Id2.16.840.1.113883.3.1937.99.61.30.10.53Effective Date2020‑04‑13 12:21:40
Statusdraft DraftVersion Label0.1
NamePCProblemObservationDisplay NameProblem Observation (harmonized)
Description
C-CDA
This template reflects a discrete observation about a patient's problem. Because it is a discrete observation, it will have a statusCode of "completed". The effectiveTime, also referred to as the “biologically relevant time” is the time at which the observation holds for the patient. For a provider seeing a patient in the clinic today, observing a history of heart attack that occurred five years ago, the effectiveTime is five years ago. The effectiveTime of the Problem Observation is the definitive indication of whether or not the underlying condition is resolved. If the problem is known to be resolved, then an effectiveTime/high would be present. If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK".

IPS
This template reflects a discrete observation about a patient's problem. Because it is a discrete observation, it will have a statusCode of "completed". The effectiveTime, also referred to as the “biologically relevant time” is the time at which the observation holds for the patient. For a provider seeing a patient in the clinic today, observing a history of heart attack that occurred five years ago, the effectiveTime is five years ago.
The effectiveTime of the Problem Observation is the definitive indication of whether or not the underlying condition is resolved. If the problem is known to be resolved, then an effectiveTime/high would be present. If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK".


Open Issues

  • No Known Condition: 
  • C-CDA : The negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. "MAY contain zero or one [0..1] @negationInd (CONF:1198-10139)"
  • IPS : explicit code <value code="no-known-problems" displayName="No known problems" codeSystem="2.16.840.1.113883.5.1150.1"/> (See example below)
ContextParent nodes of template element with id 2.16.840.1.113883.3.1937.99.61.30.10.53
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 0 transactions and 1 template, Uses 7 templates
Used by as NameVersion
2.16.840.1.113883.3.1937.99.61.30.10.55Containmentdraft Problem Concern Act (harmonized) (0.1)2020‑10‑08 11:21:56
Uses as NameVersion
2.16.840.1.113883.3.1937.99.61.30.10.56Containmentdraft Problem Status Observation (harmonized) (0.1)DYNAMIC
2.16.840.1.113883.10.20.22.4.31Containmentdraft Age Observation (2.1)2015‑08‑13
2.16.840.1.113883.10.20.22.4.113Containmentdraft Prognosis Observation (2.1)2015‑08‑13
2.16.840.1.113883.10.20.22.4.119Containmentdraft Author Participation (2.1)2015‑08‑13
2.16.840.1.113883.10.20.22.4.143Containmentdraft Priority Preference (2.1)2015‑08‑13
2.16.840.1.113883.10.22.4.19Containmentpending IPS Certainty Observation (STU1)DYNAMIC
2.16.840.1.113883.10.22.4.25Containmentpending IPS Severity Observation (STU1)DYNAMIC
RelationshipGeneralization: template 2.16.840.1.113883.10.20.22.4.4 Problem Observation (V3) (2015‑08‑01)
ref
ccda-

