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Gay Dolin


Date:


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Meeting ID: 465 862 913

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Agenda:


10:00am EST

  1. Call to order 
    1. Call for Attendance

    2. Review agenda - very full agenda, may have to move stuff to next week.
  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. Approve minutes from 2020-06-18 Agenda and Minutes

    3. HL7
  3. External Updates - ONC and others
  4. Project Updates
    1. Value Set Issues

      1. see 11:00am
    2. Provenance
    3. Other Project Updates
  5. Additional Items
    1. Workgroup approval of the publication for the HL7 Implementation Guide(s) for CDA® Release 2: Healthcare Associated Infection Reports Release 3 Normative pre-publication review package:
      1. https://www.hl7.org/documentcenter/public/wg/structure/20201806_PrepublicationReview_CDAR2_IG_HAIRPT_R3_N1_2020JUN.zip
    2. Review the status of Publication Request: HL7 FHIR® Implementation Guide: C-CDA on FHIR, Release 2 - Would like to ask Rick Geimer to attend for insight into the current status of this Publication Request in terms of R2 vs. R4?
      1. Discussed with Rick at CDAMG on  - The FHIR Management group came back with more changes that they wanted and Rick is in the process of making those. He just hasn't had a chance to finish those yet.
      2. http://build.fhir.org/ig/HL7/ccda-on-fhir-r4/

    3. Identifiers with unknown @root Russell Ottfrom Payer/Provider Information Exchange (10 minutes)
      1.  Click here to expand...
        1. Here's a brief summary of the specific challenge we’re facing:

          1. When attachments are solicited by a Payer, the Payer issues a unique Attachment Control Number the provider should use when submitting the Attachment
          2. When attachments are unsolicited, the provider creates and communicates their own Attachment Control Number to the payer, both in the X12 claim transaction as well as on the attachment they generate.
          3. Neither Payer nor Provider organizations are in the habit of managing OIDs associated with Attachment Control Numbers they create today.  They want to continue in their current practice of simply creating numbers, even though there might be “collision” of those numbers across the various organizations that create them.


          Previously, we included the following language in the Attachment Implementation Guide published in 2017 (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=464), but I think we may want to change it:


          3.4.1 The Use of OIDs in Attachments

          OIDs are used throughout the C-CDA used in Attachments. However, there are times in which an OID may

          not have been assigned to the information being exchanged. In this situation it is permissible to use ‘UNK’

          as the OID. For example, Patient ID is required in C-CDA header but Patient ID is not defined nor does it

          state whether it is Patient ID identified by provider or the payer.


          Each provider or payer should obtain an OID for their organization to establish the scope for a Patient ID.

          If a provider or payer does not have an OID for their organization to establish the scope for a Patient ID, the

          following is a valid way to represent a Patient or Member Id:

          <id NullFlavor=’UNK’ extension=’MemberID’>

    4. PACP Ballot Submissions - 10 min - Lisa R. Nelson
      1. CDAR2_IG_PERSADVCAREPLAN_R1N1_2019SEP_almalgamated_20200416_20200620 reopen comments.xls

         Click here to expand...

        Comment #12 requested that the conformance guidance be changed to SHALL and initially was considered persuasive. When we got into the execution of this change, it doesn’t seem right to change this to a SHALL, we want to review this item again and possible make a motion to reopen the comment if others agree it needs to be changed.

        Comment #44 we would also like to vote to re-open. It was marked as not persuasive, but we are finding it is closely related to other comments which are asking us to rethink the value set strategy used for the code element of personal goals, and personal preferences.  We would like to move to have the change for this code element be addressed consistently with the larger strategy to partition the general value set established for representing goals and preferences.

    5. Update on RIM Modelling for Identifiers from CDA R3 (Austin) (5 min)
      1. CDAR3_RMIM.jpg
    6. Time Block for Nick Radov C-CDA Templates for Clinical Notes STU Comments (20 min)
      1. 2020-06-25 Agenda and Minutes#1406, 2020-06-25 Agenda and Minutes#1428, 2020-06-25 Agenda and Minutes#1782, 2020-06-25 Agenda and Minutes#1789, 2020-06-25 Agenda and Minutes#1791, 2020-06-25 Agenda and Minutes#1797, 2020-06-25 Agenda and Minutes#1806, 2020-06-25 Agenda and Minutes#1922, 1995, 1997 (Expand the Clinical Notes Section of the agenda below to see more details.)
    7. Time Block for Matt Szczepankiewicz Companion Guide STU Comments (20 min)
      1. 2020-06-25 Agenda and Minutes#1983, 2020-06-25 Agenda and Minutes#1984, 2020-06-25 Agenda and Minutes#1985, 2020-06-25 Agenda and Minutes#1986, 2020-06-25 Agenda and Minutes#1994, 2020-06-25 Agenda and Minutes#1996, 2020-06-25 Agenda and Minutes#1998 (Expand the Companion Guide Section of the agenda below to see more details.)
    8. STUs Expiring in Next 6 Months (carried over from  Agenda)
    9. Sarah Gaunt or David DeRoode
  6. STU Comments - HL7 CDA® R2 Implementation Guide: C-CDA Templates for Clinical Notes Companion Guide, Release 2 STU - US Realm
    1.  Click here to expand...
      STULast UpdateCommenterComment

      1983   

       

      Order fulfillment conformance statement that are contradictory

      1984 

       

      Appendix C has a constraint with root, extension and NULL of UNK

      1985 

       

      The Provenance entry in the Appendix C is inconsistent with the author entry in the C-CDAr2.1 IG in terms of allowable values and it is misleading.

      1986 

       

      For the UDI information, can we get clarification on whether it is possible to send other information when we do not have the DI information?

      1948 

       

      Appendix B UDI
      1.1 UDI Organizer 

      Figure 1: Unique Device Identifier (UDI) Organizer Template ID root is incorrect

      1994 

       

      (Vocab issue)
      Table 9 of the Companion Guide recommends the LOINC codes 11502-2 for Laboratory Narrative notes and 11526-1 for Pathology Narrative notes. However, these codes aren't actually included in the Note Types value set (urn:oid:2.16.840.1.113883.11.20.9.68) as required by the Notes Section and Note Activity templates in Appendix A. Likewise, although no specific LOINC code is recommended for Imaging Narrative notes, the value set doesn't include any codes from the value set recommended for imaging notes in Table 8 (urn:oid:1.3.6.1.4.1.12009.10.2.5).

      1996 

       

      In Appendix C, I read the Provenance - Author Participation template as saying you can use the same trick as in the standard C-CDA Author Participation template to reference an author already defined elsewhere in the document:

      The assignedAuthor/id may be set equal to (a pointer to) an id on a participant elsewhere in the document (header or entries) or a new author participant can be described here.

      That is, that it's okay to do this:

      <assignedAuthor>
      <id extension="1386639318" root="2.16.840.1.113883.4.6" />
      </assignedAuthor>

      assuming the document actually contains a full entry for the author with that id somewhere else.

      But when an author containing the Provenance - Author Participation templateId does this, it raises a handful of schematron errors that still enforce the SHALL constraint on the representedOrganization (CONF:4440-4 and children):

      1998 

       

      The following unimplemented constraints use the expression "not(.)" throughout the main Companion Guide schematron file:

      CONF:3250-16902
      CONF:3250-16912
      CONF:3250-16914
      CONF:4435-133
      CONF:3250-16942

      Typically unimplemented constraints use a dummy expression like "not(tested)" that always returns false (since the current element doesn't have a child named "tested"), but in this case, we're asserting that the current node is null, which returns false, makes the assertion fail, and triggers a false positive schematron error.
  7. STU Comments -  HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan Document, Release 1 - US Realm
    1.  Click here to expand...
      STULast UpdateCommenterIssue
      1785

       

      These constraints need to be modified to allow for the situation where a PACP is shared as a video.
  8. STU Comments - HL7 CDA® R2 Implementation Guide International Patient Summary, Release 1
    1.  Click here to expand...
      STULast UpdateCommenterIssue
      1886

       

      (For several Templates: 2.16.840.1.113883.10.22.4.23 IPS ObservationMedia; 2.16.840.1.113883.10.22.2.1 IPS CDA recordTarget ; 2.16.840.1.113883.10.22.1.1 International Patient Summary ; 2.16.840.1.113883.10.22.3.15 IPS Translation Section )

      The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.19 Language Code
      1887

       

      2.16.840.1.113883.10.22.4.27 (2017-04-13) IPS Pregnancy Status Observation

      Change IPS Pregnancy Status Observation value element from boolean to a coded element to support the "Possible Pregnant" case.

      1888

       

      2.16.840.1.113883.10.22.4.27 (2017-04-13) IPS Pregnancy Status Observation

      Finding:
      the prEn 17269 indicates the Date of Observation as required (not mandatory) data.

      Suggestion:
      consider to change the cardinality from 0..1 R to 1..1 R

      1889

       

      2.16.840.1.113883.10.22.4.17 (2017-03-27) IPS Procedure Entry

      Finding:
      the EN 17269 and the FHIR IPS procedure have a 1..1 Procedure date

      Suggestion:
      change the cardinality from 0..1 R to 1..1 R for alignment

      1890

       

      2.16.840.1.113883.10.22.4.26 (2017-04-11) IPS Medical Device

      Finding:
      The body site of the implant cannot be specified

      Suggestion:
      Add a body site as entryRelationship to an implant procedure carrying the body site

      1891

       

      2.16.840.1.113883.10.22.4.2 (2016-11-10) IPS Medication Information (detail)

      Finding:
      Ingredient Substance code and name both are optional, which is probably not enough. HL7 Pharmacy WG and IHE have defined code O and name R.

      Suggestion:
      Make either name R or create a co-constraint code or name must be present

      1892

       

      IPSTimeUnits Value Set

      Finding:
      d day is missing in the IPSTimeUnits Value Set

      Suggestion:
      Add d

      1893

       

      Included 0 … * R from 2.16.840.1.113883.10.22.2.7 IPS CDA relatedDocument (DYNAMIC)

      Finding:
      According to the CDA constraint
      "A conformant CDA document can have a single relatedDocument with typeCode "APND"; a single relatedDocument with typeCode "RPLC"; a single relatedDocument with typeCode "XFRM"; a combination of two relatedDocuments with typeCodes "XFRM" and "RPLC"; or a combination of two relatedDocuments with typeCodes "XFRM" and "APND". No other combinations are allowed. "

      Should we change the cardinality of relatedDocument to 0..2 ?

