There are four C-CDA entry templates which are designed for expressing observations of “problems” (the OID for the template identifier is show in parenthesis, following the template name):

  • Cognitive Status Problem Observation (2.16.840.1.113883.10.20.22.4.73)
  • Family History Observation (2.16.840.1.113883.10.20.22.4.46)
  • Indication (2.16.840.1.113883.10.20.22.4.19)
  • Problem Observation (2.16.840.1.113883.10.20.22.4.4)

All four of these templates are applied to the observation clinical act statement (refer to The observation element, for additional information).

Since C-CDA allows the nesting of entry templates inside other entry templates, as well as inside section templates, there are many additional C-CDA templates which contain the four templates above. For example, the Indication template is part of seven other C-CDA entry templates and the Problem Observation template is part of five other entry templates. Those templates, in turn, are nested in other entry templates and section templates.

In all, then, there are many tens of C-CDA templates that describe types of problems using the four core “problem observation” templates, listed above.

Eight Allowed Values for the code Element in “Problem Observation” Templates
In all four of these “problem observation” templates (and, by extension, the tens of templates that use them), the code attribute of the code sub-element of the observation element, is required to be drawn from a specific set of coded concepts from the SNOMED-CT code system (refer to Codes in CDA and Codes and code systems, for additional information about coded elements, coded concepts, and code systems in CDA documents).

Specifically, there are eight allowed coded concepts for use in observations/code/@code in these templates: Finding (404684003), Complaint (409586006), Diagnosis (282291009), Condition (64572001), Finding of functional performance and activity (248536006), Symptom (418799008), Problem (55607006), and Cognitive function finding (373930000).

These concepts are intended to indicate the level of medical judgment used to determine the existence of a problem, and are collectively referred to as the allowed coded concepts in C-CDA for “Problem Type”.

Condition vs. Disease
As noted, one of the eight allowed Problem Type coded concepts has the code value 64572001, and is termed “Condition” (in terms of what should go in the displayName attribute for the code element). However, when looking up the value 64572001 in SNOMED-CT, the description provided for this coded concept is “Disease”, not “Condition”.

This is a rare situation where C-CDA guides to a different descriptive term for a coded concept value, relative to the one recommended by the underlying code system. The reason in this case is historical in nature. The CCD and CCR standards that were commonly in use prior to the publication of the C-CDA standard, used the term “Condition” for what SNOMED-CT refers to as “Disease”, in the relevant equivalent context. So, in order to provide trace-ability back to these earlier standards, it was decided to maintain the use of “Condition” as the descriptive term of this code value, even though SNOMED terms it “Disease”.

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