Profile Comparison between http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation vs http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/cda/stds/core/StructureDefinition/Observation
copyright
date	2024-05-18T00:16:25-05:00	2024-12-19T00:36:20+00:00	Values Differ
description	Advance Directive Observations may include a variety of information called different “content types”. The set of Advance Directive Observations within an Advance Directive Organizer provides a summarization of relevant information available in an external Advance Healthcare Directive document or gathered as a result of a conversation with the patient or their healthcare agent (Advance Directive document or Portable Medical Order document). The types of content in an advance directive could include, but are not limited to: * Healthcare agent consent * Resuscitation procedure preference * Intubation and Ventilation procedure preference * Antibiotics or other medication administration preference * Artificial nutrition or hydration administration preference * Diagnostic Testing procedure preference * Preferences relating to palliative care * Preferences relating to hospice care * Organ donation preference * Autopsy procedure preference * Burial or funeral preference * Care preference that is general in nature which the patient wants care providers to take into consideration, such as likes or dislikes related to the experience of receiving care * Information about a personal goal, such as seeing a grandchild born, attending a child’s wedding, finding care for a beloved pet, or dying in a certain place. Preferences can be for or against certain procedures and are typically conditional based upon a certain health scenario taking place. The type of content in a portable medical order could include but are not limited to procedures that can be ordered such as cardiopulmonary resuscitation, hospital transfer, full/selected/comfort care, antibiotics administration, artificial nutrition and hydration administration, dialysis, intubation, ventilation, and more. Advance directives are effective when the individual is unable to communicate with their medical team themselves, due to a health crisis or emergency, and persist from execution until such time as the condition of the individual renders them appropriate for use. The effectiveTime/low tells when they went into effect (or will go into effect) and the high tells when they ceased or will cease to be in effect. If the starting effective time is not known, effectiveTime/low is UNK, but this would still be considered “Active”. At a minimum the starting effective time is the date signed. If effectiveTime/high contains a value of “NA” or it is not valued, the advance directive remains active until some action is taken to make it inactive, such as updating the document contents or revocation of the document itself. (Explicit use of nullFlavor=”NA” is the preferred approach for indicating an Advance Directive that is not time bounded.) That action may update the existing information with an effectiveTime/high or it may replace the open-ended entry with a new entry that includes the effectiveTime/high information. An advance directive is active so long as the effectiveTime/high has not been passed. The author of the Advance Directive Observation is the person documenting that the directives were reviewed and verified to be accurate for provision of treatment and care. The verifier is the person who read the document and verified the advance directive information. The role of verifier and the role of author need not be fulfilled by the same person, so each role is documented separately. However, the author and the verifier often will be the same person in advance healthcare directive documents that are NOT portable medical orders. This template supports Context Conduction. The author of the organizer can be assumed to be the author of the Advance Directive Observations within the organizer unless explicitly overridden within the contained observation. When author identity confidence is high, implementers should explicitly assert conformance to the Provenance Author Participation template. Advance Directive Observations that would appear in the context of an Advance Directive Organizer: | Information Content Type (as evidenced in an external document, or provided verbally during a patient encounter and not contained in an external document) | How the Observation is used to represent this information for exchange | | --- | --- | | Existing advance healthcare directive document | Observation.code = 75320 <br/> Observation.code.translation = 92183-3 (Form type) <br/> Observation.value = a code from Advance Healthcare Directive Categories <br/> Optional: entryRelationship to reference the external source document by identifier | | Appointment of healthcare agents that are consented to by the patient.| Observation.code = 75320 <br/> Observation.code.translation = 81335-2 <br/> Observation.value = a code from Healthcare Agent or Proxy Choices <br/> If no healthcare agents are appointed, Observation.value/@nullflavor = a code from No Healthcare Agent Included Reason <br/> Observation.participant is used to record an appointed healthcare agent. Each Advance Directive Observation of this type holds only one Healthcare Agent, necessitating that if a primary healthcare agent and a backup healthcare agent are designed two Advance Directive Observation entries are required. | | Patient’s Treatment Intervention Preferences (also supports preconditional health scenarios), Care Experience Preferences, and Upon Death Preferences. | When documenting that a patient has documented or expressed Treatment Intervention Preferences, Care Experience Preferences, or Upon Death Preferences, the person verifying the content in the referenced document is the performer of the observation and the observation.value tells what type of content was verified or discussed.