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.
Context
Parent nodes of template element with id 2.16.840.1.113883.10.22.4.7
Classification
CDA Entry Level Template
Open/Closed
Open (other than defined elements are allowed)
Used by / Uses
Used by 0 transactions and 3 templates, Uses 1 template
hl7ips-issue-60: Add assert for the defined constraint (Open)
Item
DT
Card
Conf
Description
Label
hl7:act
R
(IPS…try)
@classCode
cs
1 … 1
F
ACT
@moodCode
cs
1 … 1
F
EVN
hl7:templateId
II
1 … 1
M
(IPS…try)
@root
uid
1 … 1
F
2.16.840.1.113883.10.22.4.7
hl7:id
II
0 … *
R
(IPS…try)
hl7:code
CD
1 … 1
R
(IPS…try)
@code
CONF
1 … 1
F
CONC
@codeSystem
1 … 1
F
2.16.840.1.113883.5.6 (ActClass)
hl7:statusCode
CS
1 … 1
R
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”.
(IPS…try)
CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.4ActStatusActiveCompleted (2017‑03‑06)
hl7:effectiveTime
IVL_TS
1 … 1
R
(IPS…try)
hl7:low
IVXB_TS
1 … 1
R
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.
(IPS…try)
hl7:high
IVXB_TS
0 … 1
C
This element asserts when the clinician deemed there is no longer any need to track
the underlying conditions.
(IPS…try)
Constraint
If the statusCode is completed this element is required
Template IPS Problem Concern Entry
Draft
