1.3.6.1.4.1.19376.1.5.3.1.1.11.2.3.1

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The PCC Wiki Content is used only for development of IHE PCC Content. The Normative content of the PCC Technical Framework and the current supplements can be found at http://www.ihe.net/Technical_Framework/index.cfm#PCC

Trial.gif EDD Observation 1.3.6.1.4.1.19376.1.5.3.1.1.11.2.3.1

The EDD observation reflects the clinicians best judgement about the estimated delivery date of the patient. It can be supported by patient history (eg last menses or quickening), physical examination findings (uterine size), or Ultrasound. If present, ultrasound findings generally are the most accurate supporting evidence. The observation is a Simple Observation with a supporting entryRelation of another Observation. The supporting observation may in turn have a entryRelation that gives the original observation as a gestational age or date from which the estimated due date is calculated.


Uses

See Templates using EDD Observation

Specification
EDD Observation Example

<observation classCode='OBS' moodCode='EVN'>
 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.13'/>
 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.11.2.3.1'>
 <statusCode code='completed'/>
 <effectiveTime value=' '/>
 <author typeCode='AUT'>
   <time value=' '/>
   <assignedAuthor>
     <id root=' ' extension=' '/>
   </assignedAuthor>
 </author>
 <id root=' ' extension=' '/>
 <code code='11778-8' 
       displayName='DELIVERY DATE-TMSTP-PT-^PATIENT-QN-CLINICAL.ESTIMATED'
       codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/>
 <text><reference value='id-foo'/></text>
 <value xsi:type='TS' value=' '/>
 <entryRelationship typeCode='SPRT'>
   <observation classCode='OBS' moodCode='EVN'>
     <id root=' ' extension=' '/>
     <statusCode code='completed'/>
     <effectiveTime value=' '/>
     <author typeCode='AUT'>
        <time value=' '/>
        <assignedAuthor classCode=' '>
          <id root=' ' extension=' '/>
        </assignedAuthor>
     </author>
     <code code='[11779-6|(xx-EDD-by-PE)|11781-2|(xx-EDD-by-Qck)|(xx-EDD-by-Fund)]'
           codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/>
     <value type='TS' value=' '>
     <entryRelationship typeCode='DRIV'>
       <observation  classCode='OBS' moodCode='EVN'>
         <id root=' ' extension=' '/>
         <statusCode code='completed'/>
         <effectiveTime value=' '/>
         <author typeCode='AUT'>
           <time value=' '/>
           <assignedAuthor>
             <id root=' ' extension=' '/>
           </assignedAuthor>
         </author>
         <informant typeCode='INF'>
           <relatedEntity classCode=' '>
             <id root=' ' extension=' '/>
           </relatedEntity>
         </informant>
         <code code='[8655-2|(xx-ga-by-pe)|11888-5|(xx-date-of-qck)|(xx-date-of-fund-umb) ]' 
               codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/>
         <value type='[PQ|TS]' value=' ' units='week'/>
       </observation>
     </entryRelationship>
   </observation>
 </entryRelationship>
</observation>


<templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.11.2.3.1'/>

The <templateId> identifies the observation as a type of Estimated Delivery Date Observation. The root attribute SHALL be valued with '1.3.6.1.4.1.19376.1.5.3.1.1.11.2.3.1'.

<templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.13'/>

EDD observation SHALL comply with the restrictions of the Simple Observation entry. The observation SHALL NOT include repeatNumber, interpretationCode, methodCode, or targetSiteCode as listed below.

<code code='11778-8' codeSystem='2.16.840.1.113883.6.1'/>

The <code> element indicates that this is a "clinically estimated" estimated delivery date (for example, this code is used to represent the field on the last line of the EDD section of the ACOG form). This code SHALL be the LOINC code 11778-8. It is good style to include the displayName and codeSystemName to help debugging.

<value xsi:type='TS' value=' '>

The value of the EDD SHALL be represented as a point in time.

<author typeCode='AUT'><assignedAuthor><id root=' ' extension=' '/></assignedAuthor></author>

There may be multiple clinicians following the patient and authoring the overall document, however the EDD observation has an individual author. For CDA based content, this author SHALL be listed in the CDA header and referenced from the entry by including the id element of the assignedAuthor. For HL7 Version 3 Messages based content, the author SHALL be included in full through this element.

<author typeCode='AUT'><time value=' '/></author>

The author.time is used to record the time that the author recorded the observation. It SHALL be included.

<entryRelationship typeCode='SPRT'>

The <entryRelationship> element binds the clinicians estimated EDD to supporting observations by different methods. Supporting observations SHOULD be included. If included, the typeCode SHALL be 'SPRT'. For HL7 Version 3 Messages based content, the element name is <sourceOf> rather than <entryRelationship>, however the semantics, typeCode, and nested elements remain unchanged.

