International Patient Summary (IPS), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 1.1.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-IPS/ and changes regularly. See the Directory of published versions
Official URL: http://art-decor.org/fhir/StructureDefinition/2.16.840.1.113883.10.22.4.7--20210804084927 | Version: 1.1.0-ballot | |||
Draft as of 2021-08-04 | Computable Name: IPSProblemConcernEntry | |||
Other Identifiers: OID:2.16.840.1.113883.10.22.4.7 (use: official, ) |
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 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 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.
Usage:
Description of Template, Differentials, Snapshots and how the different presentations work.
This structure is derived from Act
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Act | S | 0..* | Act | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
Slices for templateId | 1..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:primary | S | 1..1 | II | |
@root | 1..1 | string | Fixed Value: 2.16.840.1.113883.10.22.4.7 | |
@classCode | 1..1 | code | Fixed Value: ACT | |
@moodCode | 1..1 | code | Fixed Value: EVN | |
id | S | 0..* | II | |
code | S | 1..1 | CD | |
@code | 1..1 | code | Fixed Value: CONC | |
@codeSystem | 1..1 | string | Fixed Value: 2.16.840.1.113883.5.6 | |
statusCode | S | 1..1 | CS | Binding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete |
effectiveTime | S | 1..1 | IVL_TS | |
low | S | 1..1 | IVXB_TS | |
high | 0..1 | IVXB_TS | ||
Slices for entryRelationship | 1..* | EntryRelationship | Slice: Unordered, Open by value:profile | |
entryRelationship:entryRelationship-1 | SC | 1..* | EntryRelationship | entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) |
@typeCode | 1..1 | code | Fixed Value: SUBJ | |
@inversionInd | 0..1 | boolean | Fixed Value: false | |
Slices for observation | Content/Rules for all slices | |||
observation:entryRelationship-1 | S | 1..1 | IPSProblemEntry | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Act.statusCode | required | XActStatusActiveCompletehttp://terminology.hl7.org/ValueSet/v3-xActStatusActiveComplete |
Id | Grade | Path(s) | Details | Requirements |
entryRelationship-1 | null | Act.entryRelationship:entryRelationship-1 | contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) : |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Act | S | 0..* | Act | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
Slices for templateId | 1..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:primary | S | 1..1 | II | |
@root | 1..1 | string | Fixed Value: 2.16.840.1.113883.10.22.4.7 | |
@classCode | 1..1 | code | Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT | |
@moodCode | 1..1 | code | Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN | |
id | S | 0..* | II | |
code | S | 1..1 | CD | Binding: v3 Code System ActCode (example) |
@code | 1..1 | code | Fixed Value: CONC | |
@codeSystem | 1..1 | string | Fixed Value: 2.16.840.1.113883.5.6 | |
statusCode | S | 1..1 | CS | Binding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete |
effectiveTime | S | 1..1 | IVL_TS | |
low | S | 1..1 | IVXB_TS | |
high | 0..1 | IVXB_TS | ||
Slices for entryRelationship | 1..* | EntryRelationship | Slice: Unordered, Open by value:profile | |
entryRelationship:entryRelationship-1 | SC | 1..* | EntryRelationship | entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) |
@typeCode | 1..1 | code | Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SUBJ | |
@inversionInd | 0..1 | boolean | Fixed Value: false | |
Slices for observation | Content/Rules for all slices | |||
observation:entryRelationship-1 | S | 1..1 | IPSProblemEntry | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet / Code | URI |
Act.classCode | required | Fixed Value: ACThttp://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0 | |
Act.moodCode | required | Fixed Value: EVNhttp://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0 | |
Act.code | example | ActCodehttp://terminology.hl7.org/ValueSet/v3-ActCode | |
Act.statusCode | required | XActStatusActiveCompletehttp://terminology.hl7.org/ValueSet/v3-xActStatusActiveComplete | |
Act.entryRelationship:entryRelationship-1.typeCode | required | Fixed Value: SUBJhttp://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship |
Id | Grade | Path(s) | Details | Requirements |
entryRelationship-1 | null | Act.entryRelationship:entryRelationship-1 | contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) : |
Path | Conformance | ValueSet / Code | URI |
Act.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.typeId.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.templateId:primary.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.classCode | required | Fixed Value: ACThttp://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0 | |
Act.moodCode | required | Fixed Value: EVNhttp://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0 | |
Act.code | example | ActCodehttp://terminology.hl7.org/ValueSet/v3-ActCode | |
Act.code.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.statusCode | required | XActStatusActiveCompletehttp://terminology.hl7.org/ValueSet/v3-xActStatusActiveComplete | |
Act.effectiveTime.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.effectiveTime.operator | required | CDASetOperatorhttp://hl7.org/cda/stds/core/ValueSet/CDASetOperator | |
Act.priorityCode | example | ActPriorityhttp://terminology.hl7.org/ValueSet/v3-ActPriority | |
Act.languageCode | required | AllLanguageshttp://hl7.org/fhir/ValueSet/all-languages | |
Act.entryRelationship:entryRelationship-1.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.entryRelationship:entryRelationship-1.typeId.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.entryRelationship:entryRelationship-1.typeCode | required | Fixed Value: SUBJhttp://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship |
Id | Grade | Path(s) | Details | Requirements |
entryRelationship-1 | null | Act.entryRelationship:entryRelationship-1 | contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) : |
This structure is derived from Act
Summary
Mandatory: 15 elements
Must-Support: 8 elements
Fixed: 7 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from Act
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Act | S | 0..* | Act | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
Slices for templateId | 1..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:primary | S | 1..1 | II | |
@root | 1..1 | string | Fixed Value: 2.16.840.1.113883.10.22.4.7 | |
@classCode | 1..1 | code | Fixed Value: ACT | |
@moodCode | 1..1 | code | Fixed Value: EVN | |
id | S | 0..* | II | |
code | S | 1..1 | CD | |
@code | 1..1 | code | Fixed Value: CONC | |
@codeSystem | 1..1 | string | Fixed Value: 2.16.840.1.113883.5.6 | |
statusCode | S | 1..1 | CS | Binding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete |
effectiveTime | S | 1..1 | IVL_TS | |
low | S | 1..1 | IVXB_TS | |
high | 0..1 | IVXB_TS | ||
Slices for entryRelationship | 1..* | EntryRelationship | Slice: Unordered, Open by value:profile | |
entryRelationship:entryRelationship-1 | SC | 1..* | EntryRelationship | entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) |
@typeCode | 1..1 | code | Fixed Value: SUBJ | |
@inversionInd | 0..1 | boolean | Fixed Value: false | |
Slices for observation | Content/Rules for all slices | |||
observation:entryRelationship-1 | S | 1..1 | IPSProblemEntry | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Act.statusCode | required | XActStatusActiveCompletehttp://terminology.hl7.org/ValueSet/v3-xActStatusActiveComplete |
Id | Grade | Path(s) | Details | Requirements |
entryRelationship-1 | null | Act.entryRelationship:entryRelationship-1 | contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) : |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Act | S | 0..* | Act | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
Slices for templateId | 1..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:primary | S | 1..1 | II | |
@root | 1..1 | string | Fixed Value: 2.16.840.1.113883.10.22.4.7 | |
@classCode | 1..1 | code | Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT | |
@moodCode | 1..1 | code | Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN | |
id | S | 0..* | II | |
code | S | 1..1 | CD | Binding: v3 Code System ActCode (example) |
@code | 1..1 | code | Fixed Value: CONC | |
@codeSystem | 1..1 | string | Fixed Value: 2.16.840.1.113883.5.6 | |
statusCode | S | 1..1 | CS | Binding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete |
effectiveTime | S | 1..1 | IVL_TS | |
low | S | 1..1 | IVXB_TS | |
high | 0..1 | IVXB_TS | ||
Slices for entryRelationship | 1..* | EntryRelationship | Slice: Unordered, Open by value:profile | |
entryRelationship:entryRelationship-1 | SC | 1..* | EntryRelationship | entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) |
@typeCode | 1..1 | code | Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SUBJ | |
@inversionInd | 0..1 | boolean | Fixed Value: false | |
Slices for observation | Content/Rules for all slices | |||
observation:entryRelationship-1 | S | 1..1 | IPSProblemEntry | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet / Code | URI |
Act.classCode | required | Fixed Value: ACThttp://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0 | |
Act.moodCode | required | Fixed Value: EVNhttp://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0 | |
Act.code | example | ActCodehttp://terminology.hl7.org/ValueSet/v3-ActCode | |
Act.statusCode | required | XActStatusActiveCompletehttp://terminology.hl7.org/ValueSet/v3-xActStatusActiveComplete | |
Act.entryRelationship:entryRelationship-1.typeCode | required | Fixed Value: SUBJhttp://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship |
Id | Grade | Path(s) | Details | Requirements |
entryRelationship-1 | null | Act.entryRelationship:entryRelationship-1 | contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) : |
Snapshot View
Path | Conformance | ValueSet / Code | URI |
Act.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.typeId.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.templateId:primary.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.classCode | required | Fixed Value: ACThttp://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0 | |
Act.moodCode | required | Fixed Value: EVNhttp://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0 | |
Act.code | example | ActCodehttp://terminology.hl7.org/ValueSet/v3-ActCode | |
Act.code.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.statusCode | required | XActStatusActiveCompletehttp://terminology.hl7.org/ValueSet/v3-xActStatusActiveComplete | |
Act.effectiveTime.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.effectiveTime.operator | required | CDASetOperatorhttp://hl7.org/cda/stds/core/ValueSet/CDASetOperator | |
Act.priorityCode | example | ActPriorityhttp://terminology.hl7.org/ValueSet/v3-ActPriority | |
Act.languageCode | required | AllLanguageshttp://hl7.org/fhir/ValueSet/all-languages | |
Act.entryRelationship:entryRelationship-1.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.entryRelationship:entryRelationship-1.typeId.nullFlavor | required | CDANullFlavorhttp://hl7.org/cda/stds/core/ValueSet/CDANullFlavor | |
Act.entryRelationship:entryRelationship-1.typeCode | required | Fixed Value: SUBJhttp://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship |
Id | Grade | Path(s) | Details | Requirements |
entryRelationship-1 | null | Act.entryRelationship:entryRelationship-1 | contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2024-08-04) : |
This structure is derived from Act
Summary
Mandatory: 15 elements
Must-Support: 8 elements
Fixed: 7 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices: