An alert describes a clinical or administrative fact brought to the attention of the users of the clinical systems to be taken into account when shaping diagnostic and therapeutic policy or in dealing with the patient, usually because of a safety risk.
This zib is not intended to specify hypersensitivities or intolerances for a specific substance or group of substances. Monitoring for this can be represented on the basis of the zib SurveillanceDecision.
Examples of warnings:
A disorder, condition or diagnosis which can be considered as a contraindication for undergoing a certain type of therapy, such as pregnancy or long QT syndrome;
Impaired functioning of an organ system (heart failure, impaired liver or kidney function, weakened immune system);
Risk of spreading certain microorganisms (multi-resistant bacteria, tubercle bacilli, HIV, HBV, Ebola virus);
Other risks.
Purpose
Documenting and entering disorders or conditions that require attention is an important part of medical registration. It concerns the core of patient safety. In the execution of research and treatment, these patient characteristics - which are marked as a warning - constantly have to be taken into account. They provide information that is important for the patient’s condition and the options a healthcare provider has for therapy. Patient characteristics that are registered or transferred as an Alert can also be described as a Diagnosis or HypersensitivityIntolerance. The difference is in the fact that the healthcare provider considers the diagnoses, hypersensitivity or intolerance as an Alert = warning. In many cases, transfer will be subject to strict privacy rules, as the warning will not always elicit an adequate reaction in the informed environment.
Medication monitoring based on potential medication contraindications is based on non-patient-specific pharmacological characteristics of medicines. The zib Alert is not intended for medication monitoring based on specific substances to which one patient may react adversely while another does not. For this form of medication monitoring, the zib SurveillanceDecision is intended.
Evidence Base
The zib Alert covers a wide range of patient characteristics based on which the health professional wants to receive unconditional or conditional warnings. This concerns warnings regarding certain infections that require specific (isolation) measures, situations that may be a contraindication for certain treatments or examinations (such as a pacemaker for MRI examinations) or characteristics that may be a contraindication for certain medicines. This latter category 'possible contraindication for medicine' can concern a disorder or condition, but also behavior (such as being a top athlete) or desire to have children.
The MedicationContraindicationNameCodelist contains values from the G-standard Contraindications (Thesaurus 40), for medication surveillance.
Information Model
Type
Id
Concept
Card.
Definition
DefinitionCode
Reference
NL-CM:8.3.1
Alert
Root concept of the Alert information model. This root concept contains all data elements of the Alert information model.
The date and time at which the described condition was entered as a warning.
This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).
NL-CM:8.3.8
EndDateTime
0..1
The date and time at which the described condition was retracted as a warning.
This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).
NL-CM:8.3.10
Diagnosis
(0..1)
A warning about a particular diagnosis, because it may pose a risk to the patient with certain treatments. For example, 'Pacemaker' can be included as an alert.
A warning for a specific hypersensitivity or intolerance, because this can pose a risk to the patient with certain treatments. For example, an alert can be given such as 'Hypersensitivity to UV light'.
A warning, other than a condition or problem. For example, a patient can be given an ‘Aggressive patient' alert.
The warning can be entered in code (there are codes for frequently used alerts), but seeing the dynamic nature of the warnings cf. SARS and Ebola, these alerts will often be entered as free text.
Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page
Example Instances
Only available in Dutch
Alert
AlertNaam
Zwangerschap
AlertType
Conditie
BeginDatumTijd
15-11-2022
EindDatumTijd
10-08-2023
RedenBeëindigingAlert
Einde zwangerschap
Vaststeller::Zorgverlener
Naam
R. van der Laan - Bakker
Specialisme
Verloskundige
Alert
AlertNaam
Drager MRSA
AlertType
Waarschuwing
BeginDatumTijd
12-01-2024
Vaststeller::Zorgverlener
Naam
G. de Zeeuw
Specialisme
Microbioloog
Alert
AlertNaam
Topsportbeoefening
AlertType
Mogelijke medicatie contra-indicatie
BeginDatumTijd
18-10-2020
Vaststeller::Zorgverlener
Naam
L. Peeters
Specialisme
Sportgeneeskunde
Instructions
The Alerts of the type “possible contraindication for medication” are intended to be used (alongside SurveillanceDecision), to determine whether a warning is necessary.
Technical specifications in HL7v3 CDA and HL7 FHIR
To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:
HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR
Alert
StartDateTime
or as spreadsheet 