Add Flag resource element to indicate responsible Practitioner?

We would like to use FHIR to notify providers about gaps in care for particular patients. For example, a gap in care could be a failure to administer a flu vaccine to an elderly patient or lack of a foot exam in the past year for a diabetic patient. If I understand correctly those should use the Flag resource. However I don’t see an obvious way to indicate which Practitioner is responsible for closing the gap.
Would it make sense to add a new Flag element named something like “responsible”? The Type would be something like Reference (Practitioner | Organization | Group).

Have you looked at DetectedIssue?

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Flag is more like a sticky-note on the front of a patient’s file. Agree that DetectedIssue sounds more appropriate for this scenario.

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I had looked at the DetectedIssue resource but it seemed inappropriate due to this statement.

This resource only applies to documenting a risk associated with a specific planned or ongoing action, not a general propensity to risk.

Gaps in care generally do indicate only general propensities to risk. For example, if a diabetic patient hasn’t had a recent foot exam (nothing specific planned or ongoing) that increases the risk of a future amputation but doesn’t guarantee a bad outcome.

Have I misinterpreted the definition? Or should we consider expanding the definition for DetectedIssue to explicitly cover gaps in care? I am approaching the issue from the perspective of a payer sending a message to a provider organization asking them to take better care of one of our members.

Is the advice in this thread no longer applicable?
Alert Resource replacement

It’s still applicable. Alert wasn’t intended to meet the use-case for DetectedIssue.

That language is intended to say that DetectedIssue isn’t intended to say something like “Drug A is contraindicated if a patient is on Drug B”, but rather “Drug A which is currently being prescribed is contraindicated with this patient’s existing Drug B medication”. I.e. It’s capturing patient-contextual and time-contextual risk manifestations, not generic knowledge statements about risks that can exist.

In your case, you’re dealing with a specific risk at a specific time to a specific patient related to ongoing action. You’re not trying to say “diabetic patients should have regular foot exams”, you’re trying to say “this patient is diabetic and has not had a recent foot exam”. The former would not be a candidate for DetectedIssue. The latter definitely is.

If you have recommendations about how we can make the description clearer, we would certainly welcome a change request (link at the bottom of any page in the spec).

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Thanks for the clarification. I created tracker #15820.