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Various sections and entries in CCDA documents contain effectiveTime elements which indicate the date and/or times of occurrences of certain activities. These activities may include:

  • Creation date of a document
  • Start of an encounter activity between a patient and clinician
  • Ingestion period of medication

Depending on the type of activity, the effectiveTime can be documented as a single date/time value or an interval with a start date and an optional end date.

It should be populated with a date in the following format:

YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][+/-ZZZZ]

where +/-ZZZZ specifies the offset from Coordinated Universal Time (UTC).

Effective Time as a value

Documenting effective time as a single value is appropriate for activities that only require a specific date/time. For example, the date and time when a particular diagnosis was recorded.

...
<entry typeCode="DRIV">
	<act classCode="ACT" moodCode="EVN">
		...
		<entryRelationship typeCode="SUBJ"/>
			<observation classCode="OBS" moodCode="EVN">
				...
				<effectiveTime value="201209151030-0800"/>
				...
			</observation>
		</entryRelationship>  
	</act>
</entry>
...

Effective Time as an interval

Documenting effective time as an interval with a start date and an end date is appropriate for activities that occurred over a period of time or is still occurring. For example, an ongoing encounter between a patient and clinician.

The effectiveTime element must have an attribute xsi:type with the value IVL_TS.

The low value (start date/time) is typically required to indicate the start of the interval, while the high value (end date/time) is optional. If no high value is given, this indicates that the activity has not finished or is ongoing.

...
<entry typeCode="DRIV">
	<act classCode="ACT" moodCode="EVN">
		...
		<entryRelationship typeCode="SUBJ"/>
			<observation classCode="OBS" moodCode="EVN">
				...
				<effectiveTime xsi:type="IVL_TS">
					<low value="201209151030-0800"/>
					<high value="201309151030-0100"/>
				</effectiveTime>
				...
			</observation>
		</entryRelationship>  
	</act>
</entry>
...

Effective Time as nullFlavor

If the effective time information is missing, a nullFlavor attribute should be present instead. Information may be missing because it was not captured and stored etc.

nullFlavor can be used for single value instances:

<effectiveTime nullFlavor="UNK"/>

Or for intervals:

<effectiveTime xsi:type="IVL_TS">
	<low nullFlavor="UNK">
</effectiveTime>
<effectiveTime xsi:type="IVL_TS">
    <low value=20170917/>
    <high nullFlavor="UNK"/>
</effectiveTime>

nullFlavor attributes may use the following values:

ValueDescription
ASKUAsked but unknown
MSKMasked (for sensitivity of confidentiality reasons)
NANot applicable
NASKNot asked
NAVNot available
NINo information
OTHOther
UNKUnknown


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