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# Template IPS Problem Concern Entry

Id | 2.16.840.1.113883.10.22.4.7 | Effective Date | 2021‑08‑04 08:49:27
Status | Draft | Version Label | 2021
Name | IPSProblemConcernEntry | Display Name | IPS Problem Concern Entry
Description
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
Used by | as | Name | Version
--- | --- | --- | ---
2.16.840.1.113883.10.22.3.3 | Containment | IPS Problems Section (STU1) | 2017‑02‑15
2.16.840.1.113883.10.22.1.2 |  | International Patient Summary (2024) | 2024‑08‑02 13:02:39
2.16.840.1.113883.10.22.3.7 | Containment | IPS History of Past Illness Section (STU1) | 2017‑04‑12
Uses | as | Name | Version
2.16.840.1.113883.10.22.4.8 | Containment | IPS Problem Entry (2021) | DYNAMIC
Relationship | Version: template 2.16.840.1.113883.10.22.4.7 IPS Problem Concern Entry (2017‑02‑15) 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-
Example |
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>
Example |
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>
Item | DT | Card | Conf | Description | Label
--- | --- | --- | --- | --- | ---
hl7:act |  |  | R |  |
@classCode | cs | 1 … 1 | F | ACT
@moodCode | cs | 1 … 1 | F | EVN
hl7:templateId | II | 1 … 1 | M |  |
@root | uid | 1 … 1 | F | 2.16.840.1.113883.10.22.4.7
hl7:id | II | 0 … * | R |  |
hl7:code | CD | 1 … 1 | M |  |
@code |  | 1 … 1 | F | CONC
@codeSystem |  | 1 … 1 | F | 2.16.840.1.113883.5.6
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”. |
| CONF |
The value of @code SHALL be drawn from value set 2.16.840.1.113883.1.11.19890 x_ActStatusActiveComplete (DYNAMIC)
hl7:effectiveTime | IVL_TS | 1 … 1 | M |  |
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. |
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. |
| Constraint | If the statusCode is completed this element is required
hl7:entryRelationship |  | 1 … * | R | Contains 2.16.840.1.113883.10.22.4.8 IPS Problem Entry (DYNAMIC) |
@typeCode | cs | 1 … 1 | F | SUBJ
@inversionInd | bl | 0 … 1 | F | false