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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 Severity

Any condition or allergy may be the subject of a severity observation. This structure is included in the target act using the <entryRelationship> element defined in the CDA Schema.

The example below shows the recording the condition or allergy severity, and is used as the context for the following sections.

PatCareStruct HL7 Care Provision Domain (DSTU)
CCD ASTM/HL7 Continuity of Care Document

See Templates using Severity

Severity Example

  <observation classCode='COND' moodCode='EVN'>

<entryRelationship typeCode='SUBJ' inversionInd='true'> <observation classCode='OBS' moodCode='EVN'> <templateId root='2.16.840.1.113883.'/> <templateId root=''/> <code code='SEV' displayName='Severity' codeSystem='2.16.840.1.113883.5.4' codeSystemName='ActCode' /> <text><reference value='#severity-2'/></text> <statusCode code='completed'/> <value xsi:type='CD' code='H|M|L' codeSystem='2.16.840.1.113883.5.1063' codeSystemName='ObservationValue' /> </observation> </entryRelationship>


This specification models a severity observation as a separate observation from the condition. While this model is different from work presently underway by various organizations (i.e., SNOMED, HL7, TermInfo), it is not wholly incompatible with that work. In that work, qualifiers may be used to identify severity in the coded condition observation, and a separate severity observation is no longer necessary. The use of qualifiers is not precluded by this specification. However, to support semantic interoperability between EMR systems using different vocabularies, this specification does require that severity information also be provided in a separate observation. This ensures that all EMR systems have equal access to the information, regardless of the vocabularies they support.

<entryRelationship typeCode='SUBJ' inversionInd='true'>

The related statement is made about the severity of the condition (or allergy). For CDA, this observation is recorded inside an <entryRelationship> element occurring in the condition, allergy or medication entry. The containing <entry> is the subject (typeCode='SUBJ') of this new observation, which is the inverse of the normal containment structure, thus inversionInd='true'. For HL7 Version 3 Messages this relationship is represented with a <sourceOf> element, however the semantics, typeCode, and inversionInd is unchanged.

<observation moodCode='EVN' classCode='OBS'>

The related statement is another event (moodCode='EVN') observing (<observation classCode='OBS'>) the severity of the (surrounding) related entry (e.g., a condition or allergy).

<templateId root='2.16.840.1.113883.'/>
<templateId root=''/>

The <templateId> elements identifies this <observation> as a severity observation, allowing for validation of the content. As a side effect, readers of the CDA can quickly locate and identify severity observations. The templateId elements shown above must be present.

<code code='SEV' codeSystem='2.16.840.1.113883.5.4' displayName='Severity' codeSystemName='ActCode' />

This observation is of severity, as indicated by the <code> element listed above. This element is required. The code and codeSystem attributes shall be recorded exactly as shown above.

<text><reference value='#severity-2'/></text>

The <observation> element shall contain a <text> element. For CDA, the <text> elements shall contain a <reference> element pointing to the narrative where the severity is recorded, rather than duplicate text to avoid ambiguity. For HL7 Version 3 Messages, the <text> element should contain the full narrative text.

<statusCode code='completed'/>

The code attribute of <statusCode> for all severity observations shall be completed. While the <statusCode> element is required in all acts to record the status of the act, the only sensible value of this element in this context is completed.

<value xsi:type='CD' code='H|M|L' codeSystem='2.16.840.1.113883.5.1063' codeSystemName='SeverityObservation'>

The <value> element contains the level of severity. It is always represented using the CD datatype (xsi:type='CD'), even though the value may be a coded or uncoded string. If coded, it should use the HL7 SeverityObservation vocabulary (codeSystem='2.16.840.1.113883.5.1063') containing three values (H, M, and L), representing high, moderate and low severity depending upon whether the severity is life threatening, presents noticeable adverse consequences, or is unlikely substantially effect the situation of the subject.