International Patient Summary 1.0.0 Release
1.0 - CI Build

International Patient Summary 1.0.0 Release - Local Development build (v1.0). See the Directory of published versions

Resource Profile: IPS Problem Concern Entry

Official URL: http://localhost:8877/fhir/StructureDefinition/2.16.840.1.113883.10.22.4.7--20210804084927 Version: 1.0
Draft as of 2021-08-04 Computable Name: IPSProblemConcernEntry
Other Identifiers: id: urn: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,…html) 

  • The status of the condition (e.g. active, inactive, resolved,…html) 

  • The confirmation status [clinical workflow status, certainty] (e.g. confirmed, likely, unlikely,….html) 

Not all of them can be represented in a CDA using the statusCode elements of the concern (ACT.html) and observation (condition.html). 

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.html), 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.html). 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.html): Chest Pain

— Problem Observation (author/time Jan 6, 2012.html): Esophagitis

Many systems display the nested Problem Observation with the most recent author time stamp, and provide a mechanism for viewing prior observations.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CDAR2.Act

NameFlagsCard.TypeDescription & Constraintsdoco
.. Act S0..*CDAR2.ActBase for all types and resources
... classCode 1..1codeFixed Value: ACT
... moodCode 1..1codeFixed Value: EVN
... Slices for templateId 0..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:primary S1..1II
..... root 1..1stringFixed Value: 2.16.840.1.113883.10.22.4.7
... code S1..1CD
.... code 1..1stringFixed Value: CONC
.... codeSystem 1..1stringFixed Value: 2.16.840.1.113883.5.6
... statusCode S1..1CSBinding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete

... effectiveTime S1..1IVL_TS
.... low S1..1TS
.... high 0..1TS
... Slices for entryRelationship 0..*ElementSlice: Unordered, Open by value:profile
.... entryRelationship:entryRelationship-1 SC1..*IPSProblemEntryBase for all types and resources
entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
..... typeCode 1..1codeFixed Value: SUBJ
..... inversionInd 0..1booleanFixed Value: false

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Act.statusCoderequiredX_ActStatusActiveComplete

Constraints

IdGradePath(s)DetailsRequirements
entryRelationship-1nullAct.entryRelationship:entryRelationship-1contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
:
NameFlagsCard.TypeDescription & Constraintsdoco
.. Act S0..*CDAR2.ActBase for all types and resources
... classCode 1..1codeFixed Value: ACT
... moodCode 1..1codeFixed Value: EVN
... Slices for templateId 0..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:primary S1..1II
..... root 1..1stringFixed Value: 2.16.840.1.113883.10.22.4.7
... code S1..1CDBinding: v3 Code System ActCode (extensible)
.... code 1..1stringFixed Value: CONC
.... codeSystem 1..1stringFixed Value: 2.16.840.1.113883.5.6
... statusCode S1..1CSBinding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete

... effectiveTime S1..1IVL_TS
.... low S1..1TS
.... high 0..1TS
... Slices for entryRelationship C0..*ElementSlice: Unordered, Open by value:profile
.... entryRelationship:All Slices Content/Rules for all slices
..... typeCode 1..1code
..... contextConductionInd 1..1boolean
.... entryRelationship:entryRelationship-1 SC1..*IPSProblemEntryBase for all types and resources
entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
..... typeCode 1..1codeFixed Value: SUBJ
..... inversionInd 0..1booleanFixed Value: false
..... contextConductionInd 1..1boolean

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Act.codeextensibleActCode
Act.statusCoderequiredX_ActStatusActiveComplete

Constraints

IdGradePath(s)DetailsRequirements
act-er-1errorAct.entryRelationship, Act.entryRelationship:entryRelationship-1Only one of observation, regionOfInterest, observationMedia, substanceAdministration, supply, procedure, encounter, organizer, and act
: (observation | regionOfInterest | observationMedia | substanceAdministration | supply | procedure | encounter | organizer | act).count() = 1
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
entryRelationship-1nullAct.entryRelationship:entryRelationship-1contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
:
NameFlagsCard.TypeDescription & Constraintsdoco
.. Act S0..*CDAR2.ActBase for all types and resources
... classCode 1..1codeFixed Value: ACT
... moodCode 1..1codeFixed Value: EVN
... realmCode 0..*CS
... Slices for templateId 0..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:primary S1..1II
..... nullFlavor 0..1codeBinding: NullFlavor (required)
..... assigningAuthorityName 0..1string
..... displayable 0..1boolean
..... root 1..1stringFixed Value: 2.16.840.1.113883.10.22.4.7
..... extension 0..1string
... id S0..*II
... code S1..1CDBinding: v3 Code System ActCode (extensible)
.... nullFlavor 0..1codeBinding: NullFlavor (required)
.... code 1..1stringFixed Value: CONC
.... codeSystem 1..1stringFixed Value: 2.16.840.1.113883.5.6
.... codeSystemName 0..1string
.... codeSystemVersion 0..1string
.... displayName 0..1string
.... sdtcValueSet 0..1stringXML: valueSet (urn:hl7-org:sdtc)
.... sdtcValueSetVersion 0..1stringXML: valueSetVersion (urn:hl7-org:sdtc)
.... originalText 0..1ED
.... qualifier 0..*CR
.... translation 0..*CD
... negationInd 0..1boolean
... text 0..1ED
... statusCode S1..1CSBinding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete

... effectiveTime S1..1IVL_TS
.... nullFlavor 0..1codeBinding: NullFlavor (required)
.... value 0..1dateTime
.... inclusive 0..1boolean
.... operator 0..1code
.... low S1..1TS
.... high 0..1TS
.... width 0..1PQ
.... center 0..1TS
... priorityCode 0..1CEBinding: ActPriority (extensible)
... languageCode 0..1CSBinding: HumanLanguage (required)
... subject 0..1Element
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... typeCode 1..1codeBinding: ParticipationTargetSubject (required)
Fixed Value: SBJ
.... contextControlCode 1..1codeBinding: ContextControl (required)
Fixed Value: OP
.... awarenessCode 0..1CEBinding: TargetAwareness (extensible)
.... relatedSubject 1..1RelatedSubject
... specimen 0..*Specimen
... performer 0..*Performer2
... author 0..*Author
... informant 0..*Element
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... typeCode 1..1codeBinding: ParticipationInformationGenerator (required)
Fixed Value: INF
.... contextControlCode 1..1codeBinding: ContextControl (required)
Fixed Value: OP
.... assignedEntity 0..1AssignedEntity
.... relatedEntity 0..1RelatedEntity
... participant 0..*Participant2
... Slices for entryRelationship C0..*ElementSlice: Unordered, Open by value:profile
.... entryRelationship:All Slices Content/Rules for all slices
..... id 0..1idUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... typeCode 1..1code
..... inversionInd 0..1boolean
..... contextConductionInd 1..1boolean
..... sequenceNumber 0..1INT
..... negationInd 0..1boolean
..... seperatableInd 0..1BL
..... (Choice of one) 1..1
...... observation 0..1Observation
...... regionOfInterest 0..1RegionOfInterest
...... observationMedia 0..1ObservationMedia
...... substanceAdministration 0..1SubstanceAdministration
...... supply 0..1Supply
...... procedure 0..1Procedure
...... encounter 0..1Encounter
...... organizer 0..1Organizer
...... act 0..1Act
.... entryRelationship:entryRelationship-1 SC1..*IPSProblemEntryBase for all types and resources
entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
..... id 0..1idUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... typeCode 1..1codeFixed Value: SUBJ
..... inversionInd 0..1booleanFixed Value: false
..... contextConductionInd 1..1boolean
..... sequenceNumber 0..1INT
..... negationInd 0..1boolean
..... seperatableInd 0..1BL
..... (Choice of one) 1..1
...... observation 0..1Observation
...... regionOfInterest 0..1RegionOfInterest
...... observationMedia 0..1ObservationMedia
...... substanceAdministration 0..1SubstanceAdministration
...... supply 0..1Supply
...... procedure 0..1Procedure
...... encounter 0..1Encounter
...... organizer 0..1Organizer
...... act 0..1Act
... reference 0..*Element
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... typeCode 1..1code
.... seperatableInd 0..1BL
.... externalAct 0..1ExternalAct
.... externalObservation 0..1ExternalObservation
.... externalProcedure 0..1ExternalProcedure
.... externalDocument 0..1ExternalDocument
... precondition 0..*Precondition

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Act.templateId:primary.nullFlavorrequiredNullFlavor
Act.codeextensibleActCode
Act.code.nullFlavorrequiredNullFlavor
Act.statusCoderequiredX_ActStatusActiveComplete
Act.effectiveTime.nullFlavorrequiredNullFlavor
Act.priorityCodeextensibleActPriority
Act.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)
Act.subject.typeCoderequiredFixed Value: SBJ
Act.subject.contextControlCoderequiredFixed Value: OP
Act.subject.awarenessCodeextensibleTargetAwareness
Act.informant.typeCoderequiredFixed Value: INF
Act.informant.contextControlCoderequiredFixed Value: OP

Constraints

IdGradePath(s)DetailsRequirements
act-er-1errorAct.entryRelationship, Act.entryRelationship:entryRelationship-1Only one of observation, regionOfInterest, observationMedia, substanceAdministration, supply, procedure, encounter, organizer, and act
: (observation | regionOfInterest | observationMedia | substanceAdministration | supply | procedure | encounter | organizer | act).count() = 1
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
entryRelationship-1nullAct.entryRelationship:entryRelationship-1contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
:
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from CDAR2.Act

Summary

Mandatory: 12 elements
Must-Support: 7 elements
Fixed Value: 7 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Act.templateId is sliced based on the values of value:root, value:extension
  • The element Act.entryRelationship is sliced based on the value of value:profile

Differential View

This structure is derived from CDAR2.Act

NameFlagsCard.TypeDescription & Constraintsdoco
.. Act S0..*CDAR2.ActBase for all types and resources
... classCode 1..1codeFixed Value: ACT
... moodCode 1..1codeFixed Value: EVN
... Slices for templateId 0..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:primary S1..1II
..... root 1..1stringFixed Value: 2.16.840.1.113883.10.22.4.7
... code S1..1CD
.... code 1..1stringFixed Value: CONC
.... codeSystem 1..1stringFixed Value: 2.16.840.1.113883.5.6
... statusCode S1..1CSBinding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete

... effectiveTime S1..1IVL_TS
.... low S1..1TS
.... high 0..1TS
... Slices for entryRelationship 0..*ElementSlice: Unordered, Open by value:profile
.... entryRelationship:entryRelationship-1 SC1..*IPSProblemEntryBase for all types and resources
entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
..... typeCode 1..1codeFixed Value: SUBJ
..... inversionInd 0..1booleanFixed Value: false

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Act.statusCoderequiredX_ActStatusActiveComplete

Constraints

IdGradePath(s)DetailsRequirements
entryRelationship-1nullAct.entryRelationship:entryRelationship-1contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
:

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Act S0..*CDAR2.ActBase for all types and resources
... classCode 1..1codeFixed Value: ACT
... moodCode 1..1codeFixed Value: EVN
... Slices for templateId 0..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:primary S1..1II
..... root 1..1stringFixed Value: 2.16.840.1.113883.10.22.4.7
... code S1..1CDBinding: v3 Code System ActCode (extensible)
.... code 1..1stringFixed Value: CONC
.... codeSystem 1..1stringFixed Value: 2.16.840.1.113883.5.6
... statusCode S1..1CSBinding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete

... effectiveTime S1..1IVL_TS
.... low S1..1TS
.... high 0..1TS
... Slices for entryRelationship C0..*ElementSlice: Unordered, Open by value:profile
.... entryRelationship:All Slices Content/Rules for all slices
..... typeCode 1..1code
..... contextConductionInd 1..1boolean
.... entryRelationship:entryRelationship-1 SC1..*IPSProblemEntryBase for all types and resources
entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
..... typeCode 1..1codeFixed Value: SUBJ
..... inversionInd 0..1booleanFixed Value: false
..... contextConductionInd 1..1boolean

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Act.codeextensibleActCode
Act.statusCoderequiredX_ActStatusActiveComplete

Constraints

IdGradePath(s)DetailsRequirements
act-er-1errorAct.entryRelationship, Act.entryRelationship:entryRelationship-1Only one of observation, regionOfInterest, observationMedia, substanceAdministration, supply, procedure, encounter, organizer, and act
: (observation | regionOfInterest | observationMedia | substanceAdministration | supply | procedure | encounter | organizer | act).count() = 1
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
entryRelationship-1nullAct.entryRelationship:entryRelationship-1contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
:

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Act S0..*CDAR2.ActBase for all types and resources
... classCode 1..1codeFixed Value: ACT
... moodCode 1..1codeFixed Value: EVN
... realmCode 0..*CS
... Slices for templateId 0..*IISlice: Unordered, Open by value:root, value:extension
.... templateId:primary S1..1II
..... nullFlavor 0..1codeBinding: NullFlavor (required)
..... assigningAuthorityName 0..1string
..... displayable 0..1boolean
..... root 1..1stringFixed Value: 2.16.840.1.113883.10.22.4.7
..... extension 0..1string
... id S0..*II
... code S1..1CDBinding: v3 Code System ActCode (extensible)
.... nullFlavor 0..1codeBinding: NullFlavor (required)
.... code 1..1stringFixed Value: CONC
.... codeSystem 1..1stringFixed Value: 2.16.840.1.113883.5.6
.... codeSystemName 0..1string
.... codeSystemVersion 0..1string
.... displayName 0..1string
.... sdtcValueSet 0..1stringXML: valueSet (urn:hl7-org:sdtc)
.... sdtcValueSetVersion 0..1stringXML: valueSetVersion (urn:hl7-org:sdtc)
.... originalText 0..1ED
.... qualifier 0..*CR
.... translation 0..*CD
... negationInd 0..1boolean
... text 0..1ED
... statusCode S1..1CSBinding: x_ActStatusActiveComplete (required): x_ActStatusActiveComplete

