Non-Normative Content The Normative content for these specifications may be found on the HL7, IHE, and HITSP web sites.

Problem Observation

[Observation: templateId 2.16.840.1.113883.10.20.22.4.4]

A problem is a clinical statement that a clinician has noted. In health care it is a condition that requires monitoring or diagnostic, therapeutic, or educational action. It also refers to any unmet or partially met basic human need.

A Problem Observation is required to be wrapped in an act wrapper in locations such as the Problem Section, Allergies Section, and Hospital Discharge Diagnosis Section, where the type of problem needs to be identified or the condition tracked. A Problem Observation can be a valid "standalone" template instance in cases where a simple problem observation is to be sent.

The negationInd attribute, if true, specifies that the problem indicated was observed to not have occurred (which is subtly but importantly different from having not been observed). NegationInd='true' is an acceptable way to make a clinical assertion that something did not occur, for example, "no diabetes".

  1. SHALL contain exactly one [1..1] templateId ( CONF:14926, CONF:14927 ) such that it
    1. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.4"
  2. SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: 2.16.840.1.113883.5.6 HL7ActClass) (CONF:9041)
  3. SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: 2.16.840.1.113883.5.1001 HL7ActMood) (CONF:9042)
  4. MAY contain zero or one [0..1] @negationInd (CONF:10139)
    • Use negationInd="true" to indicate that the problem was not observed (CONF:16880)

  5. SHALL contain at least one [1..*] id (CONF:9043)
  6. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet Problem Type 2.16.840.1.113883.3.88.12.3221.7.2 STATIC 2008-12-18 (CONF:9045)
  7. SHOULD contain zero or one [0..1] text (CONF:9185)
  8. SHALL contain exactly one [1..1] statusCode/@code="completed" Completed (CodeSystem: 2.16.840.1.113883.5.14 ActStatus) (CONF:9049)
  9. SHOULD contain zero or one [0..1] effectiveTime (CONF:9050)
  10. SHALL contain exactly one [1..1] value with data type CD, where the @code SHOULD be selected from ValueSet Problem 2.16.840.1.113883.3.88.12.3221.7.4 DYNAMIC (CONF:9058)
  11. MAY contain zero or one [0..1] entryRelationship (CONF:9059, CONF:9060, CONF:15590)
    1. Contains @typeCode="SUBJ" SUBJ
    2. Contains exactly one [1..1] Age Observation (templateId: 2.16.840.1.113883.10.20.22.4.31)
  12. MAY contain zero or one [0..1] entryRelationship (CONF:9063, CONF:9068, CONF:15591)
    1. Contains @typeCode="REFR" REFR
    2. Contains exactly one [1..1] Problem Status (templateId: 2.16.840.1.113883.10.20.22.4.6)
  13. MAY contain zero or one [0..1] entryRelationship (CONF:9067, CONF:9064, CONF:15592)
    1. Contains @typeCode="REFR" REFR
    2. Contains exactly one [1..1] Health Status Observation (templateId: 2.16.840.1.113883.10.20.22.4.5)
  14. The text, if present, SHOULD contain zero or one [0..1] reference (CONF:15587)
  15. reference, if present, SHALL contain exactly one [1..1] @value (CONF:15588)
  16. reference/@value SHALL begin with a '#' and SHALL point to its corresponding narrative (using the approach defined in CDA Release 2, section 4.3.5.1) (CONF:15589)
  17. The effectiveTime element , if present, SHALL contain exactly one [1..1] low (CONF:15603)
  18. effectiveTime, if present, SHOULD contain zero or one [0..1] high (CONF:15604)
  19. 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 an high element within a problem does indicate that the problem has been resolved (CONF:16881)
  20. value MAY contain zero or one [0..1] @nullFlavor (CONF:10141)
  21. If the diagnosis is unknown or the SNOMED code is unknown, @nullFlavor SHOULD be UNK. If the code is something other than SNOMED, @nullFlavor SHOULD be OTH and the other code SHOULD be placed in the translation element (CONF:10142)
  22. entryRelationship with target entry Age Observation SHALL contain exactly one [1..1] @inversionInd="true" True (CONF:9069)
  23. value MAY contain zero or more [0..*] translation (CONF:16749)
  24. translation, if present, MAY contain zero or one [0..1] @code (CodeSystem: ICD10 2.16.840.1.113883.6.3) (CONF:16750)

Problem Observation example

<observation xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3">
  <id root="MDHT" extension="837088039"/>
  <code code="428375806"/>
  <text>Text Value</text>
  <effectiveTime>
    <low value="2013"/>
    <high value="2013"/>
  </effectiveTime>
  <value xsi:type="CD" code="283201430"/>
  <entryRelationship>
    <observation>
      <id root="MDHT" extension="692615318"/>
      <code code="762996271"/>
      <text>Text Value</text>
      <effectiveTime>
        <low value="2013"/>
        <high value="2013"/>
      </effectiveTime>
      <value xsi:type="PQ"/>
    </observation>
  </entryRelationship>
  <entryRelationship>
    <observation>
      <id root="MDHT" extension="647775626"/>
      <code code="588388850"/>
      <text>Text Value</text>
      <effectiveTime>
        <low value="2013"/>
        <high value="2013"/>
      </effectiveTime>
      <value xsi:type="CD" code="441026370"/>
    </observation>
  </entryRelationship>
  <entryRelationship>
    <observation>
      <id root="MDHT" extension="2050582151"/>
      <code code="208202323"/>
      <text>Text Value</text>
      <effectiveTime>
        <low value="2013"/>
        <high value="2013"/>
      </effectiveTime>
      <value xsi:type="CD" code="480101364"/>
    </observation>
  </entryRelationship>
</observation>