Consolidated CDA (C-CDA)
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Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-ccda/ and changes regularly. See the Directory of published versions

Logical Model: ProblemObservation - Detailed Descriptions

Draft as of 2024-12-19

Definitions for the ProblemObservation logical model.

Guidance on how to interpret the contents of this table can be found here

0. Observation
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
should-author: SHOULD contain author (author.exists())
2. Observation.templateId
Control1..?
SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • value @ extension
  • 4. Observation.templateId:problem-obs
    Slice Nameproblem-obs
    Control1..1
    6. Observation.templateId:problem-obs.root
    Control1..?
    Pattern Value2.16.840.1.113883.10.20.22.4.4
    8. Observation.templateId:problem-obs.extension
    Control1..?
    Pattern Value2024-05-01
    10. Observation.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-9041).

    Fixed ValueOBS
    12. Observation.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-9042).

    Fixed ValueEVN
    14. Observation.negationInd
    ShortThe negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.
    Comments

    MAY contain zero or one [0..1] @negationInd (CONF:1198-10139).

    16. Observation.id
    Comments

    SHALL contain at least one [1..*] id (CONF:1198-9043).

    Control1..?
    18. Observation.code
    BindingThe codes SHOULD be taken from Problem Type .
    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1)
    20. Observation.text
    ShortSHOULD reference the portion of section narrative text corresponding to this entry
    22. Observation.text.reference
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    24. Observation.statusCode
    Comments

    SHALL contain exactly one [1..1] statusCode (CONF:1198-9049).

    Control1..?
    26. Observation.statusCode.code
    Comments

    This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:1198-19112).

    Control1..?
    Fixed Valuecompleted
    28. Observation.effectiveTime
    ShortIf the problem is known to be resolved, but the date of resolution is not known, then the high element **SHALL** be present, and the nullFlavor attribute **SHALL** be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.
    Comments

    SHALL contain exactly one [1..1] effectiveTime (CONF:1198-9050).

    Control1..?
    30. Observation.effectiveTime.low
    ShortThe effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
    Comments

    This effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-15603).

    Control1..?
    32. Observation.effectiveTime.high
    Short𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.
    Comments

    This effectiveTime MAY contain zero or one [0..1] high (CONF:1198-15604).

    34. Observation.value
    Short𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns
    Comments

    SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHOULD be selected from ValueSet US Core Condition Codes.

    Control1..1
    BindingThe codes SHOULD be taken from US Core Condition Codes
    (preferred to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD, http://hl7.org/cda/stds/core/StructureDefinition/EIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/CO, http://hl7.org/cda/stds/core/StructureDefinition/TEL, http://hl7.org/cda/stds/core/StructureDefinition/EN, http://hl7.org/cda/stds/core/StructureDefinition/BL, http://hl7.org/cda/stds/core/StructureDefinition/AD, http://hl7.org/cda/stds/core/StructureDefinition/PIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/RTO-PQ-PQ, http://hl7.org/cda/stds/core/StructureDefinition/SXPR-TS, http://hl7.org/cda/stds/core/StructureDefinition/ED, http://hl7.org/cda/stds/core/StructureDefinition/TS, http://hl7.org/cda/stds/core/StructureDefinition/II, http://hl7.org/cda/stds/core/StructureDefinition/ST, http://hl7.org/cda/stds/core/StructureDefinition/PQ, http://hl7.org/cda/stds/core/StructureDefinition/IVL-PQ, http://hl7.org/cda/stds/core/StructureDefinition/CE, http://hl7.org/cda/stds/core/StructureDefinition/MO, http://hl7.org/cda/stds/core/StructureDefinition/IVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/ANY, http://hl7.org/cda/stds/core/StructureDefinition/INT, http://hl7.org/cda/stds/core/StructureDefinition/REAL, http://hl7.org/cda/stds/core/StructureDefinition/CV, http://hl7.org/cda/stds/core/StructureDefinition/SC
    36. Observation.value.code
    ShortA negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. When the Problem is Social Determinant of Health Observation, the observation/value SHOULD be a SNOMED code selected from ValueSet Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788 DYNAMIC (CONF:4515-32951).
    Comments

    This value MAY contain zero or one [0..1] @code (CONF:1198-31871).

