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Problem Concern Act

[Act: templateId 2.16.840.1.113883.10.20.22.4.3]

Observations of problems or other clinical statements captured at a point in time are wrapped in a "Concern" act, which represents the ongoing process tracked over time. This allows for binding related observations of problems. For example, the observation of "Acute MI" in 2004 can be related to the observation of "History of MI" in 2006 because they are the same concern. The conformance statements in this section define an outer "problem act" (representing the "Concern") that can contain a nested "problem observation" or other nested clinical statements.

  1. SHALL contain exactly one [1..1] templateId ( CONF:16772, CONF:16773 ) such that it
    1. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.3"
  2. SHALL contain exactly one [1..1] @classCode="ACT" Act (CodeSystem: 2.16.840.1.113883.5.6 HL7ActClass) (CONF:9024)
  3. SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: 2.16.840.1.113883.5.1001 HL7ActMood) (CONF:9025)
  4. SHALL contain at least one [1..*] id (CONF:9026)
  5. SHALL contain exactly one [1..1] code (CONF:9027)/@code="CONC" Concern (CodeSystem: 2.16.840.1.113883.5.6 HL7ActClass) (CONF:9440)
  6. SHALL contain exactly one [1..1] statusCode, where the @code SHALL be selected from ValueSet ProblemActStatusCode 2.16.840.1.113883.11.20.9.19 STATIC 2011-09-09 (CONF:9029)

    • The statusCode associated with any concern must be one of the following values:



      active: A concern that is still being tracked.
      suspended: A concern that is active, but which may be set aside. For example, this value might be used to suspend concern
      about a patient problem after some period of remission, but before assumption that the concern has been resolved.
      aborted: A concern that is no longer actively being tracked, but for reasons other than because the problem was resolved.
      This value might be used to mark a concern as being aborted after a patient leaves care against medical advice.
      completed:
      The problem, allergy or medical state has been resolved and the concern no longer needs to be tracked except for
      historical purposes.

  7. SHALL contain exactly one [1..1] effectiveTime (CONF:9030)
    • The effectiveTime element records the starting and ending times during which the concern was active on the Problem List.

  8. SHALL contain at least one [1..*] entryRelationship (CONF:15980)
    1. Contains @typeCode="SUBJ" SUBJ
    2. Contains exactly one [1..1] Problem Observation (templateId: 2.16.840.1.113883.10.20.22.4.4)
  9. effectiveTime SHALL contain exactly one [1..1] low (CONF:9032)
  10. effectiveTime SHOULD contain zero or one [0..1] high (CONF:9033)

Problem Concern Act example

<act xmlns="urn:hl7-org:v3">
  <id root="MDHT" extension="1651397096"/>
  <code code="346872066"/>
  <effectiveTime>
    <low value="2013"/>
    <high value="2013"/>
  </effectiveTime>
  <entryRelationship>
    <observation>
      <id root="MDHT" extension="1413743626"/>
      <code code="1503919933"/>
      <effectiveTime>
        <low value="2013"/>
        <high value="2013"/>
      </effectiveTime>
      <entryRelationship>
        <observation>
          <id root="MDHT" extension="208977757"/>
          <code code="216380380"/>
          <effectiveTime>
            <low value="2013"/>
            <high value="2013"/>
          </effectiveTime>
        </observation>
      </entryRelationship>
      <entryRelationship>
        <observation>
          <id root="MDHT" extension="2080502556"/>
          <code code="2071409445"/>
          <effectiveTime>
            <low value="2013"/>
            <high value="2013"/>
          </effectiveTime>
        </observation>
      </entryRelationship>
      <entryRelationship>
        <observation>
          <id root="MDHT" extension="1951903357"/>
          <code code="1471958264"/>
          <effectiveTime>
            <low value="2013"/>
            <high value="2013"/>
          </effectiveTime>
        </observation>
      </entryRelationship>
    </observation>
  </entryRelationship>
</act>