Generalization: template 2.16.840.1.113883.10.22.4.8 IPS Problem Entry (DYNAMIC)
ref
hl7ips-
Example
Active Problem (IPS)
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.8"/>  <id root="1.2.3.999" extension="__example only__"/>  <code code="75326-9" codeSystem="2.16.840.1.113883.6.1" displayName="Problem"/>  <text>
    <reference value="#problem-1"/>  </text>  <statusCode code="completed"/>  <effectiveTime>
    <low value="20100507"/>  </effectiveTime>  <value code="38341003" displayName="Hypertensive disorder, systemic arterial (disorder)" codeSystem="2.16.840.1.113883.6.96"/>  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <!-- template 2.16.840.1.113883.10.22.4.25 'IPS Severity Observation' (dynamic) -->
  </entryRelationship>  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <!-- template 2.16.840.1.113883.10.22.4.19 'IPS Certainty Observation' (dynamic) -->
  </entryRelationship>  <entryRelationship typeCode="REFR" inversionInd="false">
    <!-- template 2.16.840.1.113883.10.22.4.20 'IPS Problem Status Observation' (2017-03-29T00:00:00) -->
    <!-- this referred observation should report that the condition is still active -->
  </entryRelationship></observation>
Example
Problem with resolution date known (IPS)
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.8"/>  <id root="1.2.3.999" extension="__example only__"/>  <code code="75326-9" codeSystem="2.16.840.1.113883.6.1" displayName="Problem"/>  <statusCode code="completed"/>  <effectiveTime>
    <low value="2010"/>    <high value="2015"/>  </effectiveTime>  <value code="38341003" displayName="Hypertensive disorder, systemic arterial (disorder)" codeSystem="2.16.840.1.113883.6.96"/>  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <!-- template 2.16.840.1.113883.10.22.4.25 'IPS Severity Observation' (dynamic) -->
  </entryRelationship>  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <!-- template 2.16.840.1.113883.10.22.4.19 'IPS Certainty Observation' (dynamic) -->
  </entryRelationship>  <entryRelationship typeCode="REFR" inversionInd="false">
    <!-- template 2.16.840.1.113883.10.22.4.20 'IPS Problem Status Observation' (2017-03-29T00:00:00) -->
    <!-- this referred observation should report that the condition is resolved -->
  </entryRelationship></observation>
Example
Known absent problems (IPS)
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.8"/>  <id root="1.2.3.999" extension="__example only__"/>  <code code="75326-9" codeSystem="2.16.840.1.113883.6.1" displayName="Problem"/>  <statusCode code="completed"/>  <effectiveTime>
    <low nullFlavor="NI"/>  </effectiveTime>  <value code="no-known-problems" displayName="No known problems" codeSystem="2.16.840.1.113883.5.1150.1"/></observation>
ItemDTCardConfDescriptionLabel
cda:observation
IPS = C-CDAPCPrdotstion
@classCode
cs0 … 1FOBSCONFdots9041
 C-CDA
SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-9041).
IPS
0..1 F OBS
@moodCode
cs1 … 1FEVNCONFdots9042
 IPS = C-CDA

C-CDA
SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-9042).
hl7:templateId
II1 … 1MC-CDA
SHALL contain exactly one [1..1] templateId (CONF:1198-14926) such that it
a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.4" (CONF:1198-14927).
b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32508).

IPS
1..1 M  @root = 2.16.840.1.113883.10.22.4.8		PCPrdotstion
@root
uid1 … 1F2.16.840.1.113883.3.1937.99.61.30.10.53
cda:id
II0 … *RC-CDA
SHALL contain at least one [1..*] id (CONF:1198-9043).

IPS
0...* R (SHOULD)		CONFdots9043
cda:code
CD1 … 1RC-CDA
SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet Problem Type urn:oid:2.16.840.1.113883.3.88.12.3221.7.2 STATIC 2012-06-01 (CONF:1198-9045).
2.16.840.1.113883.3.88.12.3221.7.2 


IPS
The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.16 Problem Type (DYNAMIC)
(only one LOINC code = "Problem") 

TO DO

Specify the binding:
  • Value Set or Concept domain ?
  • Strength : Preferred ? Extensible? Required ?
CONFdots9045
cda:translation
0 … *CC-CDA
If code is selected from ValueSet Problem Type (SNOMEDCT) urn:oid:2.16.840.1.113883.3.88.12.3221.7.2 DYNAMIC, then it SHALL have at least one [1..*] translation, which SHOULD be selected from ValueSet Problem Type (LOINC) urn:oid:2.16.840.1.113762.1.4.1099.28 DYNAMIC (CONF:1198-32950) (CONF:1198-32950).

 
IPS
not explicitly specified 		CONFdots2848
hl7:text
ED0 … 1RC-CDA
Not explicitly specified

IPS
The element if present points to the text describing the problem being recorded; including any dates, comments, et cetera. The contains a URI in value attribute. This URI points to the free text description of the problem in the document that is being described.
PCPrdotstion
 Example<text>
  <reference value="#problem-1"/></text>
hl7:reference
TEL1 … 1MPCPrdotstion
@value
1 … 1RIPS
When used it shall refer to the narrative, typically #{label}-{generated-id}, e.g. #xxx-1
cda:statusCode
CS1 … 1MIPS = C-CDA

C-CDA
SHALL contain exactly one [1..1] statusCode (CONF:1198-9049). a. This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:1198-19112).

IPS
A clinical document normally records only those condition observation events that have been completed, not observations that are in any other state. Therefore, the shall always have code='completed'.

CONFdots9049
@code
CONF1 … 1Fcompleted
cda:effectiveTime
IVL_TS1 … 1MIPS = C-CDA

C-CDA
If the problem is known to be resolved, but the date of resolution is not known, then the high element SHALL be present, and the nullFlavor attribute SHALL be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.

SHALL contain exactly one [1..1] effectiveTime (CONF:1198-9050).