      Included 0 … 2 R from 2.16.840.1.113883.10.22.2.7 IPS CDA relatedDocument (DYNAMIC)

      1894

       

      2.16.840.1.113883.10.22.4.3 (2016-11-10) IPS Manufactured Material
      Example

      Finding:
      < cpm: quantity >
      <!-- strength -->
      < cpm: numerator xsi:type =" PQ " value =" 20 " unit =" mg " / >
      < cpm: denominator xsi:type =" PQ " value =" 1 " unit =" {tablet} " / >
      </ cpm: quantity >

      Suggestion:
      elements <numerator> and <denominator> are part of the PQR data type, the extension 'cpm:' is not needed here...

      1895
       

      IPS Template 2.16.840.1.113883.10.22.1.1
      hl7:realmCode CS 1 … 1 R

      hl7:realmCode CS 0 … 1 R

      1974

       

      representedCustodianOrganization allows for more than one telecom element

      Finding: representedCustodianOrganization allows for more than one telecom element
      - This violates the CDA schema, where only zero to one telecom elements are allowed

      1975

       

      "the languageCode element on document level (see attachment). In the Schematron message, the ISO Country code and ISO Language code are switched."
      1978

       

      The code for Absent or Unknown Devices is placed now that the participation level code.

      Move the Absent or Unknown Devices code to the Supply.code (that have been dropped earlier but need to be re-introduced here)

      1979

       

      IPS Problem Status Observation - 2.16.840.1.113883.10.22.4.20

      Adopt the value set defined in FHIR for the condition status

  9. STU Comments - HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Nutrition, Release 1 - US Realm
    1.  Click here to expand...
      STULast UpdatedCommenterIssue
      1961

       

      The Feeding Device Grouping value set (OID 2.16.840.1.113762.1.4.1095.87) is listed in section 1.7 ("Vocabulary Value Set Definitions Defined in this IG") but is not found elsewhere in the IG. The Feeding Device value set (OID 2.16.840.1.113762.1.4.1095.61) is in the Feeding Device template, but not listed in section 1.7.

      The Feeding Device template should be updated to use the Feeding Device Grouping value set rather than just the Feeding Device value set as this will allow more flexibility if the Feeding Device Grouping value set eventually contains more members.

      This issue was discovered during the annual value set review in Spring 2020.
      1962

       

      The value set Diet Item Grouping (OID 2.16.840.1.113762.1.4.1095.59) is used throughout the IG, however it is called "Diet Item" throughout the IG. This should be corrected so that the value set name used in the IG matches the actual value set name.

      The following are the locations to be corrected:
      Table 27 (and the text below it), Table 28 (text at the top), Table 71 (and the text below it), Table 74
      1966

       

      In section 6 "VALUE SETS IN THIS GUIDE" (Table 74: Value Sets), the value set "Food and Nutrition Related History Grouping" OID:2.16.840.1.113762.1.4.1095.82 is not listed as a value set in this table, but should be (it is referenced in section 1.7 Vocabulary Value Set Definitions Defined in this IG).
      1967

       

      In table 1.7 Vocabulary Value Set Definitions Defined in this IG lists a value set called "Anthropometric Measurements Grouping" but actual value set name name is "Nutrition Anthropometric Measurements Grouping" (OID:2.16.840.1.113762.1.4.1095.75). (It is listed correctly in section 6 VALUE SETS IN THIS GUIDE Table 74.)
  10. STU Comments - HL7 CDA® R2 Implementation Guide: Exchange of C-CDA Based Documents; Periodontal Attachment, Release 1 - US Realm
    1.  Click here to expand...
      STULast UpdatedCommenterIssue
      1551

       

      P.92
      7.7 Periodontal Narrative Activity

      As noted previously, general observations and notations allow the provider to express clinical observations and relevancy in unstructured text. Below would be a representative sample of the type of narrative used in the attachment:

      “Patient’s overall health is good despite her obesity. Says that she’s drinking 12+ 20oz Cokes a day. Patient admits to not following a regular oral hygiene regimen. Referring patient to OralMaxillofacial surgeon for consult due to Mandibular involvement and bone loss.”
      1550

       

      Gingival disease is evaluated in five stages: namely, gingival health, gingivitis, Slight/mild periodontitis, moderate periodontitis, and advance/aggressive periodontitis. Disease progression or treatment efficacy is both observed and measured. The image (left) depicts this progression and implementers should note the values associated with the measurement of each tooth to a particular stage of disease.

      Figure showing stages of periodontal disease.
  11. STU Comments - HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm
    1.  Click here to expand...
      STULast UpdatedCommenterIssue

       

      2.61 Procedures Section (entries optional) (V2)
      2.61.1 Procedures Section (entries required) (V2)

      I think we have a discrepancy between the narrative text in these sections versus the formal constraints on the contained "Procedure Activity Procedure (V2)" entry template. The sections are only supposed to contain historical procedures which actually altered the patient's state. However the Value Set: ProcedureAct statusCode urn:oid:2.16.840.1.113883.11.20.9.22 includes concept codes for "aborted", "active", and "cancelled". If the procedure is still active then it isn't yet historical. If the procedure was aborted or cancelled then presumably it didn't alter the patient state.

      This is creating confusion among implementers. We have received documents from multiple EHRs containing procedure entries with statusCode/@code="active".

