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HdBe-Problem

CBBDescriptionStatus
HdBe-Problem

A problem describes a situation with regard to an individual’s health and/or welfare. This situation can be described by the person involved (the patient) themselves (in the form of a complaint), or by their healthcare professional (in the form of a diagnosis, for example). The situation can form cause for diagnostic or therapeutic policy. A problem includes all kinds of medical or nursing information that represents a health problem. A problem can represent various types of health problems:

  • A complaint, finding by patient: a subjective, negatively experienced observation of the patient’s health. Examples: stomach ache, amnesia.
  • A symptom: an observation by or about the patient which may indicate a certain disease. Examples: fever, blood in stool, white spots on the roof of the mouth.
  • A diagnosis: medical interpretation of complaints and findings. Examples: Diabetes Mellitus type II, pneumonia, hemolytic-uremic syndrome.
  • A functional limitation: a reduction of functional options. Examples: reduced mobility, help required for dressing.
  • A complication: Every diagnosis seen by the healthcare professional as an unforeseen and undesired result of medical action. Examples: post-operative wound infections, loss of hearing through the use of antibiotics.

Purpose

An overview of a patient’s health problems has the purpose of informing all healthcare professionals involved in the patient’s care on the patient’s current and past health condition. It provides insight into which problems require medical action, which are under control and which are no longer current. The problem overview also directly provides medical context for medication administered and procedures carried out. The overview promotes an efficient, targeted continuation of the patient’s care. A complete list of problems is of importance for automated decision support and determining contraindications.

active

id0..1string
extensionI0..*Extension
ProblemType0..1CodeableConceptBinding
ProblemName1..1CodeableConceptBinding
FurtherSpecificationProblemName0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
Location0..1CodeableConceptBinding
Laterality0..1CodeableConceptBinding
ProblemStartDate0..1dateTime
ProblemEndDate0..1dateTime
ProblemStatus0..1CodeableConceptBinding
VerificationStatus0..1CodeableConceptBinding
Comment0..1string

Problem0..*
Problem.ProblemTypeCodeableConcept0..1
Problem.ProblemNameCodeableConcept1..1
Problem.FurtherSpecificationProblemNamestring0..1
Problem.ProblemAnatomicalLocationBackboneElement0..1
Problem.ProblemAnatomicalLocation.LocationCodeableConcept0..1
Problem.ProblemAnatomicalLocation.LateralityCodeableConcept0..1
Problem.ProblemStartDatedateTime0..1
Problem.ProblemEndDatedateTime0..1
Problem.ProblemStatusCodeableConcept0..1
Problem.VerificationStatusCodeableConcept0..1
Problem.Commentstring0..1


Problem
DefinitionRoot concept of the Problem information model. A problem describes a situation with regard to an individual’s health and/or welfare. This situation can be described by the patient themselves (in the form of a complaint) or by their health professional (in the form of a diagnosis, for example).
Cardinality0...*
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Problem.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Problem.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Problem.ProblemType
DefinitionThe type of problem; see the concept description.
Cardinality0...1
TypeCodeableConcept
Binding

ProblemType codes

ProblemType (extensible)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Problem.ProblemName
DefinitionThe problem name defines the problem.
Cardinality1...1
TypeCodeableConcept
Binding

ProblemName codes

ProblemName (extensible)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Problem.FurtherSpecificationProblemName
DefinitionFurther specification of problem name when it is recorded via a thesaurus or code system in which the required level of detail is not (yet) available.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Problem.ProblemAnatomicalLocation
DefinitionAnatomical location which is the focus of the problem.
Cardinality0...1
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Problem.ProblemAnatomicalLocation.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Problem.ProblemAnatomicalLocation.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Problem.ProblemAnatomicalLocation.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Problem.ProblemAnatomicalLocation.Location
DefinitionLocation on/in the body.
Cardinality0...1
TypeCodeableConcept
Binding

Location codes

Location (required)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Problem.ProblemAnatomicalLocation.Laterality
DefinitionLaterality adds information about body site to the anatomic location, e.g. left.
Cardinality0...1
TypeCodeableConcept
Binding

Laterality codes

Laterality (required)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Problem.ProblemStartDate
DefinitionOnset of the symptom, complaint, functional limitation, complication or date of diagnosis. A ‘vague’ date, such as only the year or the month and the year, is permitted.
Cardinality0...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Problem.ProblemEndDate
DefinitionDate on which the disorder to which the problem applies, is considered not to be present anymore.This datum needs not to be the same as the date of the change in problem status. A ‘vague’ date, such as only the year or the month and the year, is permitted.
Cardinality0...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Problem.ProblemStatus
DefinitionThe problem status describes the condition of the problem: 1. Active problems are problems of which the patient experiences symptoms or for which evidence exists. 1. Problems with the status 'Inactive' refer to problems that don't affect the patient anymore or that of which there is no evidence of existence anymore.
Cardinality0...1
TypeCodeableConcept
Binding

ProblemStatus codes

ProblemStatus (required)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Problem.VerificationStatus
DefinitionClinical status of the problem or the diagnosis.
Cardinality0...1
TypeCodeableConcept
Binding

VerificationStatus codes

VerificationStatus (required)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Problem.Comment
DefinitionComment by the one who determined or updated the Problem.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a

Example instances

problem
ProblemType 282291009 - Diagnosis interpretation (code by SNOMED CT)
ProblemName 4241002 - Listeriosis (code by SNOMED CT)
FurtherSpecificationProblemName
ProblemAnatomicalLocation ---
ProblemAnatomicalLocation.Location
ProblemAnatomicalLocation.Laterality
ProblemStartDate 2022-05-03T12:00:00
ProblemEndDate
ProblemStatus 55561003 - Active (code by SNOMED CT)
VerificationStatus 410605003 - Confirmed present (code by SNOMED CT)
Comment

zib Problem-v4.4 difference

Concept Category Description
ProblemType terminology Changed SNOMED code 116223007 (Complication) with 263718001 (Complication) because 116223007 is not included in the International Edition of SNOMED.
ProblemName terminology Removed all CodeSystems execpt SNOMED CT and changed binding strenght from required to extensible.
ProblemStatus cardinality Relaxed cardinality from 1..1 to 0..1 because it is very likely that the status is not always known. Also, the FHIR spec does not make a status mandatory.
VerificationStatus terminology Replaced NullFlavor Unknown code with SNOMED CT Unknown code.
Problem textual Replaced 'himself' by 'themselves'.
description.concept textual Put a period after 'Examples: stomach ache, amnesia'.
description.concept textual Put a period after 'roof of the mouth'.



Terminology Bindings

PathNameStrengthURL
ProblemTypeProblemTypeextensiblehttps://fhir.healthdata.be/ValueSet/ProblemType
ProblemNameProblemNameextensiblehttps://fhir.healthdata.be/ValueSet/ProblemName
ProblemAnatomicalLocation.LocationLocationrequiredhttps://fhir.healthdata.be/ValueSet/Location
ProblemAnatomicalLocation.LateralityLateralityrequiredhttps://fhir.healthdata.be/ValueSet/Laterality
ProblemStatusProblemStatusrequiredhttps://fhir.healthdata.be/ValueSet/ProblemStatus
VerificationStatusVerificationStatusrequiredhttps://fhir.healthdata.be/ValueSet/VerificationStatus