description: This template reflects a discrete observation about a patient's problem. Because it is a discrete observation, it will have a statusCode of \"completed\". The effectiveTime, also referred to as the \"biologically relevant time\" is the time at which the observation holds for the patient. For a provider seeing a patient in the clinic today, observing a history of heart attack that occurred five years ago, the effectiveTime is five years ago. \n\nThe effectiveTime of the Problem Observation is the definitive indication of whether or not the underlying condition is inactive. If the problem is known to be resolved, in remission, or otherwise inactive, then an effectiveTime/high would be present. If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of \"UNK\".
package_name: hl7.cda.us.ccda
derivation: constraint
name: ProblemObservation
type: http://hl7.org/cda/stds/core/StructureDefinition/Observation
elements:
  entryRelationship:
    index: 20
    slicing:
      rules: open
      discriminator:
      - {path: observation, type: profile}
      - {path: act, type: profile}
      min: null
      slices:
        age:
          match: {}
          schema:
            index: 21
            elements:
              typeCode:
                pattern: {type: Code, value: SUBJ}
                index: 22
              inversionInd:
                pattern: {type: Boolean, value: true}
                index: 23
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 24}
            required: [inversionInd, observation]
        prognosis:
          match: {}
          schema:
            index: 25
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 26
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 27}
            required: [observation]
        priority:
          match: {}
          schema:
            array: true
            index: 28
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 29
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 30}
            required: [observation]
        status:
          match: {}
          schema:
            index: 31
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 32
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 33}
            required: [observation]
        reference:
          match: {}
          schema:
            index: 34
            elements:
              typeCode:
                pattern: {type: Code, value: SPRT}
                index: 35
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 36}
            required: [act]
        assessment:
          match: {}
          schema:
            index: 37
            elements:
              typeCode:
                pattern: {type: Code, value: SPRT}
                index: 38
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 39}
            required: [observation]
        dateOfDiagnosis:
          match: {}
          schema:
            short: '𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis'
            index: 40
            elements:
              typeCode:
                pattern: {type: Code, value: COMP}
                index: 41
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 42}
            required: [act]
  value:
    short: '𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns'
    type: http://hl7.org/cda/stds/core/StructureDefinition/CD
    binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code'}
    index: 16
    elements:
      code: {short: 'A 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).', index: 17}
      qualifier:
        short: |-
          The 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.
        index: 18
  classCode:
    pattern: {type: Code, value: OBS}
    index: 4
  author: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Author', index: 19}
  id: {index: 7}
  code:
    binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1'}
    index: 8
  moodCode:
    pattern: {type: Code, value: EVN}
    index: 5
  effectiveTime:
    short: If 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.
    index: 13
    elements:
      low: {short: The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active., index: 14}
      high: {short: '𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.', index: 15}
    required: [low]
  templateId:
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: root, type: value}
      - {path: extension, type: value}
      min: 1
      slices:
        problem-obs:
          match: {root: 2.16.840.1.113883.10.20.22.4.4, extension: '2024-05-01'}
          schema:
            _required: true
            index: 1
            elements:
              root:
                pattern: {type: String, value: 2.16.840.1.113883.10.20.22.4.4}
                index: 2
              extension:
                pattern: {type: String, value: '2024-05-01'}
                index: 3
            required: [root, extension]
            extensions: {}
  statusCode:
    index: 11
    elements:
      code:
        pattern: {type: Code, value: completed}
        index: 12
    required: [code]
  text:
    short: SHOULD reference the portion of section narrative text corresponding to this entry
    index: 9
    elements:
      reference:
        constraint:
          value-starts-octothorpe: {human: 'If reference/@value is present, it SHALL begin with a ''#'' and SHALL point to its corresponding narrative', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/ProblemObservation', severity: error, expression: value.exists() implies value.startsWith('#')}
        index: 10
  negationInd: {short: The 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., index: 6}
package_version: 4.0.0-ballot
class: logical
kind: logical
url: http://hl7.org/cda/us/ccda/StructureDefinition/ProblemObservation
base: http://hl7.org/cda/stds/core/StructureDefinition/Observation
version: 4.0.0-ballot
required: [id, effectiveTime, value, statusCode, templateId]