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# Template eHDSI Problem

Id | 1.3.6.1.4.1.12559.11.10.1.3.1.3.7 | Effective Date | 2022‑03‑15 15:15:16 Other versions this id: eHDSIProblem as of 2023‑02‑27 15:25:42 eHDSIProblem as of 2020‑09‑02 15:24:28 eHDSIProblem as of 2020‑04‑08 14:11:41 EntryProblem as of 2019‑04‑15 08:52:41 EntryProblem as of 2019‑04‑15 08:52:27 EntryProblem as of 2019‑04‑15
Status | Retired | Version Label |
Name | eHDSIProblem | Display Name | eHDSI Problem
Description
This section makes use of the linking, severity, clinical status and comment content specifications defined elsewhere in the technical framework. In HL7 RIM parlance, observations about a problem, complaint, symptom, finding, diagnosis, or functional limitation of a patient is the event (moodCode='EVN') of observing (<observation classCode='OBS'>) that problem. The <value> of the observation comes from a controlled vocabulary representing such things. The <code> contained within the <observation> describes the method of determination from yet another controlled vocabulary. An example appears below in the figure below
Context | Parent nodes of template element with id 1.3.6.1.4.1.12559.11.10.1.3.1.3.7
Classification | CDA Entry Level Template
Open/Closed | Open (other than defined elements are allowed)
Associated with |
Associated with 2 concepts
Id | Name | Dataset
--- | --- | ---
ehdsi-dataelement-43 | Problem code | eHDSI Data Set
ehdsi-dataelement-77 | Problem code | eHDSI Data Set
Used by / Uses |
Used by 0 transactions and 0 templates, Uses 4 templates
Uses | as | Name | Version
--- | --- | --- | ---
1.3.6.1.4.1.12559.11.10.1.3.1.3.8 | Containment | eHDSI Severity | DYNAMIC
1.3.6.1.4.1.12559.11.10.1.3.1.3.9 | Containment | eHDSI Problem Status Observation | DYNAMIC
1.3.6.1.4.1.12559.11.10.1.3.1.3.10 | Containment | eHDSI Health Status Observation | DYNAMIC
1.3.6.1.4.1.12559.11.10.1.3.1.3.11 | Containment | eHDSI Comment Activity | DYNAMIC
Relationship | Version: template 1.3.6.1.4.1.12559.11.10.1.3.1.3.7 eHDSI Problem (2020‑09‑02 15:24:28) Adaptation: template 1.3.6.1.4.1.19376.1.5.3.1.4.5 IHE Problem Entry (DYNAMIC) ref ch-pcc-
Example |
Example
<observation classCode="OBS" moodCode="EVN" negationInd=" false|true "> <templateId root="1.3.6.1.4.1.12559.11.10.1.3.1.3.7"/> <id root=" " extension=" "/> <code code=" " displayName=" " codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/> <text> <reference value=" "/> </text> <statusCode code="completed"/> <effectiveTime> <low value=" "/> <high value=" "/> </effectiveTime> <value xsi:type="CD" code=" " codeSystem=" " displayName=" " codeSystemName=" "> <originalText> <reference value=" "/> </originalText> </value> <!-- zero or one <entryRelationship typeCode='REFR' inversionInd='false'> elements identifying the health status of concern --> <!-- zero or one <entryRelationship typeCode='REFR' inversionInd='false'> elements containing clinical status --> <!-- zero to many <entryRelationship typeCode='REFR' inversionInd='true'> elements containing comments --> </observation>
Item | DT | Card | Conf | Description | Label
--- | --- | --- | --- | --- | ---
hl7:observation |  |  | R | The basic pattern for reporting a problem uses the CDA <observation> element, setting the classCode='OBS' to represent that this is an observation of a problem, and the moodCode='EVN', to represent that this is an observation that has in fact taken place. The negationInd attribute, if true, specifies that the problem indicated was observed to not have occurred (which is subtly but importantly different from having not been observed). The value of negationInd should not normally be set to true. Instead, to record that there is "no prior history of chicken pox", one would use a coded value indicated exactly that. However, it is not always possible to record problems in this manner, especially if using a controlled vocabulary that does not supply pre-coordinated negations, or which do not allow the negation to be recorded with post-coordinated coded terminology. |