       

      Figure 161: Immunization Activity (V3) Example
      (page 550)

      <code code="33" codeSystem="2.16.840.1.113883.6.59" displayName="Pneumococcal polysaccharide vaccine" codeSystemName="CVX">

      Figure 224: Substance Administered Act Example
      (page 846)

      <code code="43" codeSystem="2.16.840.1.113883.6.59" displayName="Hepatitis B Vaccine" codeSystemName="CVX" />
      1942

       

      Comment Activity
      urn:oid:2.16.840.1.113883.10.20.22.4.64

      5. SHALL contain exactly one [1..1] text (CONF:81-9430).
      a. This text SHALL contain exactly one [1..1] reference (CONF:81-15967).
      i. This reference SHALL contain exactly one [1..1] @value (CONF:81-15968).
      1. This reference/@value SHALL begin with a '#' and SHALL point to its corresponding narrative (using the approach defined in CDA Release 2, section 4.3.5.1) (CONF:81-15969).
      b. This text SHALL contain exactly one [1..1] reference/@value (CONF:81-9431).

      The order of these conformance statement is confusing. It seems like 5.a.i would make more sense under 5.b
      1946

       

      Table 6 found on page 63 in CDAR2_IG_CCDA_CLINNOTES_R1_DSTU2.1_2015AUG_Vol2_2019JUNwith_errata.pdf has the following text:

      Table 6: Language Value Set: Language urn:oid:2.16.840.1.113883.1.11.11526

      A value set of codes defined by Internet RFC 5646. Use 2 character code if one exists. Use 3 character code if a 2 character code does not exist. Including type = region is allowed

      See http://www.iana.org/assignments/language-subtag-registry/language-subtag-registry
      Value Set Source: http://www.loc.gov/standards/iso639-2/php/code_list.php

      While the table states Including type = region is allowed - the value set source does not list any valid regions. Also, the two sample provided as follows need to be corrected:

      The Figure 1: US Realm Header (V3) Example shows <languageCode code="en-US" />
      which SHOULD be <languageCode code="en" />

      The Figure 2: recordTarget Example shows <languageCommunication> <languageCode code="eng" />
      which SHOULD be <languageCommunication> <languageCode code="en" /> because Table 6 (Page 63) states to use the 2 digit code if there is one.

      Lastly, this value set is not included in VSAC. Should it be?
      1945

       

      Encounter Diagnosis (V3)
      [act: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.80:2015-08-01 (open)]

      This template wraps relevant problems or diagnoses at the close of a visit or that need to be followed after the visit. If the encounter is associated with a Hospital Discharge, the Hospital Discharge Diagnosis must be used. This entry requires at least one Problem Observation entry.

       

      1.1.1 Properties

      ...

      8. SHALL contain exactly one [1..1] confidentialityCode, which SHOULD be selected from ValueSet HL7 BasicConfidentialityKind urn:oid:2.16.840.1.113883.1.11.16926 STATIC (CONF:1198-5259).
      1885

       

      @sueann svabySHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet Social History Type urn:oid:2.16.840.1.113883.3.88.12.80.60 DYNAMIC (CONF:1198-8558).
      a. If @codeSystem is not LOINC, then this code SHALL contain at least one [1..*] translation, which SHOULD be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:1198-32951).
      1873

       

      Encounter Diagnosis (V3)
      [act: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.80:2015-08-01 (open)]

      The template is missing a binding for statusCode.

      Figure 144 shows a statusCode of "active". This provides the wrong guidance.
      1859

       

      Please REMOVE/DEPRECATE this commentIn the errata release from June 2019,Figure 162 is wrong and needs to be updated to use the correct Code System OID for CVX 2.16.840.1.113762.1.4.1010.6. It currently shows as 2.16.840.1.113762.12.292
      1860

       

      In the errata release from June 2019,Figure 161 is wrong and needs to be updated to use the correct Code System OID for CVX "2.16.840.1.113883.12.292". It currently shows as 2.16.840.1.113762.6.59

       

      Care Plan (V2)
      [ClinicalDocument: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.1.15:2015-08-01 (open)]

      The CDA Care Plan represents an instance of this dynamic Care Plan at a point in time. The CDA document itself is NOT dynamic.
      Key differentiators between a Care Plan CDA and CCD (another “snapshot in time” document): There are 2 required sections:
      o Health Concerns o Interventions
      There are 2 optional sections:
      o Goals o Outcomes

      • Provides the ability to identify patient and provider priorities with each act • Provides a header participant to indicate occurrences of Care Plan review A care plan document can include entry references from the information in these sections to the information (entries) in other sections.
      Please see Volume 1 of this guide to view a Care Plan Relationship diagram and story board.

       

      Section 1.1.17.4.iv doesn't include ICD-10-PCS as an allowed code system. It has now supplanted ICD-9 in the US realm.
      1802

       

      Smoking Status - Meaningful Use (V2) (urn:hl7ii:2.16.840.1.113883.10.20.22.4.78:2014-06-09)

      . This value SHALL contain exactly one [1..1] @code, which SHALL be selected from ValueSet Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38 DYNAMIC (CONF:1098-14817).

      1800 

      1801

       

      We have trouble adding new Social History Observations when the US Gov't identifies the observation using LOINC. We really should be using LOINC in the code ("the question").

      I recommend creating a Grouping Value Set that combines the original set of concepts using SNOMEDCT (Social History Type (SNOMEDCT)) and then agree to put all new/additional social history observation codes in the Social History Type (LOINC) value set. Use the existing OID for the new Grouping VS and make two new value sets for the parts of the grouping VS.
      1798

       

      On page 392, Section 3.61.1, the last three sentences of the text read as follows:

      "Procedure act is for procedures that alter the physical condition of a patient (e.g., splenectomy). Observation act is for procedures that result in new information about a patient but do not cause physical alteration (e.g., EEG). Act is for all other types of procedures (e.g., dressing change)."