IPS
The effectiveTime, also referred to as the “biologically relevant time” is the time at which the observation holds for the patient. For a provider seeing a patient in the clinic today, observing a history of heart attack that occurred five years ago, the effectiveTime is five years ago.
The <low> and <high> values should be no more precise than known, but as precise as possible.
CONFdots9050
 Example
Known onset date (active condition)
<effectiveTime>
  <low value="20100507"/></effectiveTime>
 Example
Unknown onset date (active condition)
<effectiveTime>
  <low nullFlavor="UNK"/></effectiveTime>
 Example
Unknown resolution date
<effectiveTime>
  <low value="2010"/>  <high nullFlavor="UNK"/></effectiveTime>
 Example
Known resolution date
<effectiveTime>
  <low value="201007"/>  <high value="201703"/></effectiveTime>
cda:low
1 … 1RC-CDA
The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.

This effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-15603).

IPS
The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
CONFdots5603
cda:high
0 … 1RC-CDA
The effectiveTime/high (a.k.a. "resolution date") asserts when the condition became biologically resolved.
b. This effectiveTime MAY contain zero or one [0..1] high (CONF:1198-15604).

IPS
The effectiveTime/high (a.k.a. "resolution date") asserts when the condition e became biologically resolved.
If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK".

If this condition is known to be resolved, then the effectiveTime/high would be present.
CONFdots5604
cda:value
CD1 … 1MC-CDA
SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHOULD be selected from ValueSet Problem urn:oid:2.16.840.1.113883.3.88.12.3221.7.4 DYNAMIC (CONF:1198-9058).

2.16.840.1.113883.3.88.12.3221.7.4 

A negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.

IPS
The <value> is the condition that was found.
It may a coded or an un-coded string, but its type is always coded.
The coded form shall be used also to indicate known absent conditions or the nonavailability of information about them.

The value of @code comes preferably from value set 2.16.840.1.113883.11.22.5 CORE Problem List Disorders (DYNAMIC)
or
The value of @code comes preferably from value set 2.16.840.1.113883.11.22.17 Absent or Unknown Problems (DYNAMIC)

---------------------------------------
TO DO

Specify the binding:
  • Value Set or Concept domain ?
  • Strength : Preferred ? Extensible? Required ?
CONFdots9058
@code
0 … 1 C-CDA
This value MAY contain zero or one [0..1] @code (CONF:1198-31871).

IPS
Not explicitly specified		CONFdots1871
@xsi:type
0 … 1FCD
 C-CDA
SHALL contain exactly one [1..1] value with @xsi:type="CD", <....> 

IPS
optional
 Example
Multiple Coding
<value code="302231008" displayName="Salmonella infection" codeSystem="2.16.840.1.113883.6.96">
  <translate code="A02.9" displayName="Infezioni da Salmonella non specificate" codeSystem="2.16.840.1.113883.6.3"/></value>
 Example
Local code not mappable in the reference terminology
<value nullFlavor="NI">
  <!-- 'OTH' if CNE -->
  <translate code="12345" displayName="Not in the reference value set" codeSystem="1.2.3.999" codeSystemName="--example only--"/></value>
 Example
Textual Information
<value nullFlavor="NI">
  <originalText>
    <reference value="#value_as_text"/>  </originalText></value>
 Example
Known absent problems
<value code="160245001" displayName="No current problems or disability" codeSystem="2.16.840.1.113883.6.96"/>
hl7:originalText
R

The <originalText> element within the <code> element described above is used as follows: the <value> contains a <reference> to the <originalText> in order to link the coded value to the problem narrative text (minus any dates, comments, et cetera). The <reference> contains a URI in value attribute. This URI points to the free text description of the problem in the document that is being described.

CONFdots9058
hl7:reference
0 … 1R The URI given in the value attribute of the element points to an element in the narrative content that contains the complete text describing the medication. In a CDA document, the URI given in the value attribute of the element points to an element in the narrative content that contains the complete text describing the medication. CONFdots9058
 Example<reference value="#value_as_text"/>
cda:qualifier
CR0 … *C-CDA
The observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. For example, SNOMED CT allows constructing concepts as a combination of multiple codes. SNOMED CT defines a concept "pneumonia (disorder)" (233604007) an attribute "finding site" (363698007) and another concept "left lower lobe of lung (body structure)" (41224006). SNOMED CT allows one to combine these codes in a code phrase, as shown in the sample XML.

This value MAY contain zero or more [0..*] qualifier (CONF:1198-31870).

