Problem Value, Translation, Qualifier examples

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 4/7/2022 (previously approved 6/17/2021 example available here)
  • SDWG: 3/9/2023

C-CDA 2.1 Example:

  • 2.16.840.1.113883.10.20.22.2.5.1:2015-08-01
  • 2.16.840.1.113883.10.20.22.4.3:2015-08-01
  • 2.16.840.1.113883.10.20.22.4.119
  • 2.16.840.1.113883.10.20.22.4.4:2015-08-01

Reference to full CDA sample:

  • Problems in empty CCD

Validation location

Comments

  • This example illustrates how to structure an active problem with value codes that need translation & qualifiers.
  • Note that no formally vetted post-coordination semantics exist for codesystems besides SNOMED today (eg ICD-10), which is a limitation
  • to this example. Example was updated after the March 2022 C-CDA Implementation-a-thon.

Custodian

  • Dave Carlson (dcarlson@mieweb.com)
  • Brett Marquard brett@waveoneassociates.com (GitHub: brettmarquard)

Keywords

  • problems

 

Example: download example view on GitHub 

<section>
    <templateId root="2.16.840.1.113883.10.20.22.2.5.1"/>
    <templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01"/>
    <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" displayName="Problem List"/>
    <title>Problem List</title>
    <text>
        <table>
            <thead>
                <tr>
                    <th>Name</th>
                    <th>Dates</th>
                    <th>Status</th>
                </tr>
            </thead>
            <tbody>
                <tr ID="Problem1">
                    <td ID="Problem1Text">Diabetes mellitus due to underlying condition with chronic kidney disease on chronic dialysis (CMS/HCC)</td>
                    <td>
                        <content>Onset: February 27 2014</content>
                    </td>
                    <td>Active</td>
                </tr>
            </tbody>
        </table>
    </text>
    <entry>
        <act classCode="ACT" moodCode="EVN">
            <templateId root="2.16.840.1.113883.10.20.22.4.3" />
            <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01"/>
            <id root="102ca2e9-884c-4523-a2b4-1b6c3469c397"/>
            <code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>
            <!-- Since this is an active problem, the concern status is active. -->
            <!-- While clinicians can track resolved problems, generally active problems will have active concern status and resolved concerns will be completed -->
            <statusCode code="active"/>
            <effectiveTime>
                <!-- This equates to the time the concern was authored in the patient's chart. This may frequently be an EHR timestamp-->
                <low value="20140302124536-0500"/>
            </effectiveTime>
            <entryRelationship typeCode="SUBJ">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.4" />
                    <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
                    <id extension="10241104348" root="1.3.6.1.4.1.22812.4.111.0.4.1.2.1"/>
                    <code code="55607006" displayName="Problem"
                        codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
                        <translation code="75326-9" codeSystem="2.16.840.1.113883.6.1"
                            codeSystemName="LOINC" displayName="Problem"/>
                    </code>
                    <text>
                        <reference value="#Problem1"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime>
                        <!-- This represents the date of biological onset. -->
                        <low value="20140227"/>
                    </effectiveTime>
                    <!-- Post-coordination can be used for SNOMED to create a single problem encapsulating multiple
                         codes. No such semantics have been agreed on yet for other code systems. -->
                    <value xsi:type="CD" code="8801005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Secondary diabetes mellitus">
                        <originalText>
                            <reference value="#Problem1Text" />
                        </originalText>
                        <!-- Additional qualifiers representing the concepts not captured in the first SNOMED code. The qualifier/name
                             uses the SNOMED code "associated with" or its children ("causative agent", "due to", or "temporarily related to"). -->
                        <qualifier>
                            <name code="47429007" displayName="Associated with" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" />
                            <value code="105502003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Dependence on renal dialysis" />
                        </qualifier>
                        <qualifier>
                            <name code="47429007" displayName="Associated with" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" />
                            <value code="709044004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Chronic kidney disease" />
                        </qualifier>
                        
                        <!-- ICD-10 translation. Note the lack of specificity due to not having qualifiers! -->
                        <translation code="E08.22" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD10" displayName="Diabetes mellitus due to underlying condition with diabetic chronic kidney disease" />
                        
                        <!-- 3rd-party vocabulary codes (for example, from terminology vendors) may also allow senders to represent complex problems
                             without losing specificity... however, this requires both the sender and receiver to understand the same vendor terminology. -->
                        <translation code="65167828" codeSystem="2.16.840.1.113883.3.247.1.1" codeSystemName="3rdPartyCodeSystem" displayName="Diabetes mellitus due to underlying condition with diabetic chronic kidney disease" />
                        
                        <!-- Other translations as above... -->
                    </value>
                    <author>
                        <templateId root="2.16.840.1.113883.10.20.22.4.119"/>
                        <time value="20140302124536"/>
                        <assignedAuthor>
                            <id extension="66666" root="2.16.840.1.113883.4.6"/>
                            <code code="207RC0000X" codeSystem="2.16.840.1.113883.6.101"
                                codeSystemName="NUCC" displayName="Allopathic &amp; Osteopathic Physicians; Internal Medicine, Cardiovascular Disease"/>
                            <addr>
                                <streetAddressLine>6666 StreetName St.</streetAddressLine>
                                <city>Silver Spring</city>
                                <state>MD</state>
                                <postalCode>20901</postalCode>
                                <country>US</country>
                            </addr>
                            <telecom value="tel:+1(301)666-6666" use="WP"/>
                            <assignedPerson>
                                <name>
                                    <given>Heartly</given>
                                    <family>Sixer</family>
                                    <suffix>MD</suffix>
                                </name>
                            </assignedPerson>
                        </assignedAuthor>
                    </author>
                </observation>
            </entryRelationship>
        </act>
    </entry>
</section>

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