Id2.16.840.1.113883.3.1937.99.61.30.10.55Effective Date2020‑10‑08 11:21:56
Statusdraft DraftVersion Label0.1
NamePCProblemConcernActDisplay NameProblem Concern Act (harmonized)
Description
C-CDA
This template reflects an ongoing concern on behalf of the provider that placed the concern on a patient’s problem list. So long as the underlying condition is of concern to the provider (i.e., as long as the condition, whether active or resolved, is of ongoing concern and interest to the provider), the statusCode is “active”. Only when the underlying condition is no longer of concern is the statusCode set to “completed”. The effectiveTime reflects the time that the underlying condition was felt to be a concern; it may or may not correspond to the effectiveTime of the condition (e.g., even five years later, the clinician may remain concerned about a prior heart attack). The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved. The effectiveTime/low of the Problem Concern Act asserts when the concern became active. This equates to the time the concern was authored in the patient's chart. The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition). A Problem Concern Act can contain many Problem Observations (templateId 2.16.840.1.113883.10.20.22.4.4). Each Problem Observation is a discrete observation of a condition, and therefore will have a statusCode of “completed”. The many Problem Observations nested under a Problem Concern Act reflect the change in the clinical understanding of a condition over time. For instance, a Concern may initially contain a Problem Observation of “chest pain”: - Problem Concern 1 --- Problem Observation: Chest Pain Later, a new Problem Observation of “esophagitis” will be added, reflecting a better understanding of the nature of the chest pain. The later problem observation will have a more recent author time stamp. - Problem Concern 1 --- Problem Observation (author/time Jan 3, 2012): Chest Pain --- Problem Observation (author/time Jan 6, 2012): Esophagitis Many systems display the nested Problem Observation with the most recent author time stamp, and provide a mechanism for viewing prior observations.

IPS

This template reflects an ongoing concern on behalf of the provider that placed the concern on a patient’s problem list. 
The purpose of the concern act is that of supporting the tracking of a problem or a condition.

There are different kinds of status that could be related to a condition:

  • The status of the concern (active, inactive,..) 
  • The status of the condition (e.g. active, inactive, resolved,..) 
  • The confirmation status [clinical workflow status, certainty] (e.g. confirmed, likely, unlikely,…) 
Not all of them can be represented in a CDA using the statusCode elements of the concern (ACT) and observation (condition). 

So long as the underlying conditions are of concern to the provider (i.e., as long as the condition, whether active or resolved, is of ongoing concern and interest to the provider), the statusCode is “active”.
Only when the underlying conditions are no longer of concern is the statusCode set to “completed”. 

The effectiveTime reflects the time that the underlying condition was felt to be a concern; it may or may not correspond to the effectiveTime of the condition (e.g., even five years later, the clinician may remain concerned about a prior heart attack).
The effectiveTime/low of the Problem Concern Act asserts when the concern became active. This equates to the time the concern was authored in the patient's chart. 
The effectiveTime/high asserts when the concern become inactive, and it is present if the statusCode of the concern act is "completed".

A Problem Concern Act can contain many Problem Observations.

The many Problem Observations nested under a Problem Concern Act reflect the change in the clinical understanding of a condition over time. For instance, a Concern may initially contain a Problem Observation of “chest pain”:

- Problem Concern 1

--- Problem Observation: Chest Pain

Later, a new Problem Observation of “esophagitis” will be added, reflecting a better understanding of the nature of the chest pain. The later problem observation will have a more recent author time stamp.

- Problem Concern 1

--- Problem Observation (author/time Jan 3, 2012): Chest Pain

--- Problem Observation (author/time Jan 6, 2012): Esophagitis

Many systems display the nested Problem Observation with the most recent author time stamp, and provide a mechanism for viewing prior observations.

ContextParent nodes of template element with id 2.16.840.1.113883.3.1937.99.61.30.10.55
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 0 transactions and 0 templates, Uses 3 templates
Uses as NameVersion
2.16.840.1.113883.3.1937.99.61.30.10.53Containmentdraft Problem Observation (harmonized) (0.1)DYNAMIC
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
RelationshipGeneralization: template 2.16.840.1.113883.10.20.22.4.3 Problem Concern Act (V3) (2015‑08‑01)
ref
ccda-

Generalization: template 2.16.840.1.113883.10.12.301 CDA Act (2005‑09‑07)
ref
ad1bbr-
ItemDTCardConfDescriptionLabel
cda:act
IPS = C-CDAPCPrdotsnAct
@classCode
cs1 … 1FACTCONFdots9024
 C-CDA
SHALL contain exactly one [1..1] @classCode="ACT" Act (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-9024).
@moodCode
cs1 … 1FEVNCONFdots9025
 C-CDA
SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-9025).
hl7:templateId
II1 … 1MC-CDA
SHALL contain exactly one [1..1] templateId (CONF:1198-16772) such that it 
a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.3" (CONF:1198-16773). 
b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32509).