      This is different from the wording on page 390, Section 3.61 Procedures Section (entries optional) (V2). Updated language is in the proposed section below.

       

      Currently the Referral Note (V2) document type doesn't include a Payers section. We should add that as an optional section because sometimes the "Referred From" provider needs to tell the "Referred To" provider which insurance coverage the patient has. And in some cases the provider needs to route a copy of the document to the patient's insurance company so they also need a way to indicate which plan the patient is on (or at least which plan they believe the patient to be on).
      1793

      3.41 Immunization Medication Information (V2) includes SHALL have a manufactureMaterial where this code MAY contain zero or more [0..*] translation, which MAY be selected from ValueSet Vaccine Clinical Drug urn:oid:2.16.840.1.113762.1.4.1010.8 DYNAMIC (CONF:1098-31543).

       

      3.41 Immunization Medication Information (V2) includes SHALL have a manufactureMaterial where this code MAY contain zero or more [0..*] translation, which MAY be selected from ValueSet Vaccine Clinical Drug urn:oid:2.16.840.1.113762.1.4.1010.8 DYNAMIC (CONF:1098-31543).

       

      We have seen real-world implementation defects where planned future encounters appear in the Encounters section rather than the Plan of Treatment section where they should be. I think some developers are just querying their database encounter tables for all encounters for a particular patient and sticking everything in the Encounters section regardless of whether they are past or future. Let's introduce a new conformance rule to ensure each Encounter activity ends before the document header effectiveTime.

       

      In section 3.81 Procedure Activity Procedure (V2) the Procedure.code (CONF:1098-7656) doesn't mention HCPCS as a possible code system. I think that code system should be explicitly listed because it is in common use in the US realm along with CPT-4. There are many procedures which are in HCPCS but not in CPT-4.

      This @code SHOULD be selected from LOINC (CodeSystem: 2.16.840.1.113883.6.1) or SNOMED CT (CodeSystem: 2.16.840.1.113883.6.96), and MAY be selected from CPT-4 (CodeSystem: 2.16.840.1.113883.6.12) or ICD10 PCS (CodeSystem: 2.16.840.1.113883.6.4) or CDT-2 (Code System: 2.16.840.1.113883.6.13) (CONF:1098-19207).

       

      Section 3.23, page 483:

      Table 272: EncounterTypeCode
      Value Set: EncounterTypeCode urn:oid:2.16.840.1.113883.3.88.12.80.32
      This value set includes only the codes of the Current Procedure and Terminology designated for Evaluation and Management (99200 – 99607) (subscription to AMA Required
      Value Set Source: http://www.amacodingonline.com/

       

      <!-- ************************ ENCOUNTERS *********************** -->
      <component>
      <section>
      <!-- *** Encounters section (entries required) (V3) *** -->
      <templateId root="2.16.840.1.113883.10.20.22.2.22.1" extension="2015-08-01"/>
      <templateId root="2.16.840.1.113883.10.20.22.2.22.1"/>

      I think there is a problem with the sample CCD file C-CDA_R2-1_CCD.xml included in this package.

  12.  

11:00am EST

  1. Value Set Updates
  2. Value Set STU Comments
    1. #nnnn
  3. Adjournment
    1. Next Meeting on 2020-07-02

Notes/Minutes:

10:00am EST

  1. Call to order 
    1. Gay called the meeting to order at 10:05am EST 
    2. Call for Attendance

    3. Review agenda - very full agenda, may have to move stuff to next week.
  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. Approve minutes from 2020-06-18 Agenda and Minutes Approved by general consensus

    3. HL7
  3. External Updates - ONC and others
    1. Aug 10/11 - Tech Forum - formerly the Interop Forum
    2. ONC Tech Forum blog https://www.healthit.gov/buzz-blog/health-it/join-us-at-oncs-virtual-tech-forum-on-august-10-11-2020 Direct Link to registration https://www.onctechforum.com/ Link to register for the Virtual C-CDA Implementation-a-thon http://www.hl7.org/events/c-cda/implementation/2020/07/
  4. Project Updates
    1. Value Set Issues

      1. see 11:00am
    2. Provenance
    3. Other Project Updates
  5. Additional Items
    1. Workgroup approval of the publication for the HL7 Implementation Guide(s) for CDA® Release 2: Healthcare Associated Infection Reports Release 3 Normative pre-publication review package:
      1. https://www.hl7.org/documentcenter/public/wg/structure/20201806_PrepublicationReview_CDAR2_IG_HAIRPT_R3_N1_2020JUN.zip
      2. TypeMotion
        Motion

        Motion to approve publication package for HAI Normative Guide

        By
        Second
        Date

         

        Ref #https://www.hl7.org/documentcenter/public/wg/structure/20201806_PrepublicationReview_CDAR2_IG_HAIRPT_R3_N1_2020JUN.zip
        For32
        Neg00
        Abs00
        Status

        APPROVED

        Tally32-00-00 
        Discussion


        Action

        Sarah Gauntto send to CDAMG, Infrastructure SD, and TSC

    2. Review the status of Publication Request: HL7 FHIR® Implementation Guide: C-CDA on FHIR, Release 2 - Would like to ask Rick Geimer to attend for insight into the current status of this Publication Request in terms of R2 vs. R4?
      1. Discussed with Rick at CDAMG on  - The FHIR Management group came back with more changes that they wanted and Rick is in the process of making those. He just hasn't had a chance to finish those yet.
      2. http://build.fhir.org/ig/HL7/ccda-on-fhir-r4/

