2.16.840.1.113883.10.22.4.7

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1 Template IPSProblemConcernEntry

1.1 Aktuelle Version

Id2.16.840.1.113883.10.22.4.7Gültigkeit ab2021‑08‑04 08:49:27
Status  EntwurfVersions-Label2021
NameIPSProblemConcernEntryBezeichnungIPS Problem Concern Entry
Beschreibung
 

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.

KontextElternknoten des Template-Element mit Id 2.16.840.1.113883.10.22.4.7
KlassifikationCDA Entry Level Template
Offen/GeschlossenOffen (auch andere als die definierten Elemente sind erlaubt)
Benutzt
Benutzt 1 Template
Benutzt als NameVersion
2.16.840.1.113883.10.22.4.8Containment  IPS Problem Entry (2021)DYNAMIC
BeziehungVersion: Template 2.16.840.1.113883.10.22.4.7 IPS Problem Concern Entry (2017‑02‑15)
ref
hl7ips-

Adaptation: Template 1.3.6.1.4.1.19376.1.5.3.1.4.5.1 IHE Concern Entry (DYNAMIC)
ref
IHE-PCC-

Adaptation: Template 2.16.840.1.113883.10.20.1.27 Problem act (DYNAMIC)
ref
ccd1-

Adaptation: Template 1.3.6.1.4.1.19376.1.5.3.1.4.5.2 eHDSI Problem Concern (DYNAMIC)
ref
epsos-
Beispiel
Active Concern with several conditions
<act classCode="ACT" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.7"/>  <id root="1.2.3.999" extension="__example only__"/>  <code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>  <statusCode code="active"/>  <effectiveTime>
    <low value="20170309"/>  </effectiveTime>
  <entryRelationship typeCode="SUBJ" inversionInd="false">
    <!-- template 2.16.840.1.113883.10.22.4.8 'IPS Problem Entry' (dynamic) -->
    <!-- A condition could be active, inactive,.... -->
  </entryRelationship>
  <entryRelationship typeCode="SUBJ" inversionInd="false">
    <!-- template 2.16.840.1.113883.10.22.4.8 'IPS Problem Entry' (dynamic) -->
  </entryRelationship>
</act>
Beispiel
Concern no longer tracked
<act classCode="ACT" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.7"/>  <id root="1.2.3.999" extension="__example only__"/>  <code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>  <statusCode code="completed"/>  <effectiveTime>
    <low value="20161210"/>    <low value="20170309"/>  </effectiveTime>
  <entryRelationship typeCode="SUBJ" inversionInd="false">
    <!-- template 2.16.840.1.113883.10.22.4.8 'IPS Problem Entry' (dynamic) -->
  </entryRelationship>
</act>
ItemDTKardKonfBeschreibungLabel
hl7:act
R
 @classCode
cs1 … 1FACT
 @moodCode
cs1 … 1FEVN
 hl7:templateId
II1 … 1M
  @root
uid1 … 1F2.16.840.1.113883.10.22.4.7
 hl7:id
II0 … *R
 hl7:code
CD1 … 1M
  @code
1 … 1FCONC
  @codeSystem
1 … 1F2.16.840.1.113883.5.6
 hl7:statusCode
CS1 … 1R  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”.
 CONF
Der Wert von @code MUSS gewählt werden aus dem Value Set 2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete (DYNAMIC)
 hl7:effectiveTime
IVL_TS1 … 1M
  hl7:low
IVXB_TS1 … 1R  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.
  hl7:high
IVXB_TS0 … 1C  This element asserts when the clinician deemed there is no longer any need to track the underlying conditions.
 Constraint  If the statusCode is completed this element is required
 hl7:entryRelationship
1 … *RBeinhaltet 2.16.840.1.113883.10.22.4.8 IPS Problem Entry (DYNAMIC)
  @typeCode
cs1 … 1FSUBJ
  @inversionInd
bl0 … 1Ffalse


1.2 Zusammenstellung aller Versionen dieses Templates