<observation>
 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.13'/>
  :
</observation> [1st nesting]

Observations that support the clinical observation SHALL be included if known. These observations are the supporting calculated dates from various methods such as ultrasound dates or dates calculated from LMP (i.e., the left column of fields on the ACOG form). Supporting observations SHALL also conform to the simple observation template. Supporting observations MAY include a different effectiveTime, author, or informant. Supporting observations SHALL NOT include repeatNumber, interpretationCode, methodCode, or targetSiteCode. (Method is implied by the LOINC code). The templateId SHALL be valued as ‘1.3.6.1.4.1.19376.1.5.3.1.4.13’

<code code=' ' codeSystem='2.16.840.1.113883.6.1'/> [1st nesting]

Supporting observations SHALL include one of following LOINC values to indicate the method used to calculate the EDD.

Code Description
11779-6 DELIVERY DATE-TMSTP-PT-^PATIENT-QN-ESTIMATED FROM LAST MENSTRUAL PERIOD
(xx-EDD-by-PE) DELIVERY DATE-TMSTP-PT-^PATIENT-QN-ESTIMATED FROM CLINICIANS PHYSICAL EXAM
11781-2 DELIVERY DATE-TMSTP-PT-^PATIENT-QN-US.COMPOSITE.ESTIMATED
(xx-EDD-by-Qck) DELIVERY DATE-TMSTP-PT-^PATIENT-QN-ESTIMATED FROM DATE OF QUICKENING
(xx-EDD-by-Fund) DELIVERY DATE-TMSTP-PT-^PATIENT-QN-ESTIMATED FROM DATE FUNDAL HEIGHT REACHES UMBILICUS
<entryRelationship typeCode='DRIV'>

Observations of supporting EDD should provide observations from which they were derived such as the patients last menses, or gestational age value at a point in time.

For HL7 Version 3 Messages based content, the element name is <sourceOf> rather than <entryRelationship>, however the semantics, typeCode, and nested elements remain unchanged. ===== <observation>
 <templateId root=' '/>

  :
</observation> [2st nesting] Observations that support the calculation of supporting observation SHALL be included if known. These observations are the supporting dates or ages from various methods such as ultrasound gestational age or the date of last Menses (for example, the right column of fields on the ACOG form). Supporting observations SHALL also conform to the simple observation template. Supporting observations MAY include a different effectiveTime, author, or informant. Supporting observations SHALL NOT include repeatNumber, interpretationCode, methodCode, or targetSiteCode. (Method is implied by the LOINC code)

<code code=' ' codeSystem='2.16.840.1.113883.6.1'/> [2nd nesting]

This code is used to represent the either the relevant date, or the gestational age observation from which the EDD is derived. The following table lists the relevant LOINC codes for methods used. For observations that record the gestational age the value is recorded as a physical quantity (PQ) with the units of weeks and the activity time should be recorded to indicate the date at which the gestational age was observed. For observations that simply record a date (eg LMP) the observation value is recorded as a point in time (TS).

Code Description Type
8655-2 DATE LAST MENSTRUAL PERIOD-TMSTP-PT-^PATIENT-QN-REPORTED TS
(xx-ga-by-PE) GESTATIONAL AGE-TIME-PT-^FETUS-QN-ESTIMATED FROM CLINICIANS PHYSICAL EXAM PQ
11888-5 GESTATIONAL AGE-TIME-PT-^FETUS-QN-US.COMPOSITE.ESTIMATED PQ
(xx-date-of-Qck) DATE OF QUICKENING-TMSTP-PT-^PATIENT-QN-REPORTED TS
(xx-date-of-Fund-Umb) DATE FUNDAL HEIGHT REACHES UMBILICUS-TMSTP-PT-^PATIENT-QN-CLINICIANS PHYSICAL EXAM TS
<repeatNumber value=' '/>
<interpretationCode code=' ' codeSystem=' '/>
<targetSiteCode code=' ' codeSystem=' '/>

The <repeatNumber> <interpretationCode>, and <targetSiteCode> elements should not be present in a EDD observation.

Schematron
This text needs to be fixed-->>TODO:<<--
must include templateID and simple obs templateID
must include loinc 11778-8
must include author.assignedAuthor with Id valued
must include author.time
must have value xsi:type=ts
must include text.reference.value
may include effectiveTime
warn should include sprt relation to simple obs
assert must not include entryRelationship other than SPRT.
must not include repeatNumber, interpretationCode, methodCode, or targetSiteCode
if sprt relation included then 
  must include obs.id
  must include includes obs.code=(one of loincs)
  may include obs.author
  may include obs.effectiveTime