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 Communication Request and 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 detected issue. 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=Plan Definition)
– Warnings about using a drug in a formulary require special approval (subject=Medication)
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 sources 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.