USCDI v2: SDOH Health Concern

[Ryan Zoellner]

Hello,

In the "Cures Update (SVAP USCDI v2) Test Data for 170.315(b)(1) - Transitions of Care Ambulatory Setting" test script for patient Alice Newman, Test Case U is concerned with the SDOH Health Concern. I believe the script test case as written breaks conformance statements of the Health Concern Act V3 (2.16.840.1.113883.10.20.22.4.132). Specifically, this would be  CONF:4515-32311 in the C-CDA Companion Guide R3.

The Health Concern Act V3 is the outer wrapper of this entry. The act's code is fixed to LOINC 75310-3 "Health Concern" per the act's template. This act contains the Problem Observation describing the Health Concern with a value corresponding to the codified problem.

As written, it appears the script is expecting the Health Concern Act wrapper to contain SNOMED-CT code for "Nutrition impaired due to limited access to healthful foods", and the Problem Observation to contain SNOMED-CT code for "Food insecurity". 

If this is the case, it is possible to meet the Problem Observation expectation, but not the Health Concern Act expectation. We are looking for clarification around the expectation of these codes.

Thank you!

[Brett Marquard]

Hi, Ryan,

 

I agree this looks like an oversight in the test data – excerpt from R3 Companion guide:

 

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[Mat Davis]

Hi Brett.

From original question

"As written, it appears the script is expecting the Health Concern Act wrapper to contain SNOMED-CT code for "Nutrition impaired due to limited access to healthful foods", and the Problem Observation to contain SNOMED-CT code for "Food insecurity". if this is the case, it is possible to meet the Problem Observation expectation, but not the Health Concern Act expectation. "

Additional Clarity

Since the Health Concern act does not / cannot contain the SNOMED-CT code, what can be clarified in the info below to meet this test case and meet the expectations you posted from the R3 Companion Guide?

Food Insecurity > /entry/act/entryRelationship[1]/(problem)observation

Nutrition impaired > /entry/act/entryRelationship[2]/(problem)observation 

C-CDA Examples

Github1

<!-- The Health Concern act  -->
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.132"/>
<templateId root="2.16.840.1.113883.10.20.22.4.132" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.132" extension="2022-06-01"/>
<id root="1.3.6.1.4.1.22812.4.222.334.4.32" extension="1148128"/>
<code code="75310-3" displayName="Health concerns Document" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<statusCode code="active"/>
<entryRelationship typeCode="REFR">
<!-- The Health Concern's (SDOH) Problem Observation wrapped by the Health Concern act -->
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<id extension="1148128" root="1.3.6.1.4.1.22812.4.222.334.4.1.2.1"/>
<code code="404684003" displayName="Clinical finding (finding)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<translation code="75321-0" displayName="Clinical finding" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
</code>
<text>
<reference value="#_de1ab32d-dd06-40c0-b7c2-5fed94e4ecd6"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20180701"/>
<!-- The high value has a nullFlavor of "NI" (No Information) because it is an ongoing finding -->
<high nullFlavor="NI"/>
</effectiveTime>
<value xsi:type="CD" code="733423003" displayName="Food insecurity (finding)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<originalText>
<reference value="#_HealthConcern1"/>
</originalText>
</value>
</observation>
</entryRelationship>
</act>

Github2

<!-- SDOH Problem -->
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2022-06-01"/>
<id extension="68993" root="1.2.840.114350.1.13.6289.1.7.2.768076"/>
<id root="093A5380-00CE-11E6-B4C5-0050568B000B" extension="1.1"/>
<code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Problem">
<originalText>
<reference value="#ProblemObs_1_PT1"/>
</originalText>
<translation code="75326-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem"/>
</code>
<text>
<reference value="#ProblemObs1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20140909"/>
</effectiveTime>
<value xsi:type="CD" code="445281000124101" displayName="Nutrition impaired due to limited access to healthful foods (finding)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<translation code="Z59.48" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD-10-CM" displayName="Other specified lack of adequate food"/>
</value>
</observation>

Thanks - Mat

[Nagesh Bashyam - Drajer]

Matt

Let me look into the test data and will get back to you.

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[nagesh.bashyam (Dragon)]

Ryan

Let me look into the test data and will get back in the next couple of days.

[Mat Davis]

Much appreciated Nagesh. Thanks - Mat

[Brett Marquard]

Thanks Mat and Dragon.

 

Link to template definition: https://hl7.org/ccdasearch/templates/2.16.840.1.113883.10.20.22.4.132.html

 

Test data should be updated.

 

Best

Brett

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[Mat Davis]

Thanks as always Brett, as well as Nagesh and Ryan. This has been informative and helpful.

Thanks - Mat