IPS
1..1 M => @root F 2.16.840.1.113883.10.22.4.7
PCPrdotsnAct
@root
uid1 … 1F2.16.840.1.113883.3.1937.99.61.30.10.55
cda:id
II0 … *RC-CDA
SHALL contain at least one [1..*] id (CONF:1198-9026).

IPS 
0...* R
(=SHOULD)
CONFdots9026
cda:code
CD1 … 1MC-CDA
SHALL contain exactly one [1..1] code (CONF:1198-9027).
a. This code SHALL contain exactly one [1..1] @code="CONC" Concern (CONF:1198- 19184).
b. This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.6" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:1198-32168).

IPS
0..1 F (typo to be fixed) 
CONFdots9027
@code
CONF1 … 1FCONC
@codeSystem
1 … 1F2.16.840.1.113883.5.6
cda:statusCode
CS1 … 1RC-CDA
SHALL contain exactly one [1..1] statusCode (CONF:1198-9029).

The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.

a. This statusCode SHALL contain exactly one [1..1] @code, which SHALL be selected from ValueSet ProblemAct statusCode urn:oid:2.16.840.1.113883.11.20.9.19 STATIC (CONF:1198-31525).

IPS
So long as the underlying conditions are of concern to the provider (i.e., as long as the condition, whether active or resolved, is of ongoing concern and interest to the provider), the statusCode is “active”. 

Only when the underlying conditions are no longer of concern is the statusCode set to “completed”.

The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete (DYNAMIC)
CONFdots9029
cda:effectiveTime
1 … 1MC-CDA
SHALL contain exactly one [1..1] effectiveTime (CONF:1198-9030).
a. This effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-9032). Note: The effectiveTime/low of the Problem Concern Act asserts when the concern became active.
b. This effectiveTime MAY contain zero or one [0..1] high (CONF:1198-9033). Note: The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).

IPS
1..1 R (maybe it can be changed into M)
CONFdots9030
cda:low
1 … 1RC-CDA
This effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-9032).

IPS
This element asserts when the concern became active. This equates to the time the concern was authored in the patient's chart and the author started tracking this concern.
CONFdots9032
cda:high
0 … 1RC-CDA
This effectiveTime MAY contain zero or one [0..1] high (CONF:1198-9033).

IPS
0..1 C (If the statusCode is completed this element is required)
This element asserts when the clinician deemed there is no longer any need to track the underlying conditions
CONFdots9033
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:1198-31146).

IPS
not explicitly specified 
Contains 2.16.840.1.113883.10.20.22.4.119 Author Participation (2015‑08‑13)
CONFdots1146
cda:entryRelationship
1 … *MC-CDA
SHALL contain at least one [1..*] entryRelationship (CONF:1198-9034) 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:1198-9035).
b. SHALL contain exactly one [1..1] Problem Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.4:2015-08-01) (CONF:1198- 15980).

IPS
1..* R
Contains 2.16.840.1.113883.10.22.4.8 IPS Problem Entry (DYNAMIC)

@inversionInd 0.1 F false
--------------------------------------------------------------------------------------------------------


Contains 2.16.840.1.113883.3.1937.99.61.30.10.53 Problem Observation (harmonized) (DYNAMIC)
CONFdots9034
@typeCode
cs1 … 1FSUBJCONFdots9035
 IPS = CCDA

C-CDA
SHALL contain exactly one [1..1] @typeCode="SUBJ" Has subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-9035).
cda:entryRelationship
0 … *C-CDA
The following entryRelationship represents the importance of the concern to a provider.

MAY contain zero or more [0..*] entryRelationship (CONF:1198-31638) 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- 31639).
b. SHALL contain exactly one [1..1] Priority Preference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.143) (CONF:1198-31640).

IPS
Not present
--------------------------------------------------------------------------------------------------------

Contains 2.16.840.1.113883.10.20.22.4.143 Priority Preference (2015‑08‑13)
CONFdots1638
@typeCode
cs1 … 1FREFRCONFdots1639
 C-CDA
SHALL contain exactly one [1..1] @typeCode="REFR" refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31639).