IPS 
no description associated		CONFdots1870
cda:translation
CD0 … *C-CDA
This value MAY contain zero or more [0..*] translation (CONF:1198-16749) such that it i. MAY contain zero or one [0..1] @code (CodeSystem: ICD-10-CM urn:oid:2.16.840.1.113883.6.90 STATIC) (CONF:1198-16750).

IPS
The translation element may be used to transmit a set of other concept descriptors, using for example ICD-10 or other international or jurisdictional code systems.
CONFdots6749
@code
0 … 1 C-CDA
MAY contain zero or one [0..1] @code (CodeSystem: ICD10CM urn:oid:2.16.840.1.113883.6.90 STATIC) (CONF:1198-16750).

IPS
Not explicitly specified
CONFdots6750
cda:author
0 … *RC-CDA
SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-31147).

IPS
Not explicitly specified

Contains 2.16.840.1.113883.10.20.22.4.119 Author Participation (2015‑08‑13)		CONFdots1147
hl7:entryRelationship
0 … 1RC-CDA
Not explicitly specified

IPS

Severity
The contained entry describes a subjective assessment of the severity of the condition as evaluated by the clinician.
Contains 2.16.840.1.113883.10.22.4.25 IPS Severity Observation (DYNAMIC)		PCPrdotstion
@typeCode
cs1 … 1FSUBJ
@inversionInd
bl1 … 1Ftrue
hl7:entryRelationship
0 … 1RC-CDA
Not explicitly specified

IPS

Certainty or Verification Status 
The contained entry describes the certainty associated with a condition.
Contains 2.16.840.1.113883.10.22.4.19 IPS Certainty Observation (DYNAMIC)		PCPrdotstion
@typeCode
cs1 … 1FSUBJ
@inversionInd
bl1 … 1Ftrue
hl7:entryRelationship
0 … 1RC-CDA
MAY contain zero or one [0..1] entryRelationship (CONF:1198-9063) such that it
a. SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198- 9068).
b. SHALL contain exactly one [1..1] Problem Status (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.6:2019-06-20) (CONF:1198- 15591).

IPS

Status of the Problem  
The contained entry describes the current status of the condition, for example, whether it is active, in remission, resolved, and so on ...

Contains 2.16.840.1.113883.10.22.4.20 IPS Problem Status Observation (2017‑03‑29)

--------------------------------------------
Contains 2.16.840.1.113883.3.1937.99.61.30.10.56 Problem Status Observation (harmonized) (DYNAMIC)		PCPrdotstion
@typeCode
cs1 … 1FREFR
@inversionInd
bl0 … 1Ffalse
cda:entryRelationship
0 … 1C-CDA
MAY contain zero or one [0..1] entryRelationship (CONF:1198-9059) such that it a. SHALL contain exactly one [1..1] @typeCode="SUBJ" Has subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-9060). b. SHALL contain exactly one [1..1] @inversionInd="true" True (CONF:1198-9069). c. SHALL contain exactly one [1..1] Age Observation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.31) (CONF:1198-15590)

IPS
Not explicitly specified

Contains 2.16.840.1.113883.10.20.22.4.31 Age Observation (2015‑08‑13)		CONFdots9059
@typeCode
cs1 … 1FSUBJCONFdots9060
 SHALL contain exactly one [1..1] @typeCode="SUBJ" Has subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-9060).
@inversionInd
bl1 … 1FtrueCONFdots9069
 SHALL contain exactly one [1..1] @inversionInd="true" True (CONF:1198-9069).
cda:entryRelationship
0 … 1C-CDA
MAY contain zero or one [0..1] entryRelationship (CONF:1198-29951) such that it a. SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198- 31531). b. SHALL contain exactly one [1..1] Prognosis Observation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.113) (CONF:1198-29952).

IPS
Not explicitly specified

Contains 2.16.840.1.113883.10.20.22.4.113 Prognosis Observation (2015‑08‑13)		CONFdots9951
@typeCode
cs1 … 1FREFRCONFdots1531
 SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31531).
cda:entryRelationship
0 … *C-CDA
MAY contain zero or more [0..*] entryRelationship (CONF:1198-31063) such that it a. SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198- 31532). b. SHALL contain exactly one [1..1] Priority Preference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.143) (CONF:1198-31064).

IPS
Not explicitly specified

Contains 2.16.840.1.113883.10.20.22.4.143 Priority Preference (2015‑08‑13)		CONFdots1063
@typeCode
cs1 … 1FREFRCONFdots1532
 SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31532).