    3. Identifiers with unknown @root Russell Ottfrom Payer/Provider Information Exchange (10 minutes)
      1.  Click here to expand...
        1. Here's a brief summary of the specific challenge we’re facing:

          1. When attachments are solicited by a Payer, the Payer issues a unique Attachment Control Number the provider should use when submitting the Attachment
          2. When attachments are unsolicited, the provider creates and communicates their own Attachment Control Number to the payer, both in the X12 claim transaction as well as on the attachment they generate.
          3. Neither Payer nor Provider organizations are in the habit of managing OIDs associated with Attachment Control Numbers they create today.  They want to continue in their current practice of simply creating numbers, even though there might be “collision” of those numbers across the various organizations that create them.


          Previously, we included the following language in the Attachment Implementation Guide published in 2017 (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=464), but I think we may want to change it:


          3.4.1 The Use of OIDs in Attachments

          OIDs are used throughout the C-CDA used in Attachments. However, there are times in which an OID may

          not have been assigned to the information being exchanged. In this situation it is permissible to use ‘UNK’

          as the OID. For example, Patient ID is required in C-CDA header but Patient ID is not defined nor does it

          state whether it is Patient ID identified by provider or the payer.


          Each provider or payer should obtain an OID for their organization to establish the scope for a Patient ID.

          If a provider or payer does not have an OID for their organization to establish the scope for a Patient ID, the

          following is a valid way to represent a Patient or Member Id:

          <id NullFlavor=’UNK’ extension=’MemberID’>

        Russell Ott will bring this back up.

    4. PACP Ballot Submissions - 10 min - Lisa R. Nelson
      1. CDAR2_IG_PERSADVCAREPLAN_R1N1_2019SEP_almalgamated_20200416_20200620 reopen comments.xls

         Click here to expand...

        Comment #12 requested that the conformance guidance be changed to SHALL and initially was considered persuasive. When we got into the execution of this change, it doesn’t seem right to change this to a SHALL, we want to review this item again and possible make a motion to reopen the comment if others agree it needs to be changed.

        Comment #44 we would also like to vote to re-open. It was marked as not persuasive, but we are finding it is closely related to other comments which are asking us to rethink the value set strategy used for the code element of personal goals, and personal preferences.  We would like to move to have the change for this code element be addressed consistently with the larger strategy to partition the general value set established for representing goals and preferences.

        TypeMotion
        Motion

        Motion to open this item back up for consideration

        By
        Second
        Date

         

        Ref #12
        For28
        Neg00
        Abs00
        Status

        APPROVED

        Tally28-00-00 
        Discussion

        Vote was successful, will open this back up for discussion.

        Action

        Lisa R. Nelsonwill open up for discussion and announce a future vote.

        TypeMotion
        Motion

        Motion to open this question to address this as persuasive with mod. Bring forward with more specific proposal for specific ValueSet to be bound.

        By
        Second
        Date

         

        Ref #44
        For27
        Neg00
        Abs00
        Status

        APPROVED

        Tally27-00-00 
        Discussion

        Vote successful, will open this back up for discussion.

        Action

        Lisa R. Nelson will open this item up for further discussion and future action.

    5. Update on RIM Modelling for Identifiers from CDA R3 (Austin) (5 min)
      1. CDAR3_RMIM.jpg
        1. Austin is not here, will try to address on . Co-chairs will try to get with Austin Kreisler about getting the information from him so that we might continue working on this in his absence.
    6. Time Block for Nick Radov C-CDA Templates for Clinical Notes STU Comments (20 min)
      1. 2020-06-25 Agenda and Minutes#1406, 2020-06-25 Agenda and Minutes#1428, 2020-06-25 Agenda and Minutes#1782, 2020-06-25 Agenda and Minutes#1789, 2020-06-25 Agenda and Minutes#1791, 2020-06-25 Agenda and Minutes#1797, 2020-06-25 Agenda and Minutes#1806, 2020-06-25 Agenda and Minutes#1922, 1995, 1997 (Expand the Clinical Notes Section of the agenda below to see more details.)
        1. 1997
        2. Design Change, persuasive with mod. The ValueSet will remain unchanged. Current or historical. Planned or ordered procedure should go into plan (add text to clarify)
        3. CONF:1098-7662
        4. effectivetime high SHOULD also be in the past
        5. ValueSet will remain unchanged
        6. TypeMotion
          Motion

          Motion to approve 

          By
          Second
          Date

           

          Ref #1997
          For27
          Neg00
          Abs00
          Status

          APPROVED

          Tally27-00-00 
          Discussion

          Action
        7. TypeMotion
          Motion

          Motion to reconsider 1997 in  

          By
          Second
          Date

           

          Ref #1997
          For27
          Neg00
          Abs00
          Status

          APPROVED

          Tally27-00-00 
          Discussion

          After the previous vote, Lisa R. Nelsonnoticed that there were some structural issues with the layout for the CDA content of 1997. This subsequent motion was made to re-open the issue and allow for further work on the layout for a future session.