... effectiveTime S1..1IVL_TS
.... nullFlavor 0..1codeBinding: NullFlavor (required)
.... value 0..1dateTime
.... inclusive 0..1boolean
.... operator 0..1code
.... low S1..1TS
.... high 0..1TS
.... width 0..1PQ
.... center 0..1TS
... priorityCode 0..1CEBinding: ActPriority (extensible)
... languageCode 0..1CSBinding: HumanLanguage (required)
... subject 0..1Element
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... typeCode 1..1codeBinding: ParticipationTargetSubject (required)
Fixed Value: SBJ
.... contextControlCode 1..1codeBinding: ContextControl (required)
Fixed Value: OP
.... awarenessCode 0..1CEBinding: TargetAwareness (extensible)
.... relatedSubject 1..1RelatedSubject
... specimen 0..*Specimen
... performer 0..*Performer2
... author 0..*Author
... informant 0..*Element
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... typeCode 1..1codeBinding: ParticipationInformationGenerator (required)
Fixed Value: INF
.... contextControlCode 1..1codeBinding: ContextControl (required)
Fixed Value: OP
.... assignedEntity 0..1AssignedEntity
.... relatedEntity 0..1RelatedEntity
... participant 0..*Participant2
... Slices for entryRelationship C0..*ElementSlice: Unordered, Open by value:profile
.... entryRelationship:All Slices Content/Rules for all slices
..... id 0..1idUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... typeCode 1..1code
..... inversionInd 0..1boolean
..... contextConductionInd 1..1boolean
..... sequenceNumber 0..1INT
..... negationInd 0..1boolean
..... seperatableInd 0..1BL
..... (Choice of one) 1..1
...... observation 0..1Observation
...... regionOfInterest 0..1RegionOfInterest
...... observationMedia 0..1ObservationMedia
...... substanceAdministration 0..1SubstanceAdministration
...... supply 0..1Supply
...... procedure 0..1Procedure
...... encounter 0..1Encounter
...... organizer 0..1Organizer
...... act 0..1Act
.... entryRelationship:entryRelationship-1 SC1..*IPSProblemEntryBase for all types and resources
entryRelationship-1: contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
..... id 0..1idUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... typeCode 1..1codeFixed Value: SUBJ
..... inversionInd 0..1booleanFixed Value: false
..... contextConductionInd 1..1boolean
..... sequenceNumber 0..1INT
..... negationInd 0..1boolean
..... seperatableInd 0..1BL
..... (Choice of one) 1..1
...... observation 0..1Observation
...... regionOfInterest 0..1RegionOfInterest
...... observationMedia 0..1ObservationMedia
...... substanceAdministration 0..1SubstanceAdministration
...... supply 0..1Supply
...... procedure 0..1Procedure
...... encounter 0..1Encounter
...... organizer 0..1Organizer
...... act 0..1Act
... reference 0..*Element
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... typeCode 1..1code
.... seperatableInd 0..1BL
.... externalAct 0..1ExternalAct
.... externalObservation 0..1ExternalObservation
.... externalProcedure 0..1ExternalProcedure
.... externalDocument 0..1ExternalDocument
... precondition 0..*Precondition

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Act.templateId:primary.nullFlavorrequiredNullFlavor
Act.codeextensibleActCode
Act.code.nullFlavorrequiredNullFlavor
Act.statusCoderequiredX_ActStatusActiveComplete
Act.effectiveTime.nullFlavorrequiredNullFlavor
Act.priorityCodeextensibleActPriority
Act.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)
Act.subject.typeCoderequiredFixed Value: SBJ
Act.subject.contextControlCoderequiredFixed Value: OP
Act.subject.awarenessCodeextensibleTargetAwareness
Act.informant.typeCoderequiredFixed Value: INF
Act.informant.contextControlCoderequiredFixed Value: OP

Constraints

IdGradePath(s)DetailsRequirements
act-er-1errorAct.entryRelationship, Act.entryRelationship:entryRelationship-1Only one of observation, regionOfInterest, observationMedia, substanceAdministration, supply, procedure, encounter, organizer, and act
: (observation | regionOfInterest | observationMedia | substanceAdministration | supply | procedure | encounter | organizer | act).count() = 1
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
entryRelationship-1nullAct.entryRelationship:entryRelationship-1contains IPS Problem Entry 2.16.840.1.113883.10.22.4.8 (2021-08-04.html)
:
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from CDAR2.Act

Summary

Mandatory: 12 elements
Must-Support: 7 elements
Fixed Value: 7 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Act.templateId is sliced based on the values of value:root, value:extension
  • The element Act.entryRelationship is sliced based on the value of value:profile

 

Other representations of profile: CSV, Excel, Schematron