@classCode | cs | 1 … 1 | F | OBS
@moodCode | cs | 1 … 1 | F | EVN
@negationInd | bl | 0 … 1 |  |
hl7:templateId | II | 1 … 1 | R | eHDSI Problem |
@root | uid | 1 … 1 | F | 1.3.6.1.4.1.12559.11.10.1.3.1.3.7
hl7:templateId | II | 0 … 1 | R | IHE Problem Entry (IHE PCC) |
@root | uid | 1 … 1 | F | 1.3.6.1.4.1.19376.1.5.3.1.4.5
hl7:templateId | II | 0 … 1 | R | Problem observation (CCD) |
@root | uid | 1 … 1 | F | 2.16.840.1.113883.10.20.1.28
hl7:id | II | 1 … 1 | M | The specific observation being recorded must have an identifier (<id>) that shall be provided for tracking purposes. If the source EMR does not or cannot supply an intrinsic identifier, then a GUID shall be provided as the root, with no extension (e.g., <id root='CE1215CD-69EC-4C7B-805F-569233C5E159'/>). While CDA allows for more than one identifier element to be provided, this profile requires that only one be used. |
hl7:code | CD.EPSOS (extensible) | 1 … 1 | R | The <code> describes the process of establishing a problem. The code element should be used, as the process of determining the value is important to clinicians (e.g., a diagnosis is a more advanced statement than a symptom). The recommended vocabulary for describing problems is Value set eHDSICodeProb, OID 1.3.6.1.4.1.12559.11.10.1.3.1.42.23. This value set is required in eHDSI when used within the Problem Concern Entry (OID: 1.3.6.1.4.1.12559.11.10.1.3.1.3.15) |
| CONF |
The value of @code SHOULD be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.23 eHDSICodeProb (DYNAMIC)
hl7:text | ED | 1 … 1 | M | The <text> element is required and points to the text describing the problem being recorded; including 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. |
hl7:reference | TEL | 1 … 1 | M |  |
@value |  | 1 … 1 | R | Reference pointing to the narrative, typically #{label}-{generated-id}, e.g. #xxx-1
hl7:statusCode | CS | 0 … 1 | R | A clinical document normally records only those condition observation events that have been completed, not observations that are in any other state. Therefore, the <statusCode> shall always have code='completed'. |
@code | CONF | 0 … 1 | F | completed
hl7:effectiveTime | IVL_TS | 0 … 1 | R | The <effectiveTime> of this <observation> is the time interval over which the <observation> is known to be true. The <low> and <high> values should be no more precise than known, but as precise as possible. While CDA allows for multiple mechanisms to record this time interval (e.g. by low and high values, low and width, high and width, or centre point and width), we are constraining Medical summaries to use only the low/high form. The <low> value is the earliest point for which the condition is known to have existed. The <high> value, when present, indicates the time at which the observation was no longer known to be true. Thus, the implication is made that if the <high> value is specified, that the observation was no longer seen after this time, and it thus represents the date of resolution of the problem. Similarly, the <low> value may seem to represent onset of the problem. Neither of these statements is necessarily precise, as the <low> and <high> values may represent only an approximation of the true onset and resolution (respectively) times. For example, it may be the case that onset occurred prior to the <low> value, but no observation may have been possible before that time to discern whether the condition existed prior to that time. The <low> value should normally be present. There are exceptions, such as for the case where the patient may be able to report that they had chicken pox, but are unsure when. In this case, the <effectiveTime> element shall have a <low> element with a nullFlavor attribute set to 'UNK'. The <high> value need not be present when the observation is about a state of the patient that is unlikely to change (e.g., the diagnosis of an incurable disease). |