<br/> The documented preference is included as a reference to the Treatment Intervention Preference, Care Experience Preference or Upon Death Preference identified in the source document.<br/>The verified current preference can be included as entryRelationships to a Treatment Intervention Preference or Care Experience Preference where the performer is the person verifying the information with the patient or the healthcare agent, the informant is the patient or healthcare agent, and the author is the person recording this documentation in the EHR. <br/> Observation.code = 75320 <br/> Observation.code.translation = 95541-9 Care Experience Preference <br/> 81378-2 Personal Intervention Preference <br/> 81337-8 Upon Death Preferences <br/> Observation.value = code from Advance Directive Content Type | | Personal healthcare goals (also supports preconditional health scenarios) | Observation.code = 75320 <br/> Observation.code.translation = 87528-6 Personal Health Goal <br/> Observation.value = a code from Health Goals at End of Life Grouping | | Practitioner Orders that are in place in a Portable Medical Order document. | Observation.code = 75320 <br/> Observation.code.translation = Code should come from CPT or SNOMED CT codes. <br/> Observation.value will be from a specialized value set including coded values appropriate for the specific order. Or if coded concepts are not available, Observation.value will be a Boolean where T = perform and F=do-not-perform | {:.grid} Advance Directive Observation that would not be contained in the context of an Advance Directive Organizer: | Information Content Type (as evidenced in an external document, or provided verbally during a patient encounter and not contained in an external document) | How the Observation is used to represent this information for exchange | | --- | --- | | Advance Directive Observation authored by the organization creating the C-CDA document to show the Patient’s DNR Status. | Observation.code = 75320 <br/> Observation.code.translation = 100822-6 Cardiopulmonary resuscitation orders <br/> Observation.value will be LA33470-8 (Yes CPR) or LA33471-6 (No CPR) | {:.grid}	The Advance Directive Observation template is nested within the Advance Directive Existence Observation, which indicates whether the individual has any advance directive documents. This template provides details about the type of advance directive document and may also include information on the document’s author, as well as any individuals who verified its contents with the patient or their designated healthcare agent.	Values Differ
experimental
fhirVersion	5.0.0
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	logical
name	AdvanceDirectiveObservation
publisher	Health Level Seven
purpose
status	draft
title	Advance Directive Observation
type	http://hl7.org/cda/stds/core/StructureDefinition/Observation
url	http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation
version	3.0.0	4.0.0-ballot	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	R Type	R Description & Constraints	Comments
Observation	C	1..1	Observation	Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author should-informant: SHOULD contain informant	C	1..1	Observation	Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author should-informant: SHOULD contain informant
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
realmCode		0..*	CS			0..*	CS
typeId		0..1	II		C	0..1	II	II-1: An II instance must have either a root or an nullFlavor.	StructureDefinition AdvanceDirectiveObservation has added constraint that is not found in AdvanceDirectiveObservation and it is uncertain whether they are compatible (root.exists() or nullFlavor.exists())
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
assigningAuthorityName		0..1	??			0..1	??
displayable		0..1	??			0..1	??
root		1..1	??, ??, ??	Fixed Value: 2.16.840.1.113883.1.3		1..1	??, ??, ??	Fixed Value: 2.16.840.1.113883.1.3
st-simple		1..1	string	Primitive Type string URL: http://hl7.org/cda/stds/core/StructureDefinition/st-simple		1..1	string	Primitive Type string URL: http://hl7.org/cda/stds/core/StructureDefinition/st-simple
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension		1..*	II	Slice: Unordered, Open by value:root, value:extension
classCode		1..1	??	Binding: ?? (required) Fixed Value: OBS		1..1	??	Binding: ?? (required) Fixed Value: OBS
moodCode		1..1	??	Binding: ?? (required) Fixed Value: EVN		1..1	??	Binding: ?? (required) Fixed Value: EVN
negationInd		0..1	??			0..1	??
id		1..*	II			1..*	II
code	C	1..1	CD	Binding: ?? (example) should-translation: SHOULD contain translation	C	1..1	CD	Advance Directive Binding: ?? (example) should-translation: SHOULD contain translation
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
code		1..1	??	Required Pattern: 75320-2		1..1	??	Required Pattern: 75320-2
codeSystem		0..1	??, ??, ??			1..1	??, ??, ??	LOINC Required Pattern: 2.16.840.1.113883.6.1	Element minimum cardinalities differ: '0' vs '1'
codeSystemName		0..1	??			0..1	??
codeSystemVersion		0..1	??			0..1	??
displayName		0..1	??			0..1	??
sdtcValueSet		0..1	??	XML: valueSet (urn:hl7-org:sdtc)		0..1	??	XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion		0..1	??	XML: valueSetVersion (urn:hl7-org:sdtc)		0..1	??	XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..1	ED			0..1	ED
qualifier		0..*	CR			0..*	CR
translation		0..*	CD	Binding: ?? (preferred)		0..*	CD	𝗨𝗦𝗖𝗗𝗜: Advance Directive Type Binding: ?? (preferred)
derivationExpr		0..1	ST			0..1	ST
text		1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry		1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
compression		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
integrityCheck		0..1	??			0..1	??
