FHIR Chat · CCDA Equivalence to FHIR "Problem List"

Stream: C-CDA

Topic: CCDA Equivalence to FHIR "Problem List"

Dave Carlson (MIE) (Dec 30 2020 at 17:21):

In FHIR, there is a "flag" you can put on conditions to make them on the "Problem List" specifically.
https://www.hl7.org/fhir/condition.html ("category")

And we've taken that into account in how we are putting items in our conditions in our software ("Problem List" items vs. "Other Problems").

From a CCDA standpoint, is there any defined way that these conditions should be marked or "split up" to point out something that is "problem list" vs not?

Dave Carlson (MIE) (Jan 04 2021 at 14:22):

To put a slightly finer point on it, the Problems section "2.16.840.1.113883.10.20.22.2.5.1" is called "Problems Section" in some areas, but, is often called "Problem List" itself in others (or at the same time... http://ccda.art-decor.org/ccda-html-20121009T144758/tmp-2.16.840.1.113883.10.20.22.2.5.1.html).

But, as shown in FHIR, you can have "problems" that are not technically on the "Problem List", that difference is what I'm trying to figure out, if there is something to be put on the records in the 2.5.1 section itself, or is there another appropriate section, etc.

John Moehrke (Jan 04 2021 at 14:24):

The IPS does have a section on problem list. http://hl7.org/fhir/uv/ips/ipsStructure.html

Dave Carlson (MIE) (Jan 04 2021 at 14:44):

John Moehrke said:

The IPS does have a section on problem list. http://hl7.org/fhir/uv/ips/ipsStructure.html

So, looking at that, I would take it as saying things on the "PHI" list would be considered not necessarily on the Problem List (I suppose something could be listed in both, but, something could be only listed under the "PHI" section?). Does C-CDA have a OID coded section for "Past History of Illness" vs. "Problems Section/List" though? I am having trouble finding one.

Lisa Nelson (Jan 14 2021 at 00:54):

@Dave Carlson (MIE) C-CDA supports a Past Medical History Section. Past Medical History (V3)
[section: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.2.20:

Dave Carlson (MIE) (Jan 14 2021 at 15:02):

Thanks Lisa,

In the CCDA examples group, any examples of 2.16.840.1.113883.10.20.22.2.20 are pretty buried (in discharge summary), and appear to be only textual, and pointing to "1.3.6.1.4.1.19376.1.5.3.1.3.4" (which is more "IHE" and not C-CDA oid based, no?).

Maybe it can be discussed on a Examples WG call, but maybe some examples with 22.2.20 would be in order in the examples WG, even if they are somewhat similar to the 2.16.840.1.113883.10.20.22.2.5.1 "Problem (List) Section" examples (as far as content, although 2.5.1 uses Acts as 2.16.840.1.113883.10.20.22.4.3 within it, and 22.2.20 uses Problem Observations as 2.16.840.1.113883.10.20.22.4.4 within itself).