hl7:value | CD.EPSOS (extensible) | 1 … 1 | R | The <value> is the condition that was found. This element is required. While the value may be a coded or an un-coded string, the type is always a coded value (xsi:type='CD'). If coded, the code and codeSystem attributes shall be present. The value set to be used when this template is specialized for describing adverse reaction is eHDSIReactionAllergy. The Value Set used is eHDSIIllnessandDisorder, with the OID 1.3.6.1.4.1.12559.11.10.1.3.1.42.5. One of the concepts from the Value Set eHDSIAbsentOrUnknownProblem shall be used in the <value> element to indicate the known absence of problems, or that problems are not known. |
ehdsi-dataelement-43 | Problem code | eHDSI Data Set
ehdsi-dataelement-77 | Problem code | eHDSI Data Set
| CONF |
The value of @code SHOULD be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.5 eHDSIIllnessandDisorder (DYNAMIC)
or
The value of @code SHOULD be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.50 eHDSIAbsentOrUnknownProblem (DYNAMIC)
or
The value of @code SHOULD be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.63 eHDSIRareDisease (DYNAMIC)
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. |
hl7:reference |  | 0 … 1 | R | 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. |
| Example | <reference value="#eP_as_text"/>
hl7:entryRelationship |  | 0 … 1 | R | An optional <entryRelationship> element MAY be present indicating the severity of the problem. If present, this <entryRelationship> element SHALL contain a severity observation conforming to the Severity entry template (1.3.6.1.4.1.12559.11.10.1.3.1.3.8). The severity codes to be used are from the eHDSISeverity value set with OID 1.3.6.1.4.1.12559.11.10.1.3.1.42.13. This shall be represented with the <entryRelationship> element. The typeCode shall be ‘SUBJ’ and inversionInd shall be ‘true’. Contains 1.3.6.1.4.1.12559.11.10.1.3.1.3.8 eHDSI Severity (DYNAMIC) |
@typeCode | cs | 1 … 1 | F | SUBJ
@inversionInd | bl | 1 … 1 | F | true
hl7:entryRelationship |  | 0 … 1 | R | An optional <entryRelationship> may be present indicating the clinical status of the problem, e.g., resolved, in remission, active. When present, this <entryRelationship> element shall contain a clinical status observation conforming to the Problem Status Observation template (1.3.6.1.4.1.12559.11.10.1.3.1.3.9). The value set to be used is eHDSIStatusCode with OID 1.3.6.1.4.1.12559.11.10.1.3.1.42.15. This shall be represented with the <entryRelationship> element. The typeCode shall be ‘REFR’ and inversionInd shall be ‘false’. Contains 1.3.6.1.4.1.12559.11.10.1.3.1.3.9 eHDSI Problem Status Observation (DYNAMIC) |
@typeCode | cs | 1 … 1 | F | REFR
@inversionInd | bl | 0 … 1 | F | false
hl7:entryRelationship |  | 0 … 1 | R | An optional <entryRelationship> may be present referencing the health status of the patient, e.g., resolved, in remission, active. When present, this <entryRelationship> element shall contain a clinical status observation conforming to the template (1.3.6.1.4.1.12559.11.10.1.3.1.3.10). The value set to be used is eHDSIResolutionOutcome, OID 1.3.6.1.4.1.12559.11.10.1.3.1.42.30. The typeCode shall be ‘REFR’ and inversionInd shall be ‘false’. This shall be represented with the <entryRelationship> element. Contains 1.3.6.1.4.1.12559.11.10.1.3.1.3.10 eHDSI Health Status Observation (DYNAMIC) |
@typeCode | cs | 1 … 1 | F | REFR
@inversionInd | bl | 0 … 1 | F | false
hl7:entryRelationship |  | 0 … 1 | R | One or more optional <entryRelationship> elements may be present providing an additional comments (annotations) for the condition. When present, this <entryRelationship> element shall contain a comment observation conforming to the entry template (1.3.6.1.4.1.12559.11.10.1.3.1.3.11). The typeCode shall be ‘SUBJ’ and inversionInd shall be ‘true’. This shall be represented with the <entryRelationship> element. Contains 1.3.6.1.4.1.12559.11.10.1.3.1.3.11 eHDSI Comment Activity (DYNAMIC) |
@typeCode | cs | 1 … 1 | F | SUBJ
@inversionInd | bl | 1 … 1 | F | true