a consumer must\nnot infer from its presence that any review has run, that any result was abnormal, or that anyone\nwas notified. Where such a review does act, it does so by adding to the order's own `note` and to\nthe tasks filed against the order, not by writing back here.\n\n**Absent and `false` mean the same thing.** A writer creates the extension only when switching the\ninstruction on and thereafter sets the value in place, so `false` occurs on orders where it was once\non. Read either as \"not requested\".\n\n**At most one per order.** A reader encountering more than one should take the first.\n\n**Nothing acts on this instruction today.** The review that would surface an abnormal result reads a\ncompanion marker alongside this flag, and no writer produces that marker, so an order carrying\n`true` records the preference and goes no further; that is tracked as FHIR-387. Treat the value as\nthe requester's stated preference alone, and never as evidence that a review ran or that a result\nwas abnormal.\n\n**Nexus EMR writes this today at\n`http://services.well.com/fhir/ServiceRequest/action-on-abnormal` (FHIR-371)**: it is live in\nstored `ServiceRequest.extension` values and in code, and is under migration to the canonical\ndeclared here. Write the canonical; expect both until the migration completes, and match both\naddresses exactly -- the pre-migration address carries a `ServiceRequest` path segment the canonical\ndoes not, so a rule built on the whole address rather than its last segment will not reach it.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "ServiceRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "snapshot": { "element": [ { "id": "Extension", "path": "Extension", "short": "Action on Abnormal Extension", "definition": "Records that the requester wants this order brought back to them if what it produces is abnormal.\n\n**An instruction recorded on the order, not a finding about a result.** It is set when the order is\nplaced and applies to whatever the order eventually yields. Nothing about a value of `true` says any\nresult was abnormal, and a consumer must not read it as an abnormality marker -- `Observation`\ninterpretation codes are where that question is answered.\n\n**Whether the instruction fires is decided elsewhere**, by a periodic review of what the order\nproduced. This element is the preference alone: it changes nothing by itself, and a consumer must\nnot infer from its presence that any review has run, that any result was abnormal, or that anyone\nwas notified. Where such a review does act, it does so by adding to the order's own `note` and to\nthe tasks filed against the order, not by writing back here.\n\n**Absent and `false` mean the same thing.** A writer creates the extension only when switching the\ninstruction on and thereafter sets the value in place, so `false` occurs on orders where it was once\non. Read either as \"not requested\".\n\n**At most one per order.** A reader encountering more than one should take the first.\n\n**Nothing acts on this instruction today.** The review that would surface an abnormal result reads a\ncompanion marker alongside this flag, and no writer produces that marker, so an order carrying\n`true` records the preference and goes no further; that is tracked as FHIR-387. Treat the value as\nthe requester's stated preference alone, and never as evidence that a review ran or that a result\nwas abnormal.\n\n**Nexus EMR writes this today at\n`http://services.well.com/fhir/ServiceRequest/action-on-abnormal` (FHIR-371)**: it is live in\nstored `ServiceRequest.extension` values and in code, and is under migration to the canonical\ndeclared here. Write the canonical; expect both until the migration completes, and match both\naddresses exactly -- the pre-migration address carries a `ServiceRequest` path segment the canonical\ndoes not, so a rule built on the whole address rather than its last segment will not reach it.", "min": 0, "max": "*", "base": { "path": "Extension", "min": 0, "max": "*" }, "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" } ], "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Extension.id", "path": "Extension.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Extension.extension", "path": "Extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "0", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Extension.url", "path": "Extension.url", "representation": [ "xmlAttr" ], "short": "identifies the meaning of the extension", "definition": "Source of the definition for the extension code - a logical name or a URL.", "comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.", "min": 1, "max": "1", "base": { "path": "Extension.url", "min": 1, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "uri" } ] } ], "fixedUri": "https://fhir.apps.health/StructureDefinition/action-on-abnormal", "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "short": "True when the requester asked to be brought an abnormal result", "definition": "`true` when the requester asked for this order to be surfaced to them if what it produces is abnormal. `false` means not requested and carries nothing an absent extension does not; it exists so the instruction can be switched off in place.", "min": 1, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] } ] }, "differential": { "element": [ { "id": "Extension", "path": "Extension", "short": "Action on Abnormal Extension", "definition": "Records that the requester wants this order brought back to them if what it produces is abnormal.\n\n**An instruction recorded on the order, not a finding about a result.** It is set when the order is\nplaced and applies to whatever the order eventually yields. Nothing about a value of `true` says any\nresult was abnormal, and a consumer must not read it as an abnormality marker -- `Observation`\ninterpretation codes are where that question is answered.\n\n**Whether the instruction fires is decided elsewhere**, by a periodic review of what the order\nproduced. This element is the preference alone: it changes nothing by itself, and a consumer must\nnot infer from its presence that any review has run, that any result was abnormal, or that anyone\nwas notified. Where such a review does act, it does so by adding to the order's own `note` and to\nthe tasks filed against the order, not by writing back here.\n\n**Absent and `false` mean the same thing.** A writer creates the extension only when switching the\ninstruction on and thereafter sets the value in place, so `false` occurs on orders where it was once\non. Read either as \"not requested\".\n\n**At most one per order.** A reader encountering more than one should take the first.\n\n**Nothing acts on this instruction today.** The review that would surface an abnormal result reads a\ncompanion marker alongside this flag, and no writer produces that marker, so an order carrying\n`true` records the preference and goes no further; that is tracked as FHIR-387. Treat the value as\nthe requester's stated preference alone, and never as evidence that a review ran or that a result\nwas abnormal.\n\n**Nexus EMR writes this today at\n`http://services.well.com/fhir/ServiceRequest/action-on-abnormal` (FHIR-371)**: it is live in\nstored `ServiceRequest.extension` values and in code, and is under migration to the canonical\ndeclared here. Write the canonical; expect both until the migration completes, and match both\naddresses exactly -- the pre-migration address carries a `ServiceRequest` path segment the canonical\ndoes not, so a rule built on the whole address rather than its last segment will not reach it." }, { "id": "Extension.extension", "path": "Extension.extension", "max": "0" }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "https://fhir.apps.health/StructureDefinition/action-on-abnormal" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "short": "True when the requester asked to be brought an abnormal result", "definition": "`true` when the requester asked for this order to be surfaced to them if what it produces is abnormal. `false` means not requested and carries nothing an absent extension does not; it exists so the instruction can be switched off in place.", "min": 1, "type": [ { "code": "boolean" } ], "mustSupport": true } ] } }