Template ID(s) |
2.16.840.1.113883.10.20.1.17 (HL7 CCD 3.2.2.1) 1.3.6.1.4.1.19376.1.5.3.1.4.13.7 (IHE PCC CDA Suppl: 6.3.4.2.9) |
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Description |
The Advance Directive observation is used to convey information about a single advance directive which has been identified by the patient. |
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RMIM Class |
Observation |
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Expected Entry Relationships |
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Entry |
Template ID |
Reference |
Advance Directive Status |
2.16.840.1.113883.10.20.1.372.16.840.1.113883.10.20.1.57 |
3.4.2.2 |
Profiled Elements |
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|
Element |
Notes |
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code [1..1]
CE |
The code of the advance directive observation MUST be present and SHOULD be drawn from the following table of SNOMED codes.
|
Code |
Description |
Value |
304251008 |
Resuscitation |
Boolean |
52765003 |
Intubation |
Boolean |
225204009 |
IV Fluid and Support |
Boolean |
89666000 |
CPR |
Boolean |
281789004 |
Antibiotics |
Boolean |
78823007 |
Life Support |
Boolean |
61420007 |
Tube Feedings |
Boolean |
116859006 |
Transfusion of blood product |
Boolean |
71388002 |
Other Directive |
None |
Or from the following table of LOINC codes:
Code |
Description |
Value |
xx-bld-transf-ok |
Blood Transfusion Ok |
Boolean |
| |
effectiveTime [1..1]
IVL |
The effectiveTime element identifies the time range when the directive is to be enforced. |
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statusCode [1..1]CS |
The statusCode element must be present and must be valued as "completed". |
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value [1..1]ANY |
The value element must match the value indicated by the appropriate <code> value. |
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OpenSHR Implementation Notes |
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|
Data Model |
Obs |
|
Code File |
AdvanceDirectiveObservationEntryProcessor.java |
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Permitted Moods |
EVN |
|
Additional Constraints |
- When <code> is set to "Other Directive" the use of "Value" is prohibited
- Advance directive code must be drawn from SNOMED-CT or must be exactly "xx-bld-transf-ok" if from LOINC.
- Advance directive must carry an advance directive status observation in an entryRelationship
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Notes |
- APS templates require the presence of an advance directive indicating the consent to perform blood transfusion. If no directive has been recorded by a patient (i.e. no directives exist on their patient file) then OpenSHR will generate one for any ODD document requiring an Advance Directive. When this is the case, the value of the directive will be a null flavor of UNK and the author will point to the deployed instance of OpenSHR
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Example |
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The following example illustrates the patient has an active DNR (do not resuscitate) order attached to their information.
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<observation classCode="OBS" moodCode="EVN">
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.7"/>
<templateId root="2.16.840.1.113883.10.20.1.17"/>
<id root="4dce8759-e246-4eaa-be61-255b4ed6d57a"/>
<code code="304251008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Resuscitation"/>
<text representation="TXT" language="en-US">
<reference value="#obs317ef3a7"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<high value="20140502"/>
</effectiveTime>
<value xsi:type="BL" value="false"/>
<entryRelationship typeCode="REFR" contextConductionInd="true">
<!-- See 3.4.2.2 for example of what goes here -->
</entryRelationship>
</observation> |
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The following example illustrates that the patient does not have a blood transfusion advance directive, or that the status of the advance directive for blood transfusion is not present. This is often appended by OpenSHR as the APS template requires the presence of a blood transfusion order. Note the negation and nullFlavor of value to indicate no information (NI) is present.
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|
|
<observation classCode="OBS" moodCode="EVN" negationInd="true">
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.7"/>
<templateId root="2.16.840.1.113883.10.20.1.17"/>
<code code="(xx-bld-transf-ok)" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Blood Transfusion"/>
<text representation="TXT" language="en-US">
<reference value="#obs317ef3a7"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<high value="20141028095457.321-0600"/>
</effectiveTime>
<value xsi:type="BL" nullFlavor="NI"/>
<entryRelationship typeCode="REFR" contextConductionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.37"/>
<templateId root="2.16.840.1.113883.10.20.1.57"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/>
<text representation="TXT" language="en-US">
<reference value="#obs8a4b3b73"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" nullFlavor="NI"/>
</observation>
</entryRelationship>
</observation> |
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