    Binding

    See additional binding

    38. Observation.value.qualifier
    ShortThe observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1 using the V3 CD Data type 1 style. This is shown in the sample XML.
    Comments

    This value MAY contain zero or more [0..*] qualifier (CONF:1198-31870).

    40. Observation.author
    Comments

    SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-31147).

    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
    42. Observation.entryRelationship
    SlicingThis element introduces a set of slices on Observation.entryRelationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • profile @ observation
    • profile @ act
    • 44. Observation.entryRelationship:age
      Slice Nameage
      Comments

      MAY contain zero or one [0..1] entryRelationship (CONF:1198-9059) such that it

      Control0..1
      46. Observation.entryRelationship:age.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="SUBJ" Has subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-9060).

      Fixed ValueSUBJ
      48. Observation.entryRelationship:age.inversionInd
      Comments

      SHALL contain exactly one [1..1] @inversionInd="true" True (CONF:1198-9069).

      Control1..?
      Fixed Valuetrue
      50. Observation.entryRelationship:age.observation
      Comments

      SHALL contain exactly one [1..1] Age Observation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.31) (CONF:1198-15590).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Age Observation)
      52. Observation.entryRelationship:prognosis
      Slice Nameprognosis
      Comments

      MAY contain zero or one [0..1] entryRelationship (CONF:1198-29951) such that it

      Control0..1
      54. Observation.entryRelationship:prognosis.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31531).

      Fixed ValueREFR
      56. Observation.entryRelationship:prognosis.observation
      Comments

      SHALL contain exactly one [1..1] Prognosis Observation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.113) (CONF:1198-29952).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Prognosis Observation)
      58. Observation.entryRelationship:priority
      Slice Namepriority
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:1198-31063) such that it

      Control0..*
      60. Observation.entryRelationship:priority.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31532).

      Fixed ValueREFR
      62. Observation.entryRelationship:priority.observation
      Comments

      SHALL contain exactly one [1..1] Priority Preference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.143) (CONF:1198-31064).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Priority Preference)
      64. Observation.entryRelationship:status
      Slice Namestatus
      Comments

      MAY contain zero or one [0..1] entryRelationship (CONF:1198-9063) such that it

      Control0..1
      66. Observation.entryRelationship:status.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-9068).

      Fixed ValueREFR
      68. Observation.entryRelationship:status.observation
      Comments

      SHALL contain exactly one [1..1] Problem Status (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.6:2019-06-20) (CONF:1198-15591).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Problem Status)
      70. Observation.entryRelationship:reference
      Slice Namereference
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:4515-32968) such that it

      Control0..1
      72. Observation.entryRelationship:reference.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="SPRT" Has Support (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4515-32968).

      Fixed ValueSPRT
      74. Observation.entryRelationship:reference.act
      Comments

      SHALL contain exactly one [1..1] Entry Reference (identifier: 2.16.840.1.113883.10.20.22.4.122) (CONF:4515-32966).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act(Entry Reference)
      76. Observation.entryRelationship:assessment
      Slice Nameassessment
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:4515-32953) such that it

      Control0..1
      78. Observation.entryRelationship:assessment.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="SPRT" Has Support (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4515-32955).

      Fixed ValueSPRT
      80. Observation.entryRelationship:assessment.observation
      Comments

      SHALL contain exactly one [1..1] Assessment Scale Observation (identifier: 2.16.840.1.113883.10.20.22.4.69) (CONF:4515-32954).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Assessment Scale Observation)
      82. Observation.entryRelationship:dateOfDiagnosis
      Slice NamedateOfDiagnosis
      Short𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:4515-33012) such that it

      Control0..1
      84. Observation.entryRelationship:dateOfDiagnosis.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="COMP" has Component (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4515-33014).

      Fixed ValueCOMP
      86. Observation.entryRelationship:dateOfDiagnosis.act
      Comments

      SHALL contain exactly one [1..1] Date of Diagnosis Act (identifier: 2.16.840.1.113883.10.20.22.4.502) (CONF:4515-33013).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act(Date of Diagnosis Act)