integrityCheckAlgorithm		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
language		0..1	??			0..1	??
mediaType		0..1	??	Binding: ?? (example)		0..1	??	Binding: ?? (example)
representation		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
xmlText		0..1	??	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.		0..1	??	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
thumbnail		0..1	ED			0..1	ED
statusCode		1..1	CS	Binding: ?? (required)		1..1	CS	Binding: ?? (required)
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
code		1..1	??	Fixed Value: completed		1..1	??	Fixed Value: completed
codeSystem		0..0				0..0
codeSystemName		0..0				0..0
codeSystemVersion		0..0				0..0
displayName		0..0				0..0
sdtcValueSet		0..1	??	XML: valueSet (urn:hl7-org:sdtc)		0..1	??	XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion		0..1	??	XML: valueSetVersion (urn:hl7-org:sdtc)		0..1	??	XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..0				0..0
qualifier		0..0				0..0
translation		0..0				0..0
effectiveTime		1..1	IVL_TS			1..1	IVL_TS
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
value		0..1	??	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]		0..1	??	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
operator		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
low		1..1	IVXB_TS			1..1	IVXB_TS
center		0..1	TS			0..1	TS
width		0..1	PQ			0..1	PQ
high	C	1..1	IVXB_TS	1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).	C	1..1	IVXB_TS	1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
priorityCode		0..1	CE	Binding: ?? (example)		0..1	CE	Binding: ?? (example)
repeatNumber		0..1	IVL_INT			0..1	IVL_INT
languageCode		0..1	CS	Binding: ?? (required)		0..1	CS	Binding: ?? (required)
value		1..1	CD	Binding: ?? (required): Advance Directive Content Type		0..1	ANY, BL, ED, ST, CD, CV, CE, CO, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ		Element minimum cardinalities differ: '1' vs '0'
interpretationCode		0..*	CE	Binding: ?? (required)		0..*	CE	Binding: ?? (required)
methodCode		0..*	CE	Binding: ?? (example)		0..*	CE	Binding: ?? (example)
targetSiteCode		0..*	CD			0..*	CD
subject		0..1	Subject			0..1	Subject
specimen		0..*	Specimen			0..*	Specimen
performer		0..*	Performer2			0..*	Performer2
author		0..*	??	Base for all types and resources		0..*	??	Base for all types and resources
informant		0..*	Informant	SHOULD contain informant		0..*	Informant	SHOULD contain informant
Slices for participant		0..*	Participant2	Slice: Unordered, Open by value:typeCode		0..*	Participant2	Slice: Unordered, Open by value:typeCode
entryRelationship		0..*	EntryRelationship			0..*	EntryRelationship
Slices for reference		1..*	Reference	Slice: Unordered, Open by value:typeCode		1..*	Reference	Slice: Unordered, Open by value:typeCode
precondition		0..*	Precondition			0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML: precondition2 (urn:hl7-org:sdtc)		0..*	Precondition2	XML: precondition2 (urn:hl7-org:sdtc)
referenceRange		0..*	InfrastructureRoot			0..*	InfrastructureRoot
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
realmCode		0..*	CS			0..*	CS
typeId		0..1	II		C	0..1	II	II-1: An II instance must have either a root or an nullFlavor.	StructureDefinition AdvanceDirectiveObservation has added constraint that is not found in AdvanceDirectiveObservation and it is uncertain whether they are compatible (root.exists() or nullFlavor.exists())
nullFlavor		0..1	??	Binding: ?? (required)		0..1	??	Binding: ?? (required)
assigningAuthorityName		0..1	??			0..1	??
displayable		0..1	??			0..1	??
root		1..1	??, ??, ??	Fixed Value: 2.16.840.1.113883.1.3		1..1	??, ??, ??	Fixed Value: 2.16.840.1.113883.1.3
st-simple		1..1	string	Primitive Type string URL: http://hl7.org/cda/stds/core/StructureDefinition/st-simple		1..1	string	Primitive Type string URL: http://hl7.org/cda/stds/core/StructureDefinition/st-simple
templateId		0..*	II			0..*	II
typeCode		0..1	??	Binding: ?? (required) Fixed Value: REFV		0..1	??	Binding: ?? (required) Fixed Value: REFV
observationRange		1..1	ObservationRange			1..1	ObservationRange
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML: inFulfillmentOf1 (urn:hl7-org:sdtc)		0..*	InFulfillmentOf1	XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
sdtcCategory						0..*	CD	XML: category (urn:hl7-org:sdtc)	Added this element
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