DetectedIssue

This guidance applies to inbound RxRenewalRequest and RxChangeRequest messages processed by the ePrescription module.

In the ideal scenario, the resources sent by the pharmacy and those already stored in the existing Aidbox instance should match. In practice, discrepancies may occur, and in such cases a DetectedIssue will be created and there will be a link to it: MedicationRequest.detectedIssue. This resource is intended to illustrate inconsistencies for the EHR platform using the ePrescription Module, and it does not impose any further constraints.

Below is the list of checks leading to DetectedIssue creation.

Medication:

• NDC. Existing Medication.code.coding with system = http://hl7.org/fhir/sid/ndc should equal incoming NDC code.

Pharmacy (Organization):

• name (verbatim)
• identifiers (incoming ones should be present in the existing pharmacy identifier)
• address
• telecom

Provider location (represented as Location or Organization):

• address
• telecom

Practitioner:

• identifiers (incoming ones should be present in the existing practitioner)
• names (family and given only)

PractitionerRole:

• SPI (identifier with system = urn:surescripts:spi)
• specialty (specialty.coding with system = http://nucc.org/provider-taxonomy)
• mismatches in related Practitioner or Location

Patient:

• names
• gender
• birth date
• identifiers
• address
• any telecom channel (phone, fax, pager, email)

Example DetectedIssue (all resources mismatched):

{
  "resourceType": "DetectedIssue",
  "id": "4b2dd7a6-41f6-4b4c-a3b6-d8e9c1a8c765",
  "status": "registered",
  "contained": [
    {
      "resourceType": "Medication",
      "id": "3c6cbd71-02a8-4337-98b5-2c1f4a87e603",
      "code": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/ndc",
            "code": "0074-4339-22",
            "display": "Amoxicillin 500 mg capsule"
          }
        ],
        "text": "Amoxicillin 500 mg oral capsule"
      }
    },
    {
      "resourceType": "Organization",
      "id": "6fb84e57-8a26-4b31-89a3-2f5859011a0c",
      "name": "Walgreens Pharmacy #4567",
      "identifier": [
        {
          "system": "urn:oid:1.2.840.114350",
          "value": "RX-4567"
        }
      ],
      "address": [
        {
          "line": ["1501 5th Ave"],
          "city": "Seattle",
          "state": "WA",
          "postalCode": "98101"
        }
      ],
      "telecom": [
        {
          "system": "phone",
          "value": "206-555-4120"
        },
        {
          "system": "fax",
          "value": "206-555-4121"
        }
      ]
    },
    {
      "resourceType": "Location",
      "id": "a3f2b1d0-9c4c-4f69-9af8-3a7f4a1a8b29",
      "name": "Northgate Medical Center Suite 210",
      "address": {
        "line": ["401 NE Northgate Way", "Suite 210"],
        "city": "Seattle",
        "state": "WA",
        "postalCode": "98125"
      },
      "telecom": [
        {
          "system": "phone",
          "value": "206-555-2180"
        }
      ]
    },
    {
      "resourceType": "Practitioner",
      "id": "dbe0b7d4-92da-44c0-8a65-1f50f9d3e8ad",
      "name": [
        {
          "family": "Nguyen",
          "given": ["John", "T"],
          "prefix": ["Dr."]
        }
      ],
      "identifier": [
        {
          "system": "http://hl7.org/fhir/sid/us-npi",
          "value": "1780654390"
        }
      ]
    },
    {
      "resourceType": "PractitionerRole",
      "id": "f14e6f2b-261d-4bda-9387-44ec84ec4c72",
      "identifier": [
        {
          "system": "urn:surescripts:spi",
          "value": "SPI-662331"
        }
      ],
      "specialty": [
        {
          "coding": [
            {
              "system": "http://nucc.org/provider-taxonomy",
              "code": "207Q00000X",
              "display": "Family Medicine"
            }
          ],
          "text": "Family Medicine"
        }
      ]
    },
    {
      "resourceType": "Patient",
      "id": "9a1d6cf5-5ccf-49a7-9f8e-7a06d9d183b2",
      "identifier": [
        {
          "system": "http://hospital.example.org/mrn",
          "value": "MRN-204859"
        }
      ],
      "name": [
        {
          "family": "Garcia",
          "given": ["Maria", "Elena"]
        }
      ],
      "gender": "female",
      "birthDate": "1985-03-10",
      "address": [
        {
          "line": ["7820 Greenwood Ave N"],
          "city": "Seattle",
          "state": "WA",
          "postalCode": "98103"
        }
      ],
      "telecom": [
        {
          "system": "phone",
          "value": "206-555-9034"
        },
        {
          "system": "email",
          "value": "maria.garcia@example.com"
        }
      ]
    }
  ],
  "implicated": [
    { "reference": "#3c6cbd71-02a8-4337-98b5-2c1f4a87e603" },
    { "reference": "Medication/8f3b4c55-0d69-4b40-b7a7-5ad0c2e51d28" },
    { "reference": "#6fb84e57-8a26-4b31-89a3-2f5859011a0c" },
    { "reference": "Organization/1de45c01-9d0a-4b7f-a24c-94fa2b0b9f67" },
    { "reference": "#a3f2b1d0-9c4c-4f69-9af8-3a7f4a1a8b29" },
    { "reference": "Location/7311c57a-78ac-472f-9c6c-219c2f478255" },
    { "reference": "#dbe0b7d4-92da-44c0-8a65-1f50f9d3e8ad" },
    { "reference": "Practitioner/d0f8d2ac-1fb9-4c4c-8e82-3fb16d0a15e4" },
    { "reference": "#f14e6f2b-261d-4bda-9387-44ec84ec4c72" },
    { "reference": "PractitionerRole/2b4d7f45-5d13-4778-94df-8123f254ba2e" },
    { "reference": "#9a1d6cf5-5ccf-49a7-9f8e-7a06d9d183b2" },
    { "reference": "Patient/b6ddf4ce-e9c4-4ae3-9d31-1b3d2f8af9ae" }
  ]
}