          Action
        8. Didi Davis brought up issue 1946 which has been a problem with the language/country/region coding used and the related ValueSet
        9. Time Block for Matt Szczepankiewicz Companion Guide STU Comments (20 min)
          1. 2020-06-25 Agenda and Minutes#1983, 2020-06-25 Agenda and Minutes#1984, 2020-06-25 Agenda and Minutes#1985, 2020-06-25 Agenda and Minutes#1986, 2020-06-25 Agenda and Minutes#1994, 2020-06-25 Agenda and Minutes#1996, 2020-06-25 Agenda and Minutes#1998 (Expand the Companion Guide Section of the agenda below to see more details.)
        10. STUs Expiring in Next 6 Months (carried over from  Agenda)
  6. STU Comments - HL7 CDA® R2 Implementation Guide: C-CDA Templates for Clinical Notes Companion Guide, Release 2 STU - US Realm
    1.  Click here to expand...
      STULast UpdateCommenterComment

      1983   

       

      Order fulfillment conformance statement that are contradictory

      1984 

       

      Appendix C has a constraint with root, extension and NULL of UNK

      1985 

       

      The Provenance entry in the Appendix C is inconsistent with the author entry in the C-CDAr2.1 IG in terms of allowable values and it is misleading.

      1986 

       

      For the UDI information, can we get clarification on whether it is possible to send other information when we do not have the DI information?

      1948 

       

      Appendix B UDI
      1.1 UDI Organizer 

      Figure 1: Unique Device Identifier (UDI) Organizer Template ID root is incorrect

      1994 

       

      (Vocab issue)
      Table 9 of the Companion Guide recommends the LOINC codes 11502-2 for Laboratory Narrative notes and 11526-1 for Pathology Narrative notes. However, these codes aren't actually included in the Note Types value set (urn:oid:2.16.840.1.113883.11.20.9.68) as required by the Notes Section and Note Activity templates in Appendix A. Likewise, although no specific LOINC code is recommended for Imaging Narrative notes, the value set doesn't include any codes from the value set recommended for imaging notes in Table 8 (urn:oid:1.3.6.1.4.1.12009.10.2.5).

      1996 

       

      In Appendix C, I read the Provenance - Author Participation template as saying you can use the same trick as in the standard C-CDA Author Participation template to reference an author already defined elsewhere in the document:

      The assignedAuthor/id may be set equal to (a pointer to) an id on a participant elsewhere in the document (header or entries) or a new author participant can be described here.

      That is, that it's okay to do this:

      <assignedAuthor>
      <id extension="1386639318" root="2.16.840.1.113883.4.6" />
      </assignedAuthor>

      assuming the document actually contains a full entry for the author with that id somewhere else.

      But when an author containing the Provenance - Author Participation templateId does this, it raises a handful of schematron errors that still enforce the SHALL constraint on the representedOrganization (CONF:4440-4 and children):

      1998 

       

      The following unimplemented constraints use the expression "not(.)" throughout the main Companion Guide schematron file:

      CONF:3250-16902
      CONF:3250-16912
      CONF:3250-16914
      CONF:4435-133
      CONF:3250-16942

      Typically unimplemented constraints use a dummy expression like "not(tested)" that always returns false (since the current element doesn't have a child named "tested"), but in this case, we're asserting that the current node is null, which returns false, makes the assertion fail, and triggers a false positive schematron error.
  7. STU Comments -  HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan Document, Release 1 - US Realm
    1.  Click here to expand...
      STULast UpdateCommenterIssue
      1785

       

      These constraints need to be modified to allow for the situation where a PACP is shared as a video.
  8. STU Comments - HL7 CDA® R2 Implementation Guide International Patient Summary, Release 1
    1.  Click here to expand...
      STULast UpdateCommenterIssue
      1886

       

      (For several Templates: 2.16.840.1.113883.10.22.4.23 IPS ObservationMedia; 2.16.840.1.113883.10.22.2.1 IPS CDA recordTarget ; 2.16.840.1.113883.10.22.1.1 International Patient Summary ; 2.16.840.1.113883.10.22.3.15 IPS Translation Section )

      The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.19 Language Code
      1887

       

      2.16.840.1.113883.10.22.4.27 (2017-04-13) IPS Pregnancy Status Observation

      Change IPS Pregnancy Status Observation value element from boolean to a coded element to support the "Possible Pregnant" case.

      1888

       

      2.16.840.1.113883.10.22.4.27 (2017-04-13) IPS Pregnancy Status Observation

      Finding:
      the prEn 17269 indicates the Date of Observation as required (not mandatory) data.

      Suggestion:
      consider to change the cardinality from 0..1 R to 1..1 R

      1889

       

      2.16.840.1.113883.10.22.4.17 (2017-03-27) IPS Procedure Entry

      Finding:
      the EN 17269 and the FHIR IPS procedure have a 1..1 Procedure date

      Suggestion:
      change the cardinality from 0..1 R to 1..1 R for alignment

      1890

       

      2.16.840.1.113883.10.22.4.26 (2017-04-11) IPS Medical Device

      Finding:
      The body site of the implant cannot be specified

      Suggestion:
      Add a body site as entryRelationship to an implant procedure carrying the body site

      1891

       

      2.16.840.1.113883.10.22.4.2 (2016-11-10) IPS Medication Information (detail)

      Finding:
      Ingredient Substance code and name both are optional, which is probably not enough. HL7 Pharmacy WG and IHE have defined code O and name R.

