1. PCWG – Chicago WGM C-CDA: Problem/Allergy Problem Status Observation Templates
Stephen Chu, PCWG co-chair
Russ Leftwich, PCWG co-chair
Elaine Ayres, PCWG co-chair
Laura Heermann Langford, PCWG co-chair
Rob Hausam, vocab facilitator
Lisa Nelson, PCWG Liaison from SDWG

2. Allergy Problem Observation in C-CDA 1.1
2/25/2019

3. Allergy Status Observation in C-CDA 1.1
Table 126: Allergy
Status Observation
2/25/2019

4. Problem Observation in C-CDA 1.1
Health Status Observation: This template represents observations regarding the outcome of care from the interventions used to treat the patient. These observations represent status, at points in time, related to established care plan goals and/or interventions (Contains “Outcome Observation” template)
Outcome Observation contains: Act Reference (NEW); Author Participation (NEW); Goal Observation (NEW); Intervention Act (NEW); Progress Toward Goal Observation (NEW)
The “Problem Status” Observation uses the same HITSPProblemStatus
values
2/25/2019

5. In C-CDA 2.0 Allergy Status Observation and Problem Status templates are deprecated
2/25/2019

6. In C-CDA 2.0 Allergy Status Observation and Problem Status templates are deprecated
2/25/2019

7. Determining Problem status in absence of Allergy Status Observation and Problem Status
inadequate for
expressing the
rich semantics
clinical status
of the problem
or concern
statusCode:
- metadata
Not displayed
as human
readable data.
How is that
useful for
expressing
clinical status?
Using “statusCode + effectiveTime to communicate “status”: inadequate
2/25/2019

8. In C-CDA 2.0 Allergy Status Observation and Problem Status templates are deprecated
Determining “Problem Concern Status” in the absence of these templates:
The statusCode of the Problem Concern Observation is the definitive indication of the status of the concern
Issues
Status of the concern = status of the Act (status of workflow)
≠ rich semantics of clinical status of the problem/concern
The effectiveTime of the Problem Observation is the definitive indication of whether or not the underlying condition is resolved
2/25/2019

9. Determining Allergy Status
The Allergy Status Observation template has been deprecated in Consolidated CDA Release 2
"Determining a Clinical Statement's Status", i.e. the status of an allergy is determined based on attributes of the Allergy Problem Act and Allergy - Intolerance Observation
statusCode + effectiveTime
2/25/2019

10. Semantics of clinical status: much more complex
The status of most clinical problems or conditions (allergy and intolerance included) need to be represented by one of the following values:
Active
Inactive (semantically different from resolved)
Resolved
Refuted
2/25/2019

11. Semantics of clinical status: much more complex
Cancer, psychiatric/psychological problems (substances dependencies included) require additional status values:
Remission states
In remission
Partial remission
Full/complete remission
Early full/partial remission
Sustained full/partial remission
Relapse states
Relapse
relapse after partial remission
relapse after full remission
2/25/2019

12. Semantics of clinical status: much more complex
The semantic complexity requires the reinstatement of:
Problem status template
Allergy status observation template
Post Chicago WGM communications:
From: Russ Leftwich Sent: Tuesday, 7 October :06 AM To: Stephen Chu; Lisa Nelson; Elaine Ayres Subject: Re: SDWG Agenda Request
A couple of questions.  I don't know that they need to be answered on Thursday, or even asked. 
Is recurrence an exact synonym for relapse?
Are asymptomatic and clinically undetectable synonyms for inactive?  
Russ
2/25/2019

13. Is recurrence an exact synonym for relapse?
From: Stephen Chu Sent: Tuesday, 7 October :47 AM To: Lisa Nelson; Elaine Ayres Subject: RE: SDWG Agenda Request
Hi Russ,
Is recurrence an exact synonym for relapse?
[Stephen: It depends on the context of use.
Synonyms of “recurrence” = returning, repeating, reoccurring. In that context, yes, “recurrence” may be
considered as a synonym for relapse.
“Recurrent” in the context of concepts such as “recurrent pyrogenic cholangitis” is a diagnosis of its own
right.
One may argue that “pyrogenic cholangitis” with a clinical status = “recurrence” or “relapse” may be treated
as synonymous as “recurrent pyrogenic cholangitis”. But I would not use it in that way.]
Are asymptomatic and clinically undetectable synonyms for inactive?
[Stephen: inactive = quiescent, at rest, state of quietness
Remission = disappearance of signs and symptoms of a disease.
It may be considered that diseases/problems in inactive state are therefore asymptomatic and clinically
undetectable; although the concept of remission (rather than inactive) is used to qualify clinical status of
diseases/disorders such as cancer, multiple sclerosis, behavioural disorders)
As such, the answer is likely to be these concepts may be considered synonymous, but the context of use
will determine which specific concept to be used.
Regards,
Stephen
2/25/2019