      Suggestion:
      Make either name R or create a co-constraint code or name must be present

      1892

       

      IPSTimeUnits Value Set

      Finding:
      d day is missing in the IPSTimeUnits Value Set

      Suggestion:
      Add d

      1893

       

      Included 0 … * R from 2.16.840.1.113883.10.22.2.7 IPS CDA relatedDocument (DYNAMIC)

      Finding:
      According to the CDA constraint
      "A conformant CDA document can have a single relatedDocument with typeCode "APND"; a single relatedDocument with typeCode "RPLC"; a single relatedDocument with typeCode "XFRM"; a combination of two relatedDocuments with typeCodes "XFRM" and "RPLC"; or a combination of two relatedDocuments with typeCodes "XFRM" and "APND". No other combinations are allowed. "

      Should we change the cardinality of relatedDocument to 0..2 ?

      Included 0 … 2 R from 2.16.840.1.113883.10.22.2.7 IPS CDA relatedDocument (DYNAMIC)

      1894

       

      2.16.840.1.113883.10.22.4.3 (2016-11-10) IPS Manufactured Material
      Example

      Finding:
      < cpm: quantity >
      <!-- strength -->
      < cpm: numerator xsi:type =" PQ " value =" 20 " unit =" mg " / >
      < cpm: denominator xsi:type =" PQ " value =" 1 " unit =" {tablet} " / >
      </ cpm: quantity >

      Suggestion:
      elements <numerator> and <denominator> are part of the PQR data type, the extension 'cpm:' is not needed here...

      1895
       

      IPS Template 2.16.840.1.113883.10.22.1.1
      hl7:realmCode CS 1 … 1 R

      hl7:realmCode CS 0 … 1 R

      1974

       

      representedCustodianOrganization allows for more than one telecom element

      Finding: representedCustodianOrganization allows for more than one telecom element
      - This violates the CDA schema, where only zero to one telecom elements are allowed

      1975

       

      "the languageCode element on document level (see attachment). In the Schematron message, the ISO Country code and ISO Language code are switched."
      1978

       

      The code for Absent or Unknown Devices is placed now that the participation level code.

      Move the Absent or Unknown Devices code to the Supply.code (that have been dropped earlier but need to be re-introduced here)

      1979

       

      IPS Problem Status Observation - 2.16.840.1.113883.10.22.4.20

      Adopt the value set defined in FHIR for the condition status

  9. STU Comments - HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Nutrition, Release 1 - US Realm
    1.  Click here to expand...
      STULast UpdatedCommenterIssue
      1961

       

      The Feeding Device Grouping value set (OID 2.16.840.1.113762.1.4.1095.87) is listed in section 1.7 ("Vocabulary Value Set Definitions Defined in this IG") but is not found elsewhere in the IG. The Feeding Device value set (OID 2.16.840.1.113762.1.4.1095.61) is in the Feeding Device template, but not listed in section 1.7.

      The Feeding Device template should be updated to use the Feeding Device Grouping value set rather than just the Feeding Device value set as this will allow more flexibility if the Feeding Device Grouping value set eventually contains more members.

      This issue was discovered during the annual value set review in Spring 2020.
      1962

       

      The value set Diet Item Grouping (OID 2.16.840.1.113762.1.4.1095.59) is used throughout the IG, however it is called "Diet Item" throughout the IG. This should be corrected so that the value set name used in the IG matches the actual value set name.

      The following are the locations to be corrected:
      Table 27 (and the text below it), Table 28 (text at the top), Table 71 (and the text below it), Table 74
      1966

       

      In section 6 "VALUE SETS IN THIS GUIDE" (Table 74: Value Sets), the value set "Food and Nutrition Related History Grouping" OID:2.16.840.1.113762.1.4.1095.82 is not listed as a value set in this table, but should be (it is referenced in section 1.7 Vocabulary Value Set Definitions Defined in this IG).
      1967

       

      In table 1.7 Vocabulary Value Set Definitions Defined in this IG lists a value set called "Anthropometric Measurements Grouping" but actual value set name name is "Nutrition Anthropometric Measurements Grouping" (OID:2.16.840.1.113762.1.4.1095.75). (It is listed correctly in section 6 VALUE SETS IN THIS GUIDE Table 74.)
  10. STU Comments - HL7 CDA® R2 Implementation Guide: Exchange of C-CDA Based Documents; Periodontal Attachment, Release 1 - US Realm
    1.  Click here to expand...
      STULast UpdatedCommenterIssue
      1551

       

      P.92
      7.7 Periodontal Narrative Activity

      As noted previously, general observations and notations allow the provider to express clinical observations and relevancy in unstructured text. Below would be a representative sample of the type of narrative used in the attachment:

      “Patient’s overall health is good despite her obesity. Says that she’s drinking 12+ 20oz Cokes a day. Patient admits to not following a regular oral hygiene regimen. Referring patient to OralMaxillofacial surgeon for consult due to Mandibular involvement and bone loss.”
      1550

       

      Gingival disease is evaluated in five stages: namely, gingival health, gingivitis, Slight/mild periodontitis, moderate periodontitis, and advance/aggressive periodontitis. Disease progression or treatment efficacy is both observed and measured. The image (left) depicts this progression and implementers should note the values associated with the measurement of each tooth to a particular stage of disease.

      Figure showing stages of periodontal disease.
  11. STU Comments - HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm
    1.  Click here to expand...
      STULast UpdatedCommenterIssue

       

      2.61 Procedures Section (entries optional) (V2)
      2.61.1 Procedures Section (entries required) (V2)

      I think we have a discrepancy between the narrative text in these sections versus the formal constraints on the contained "Procedure Activity Procedure (V2)" entry template. The sections are only supposed to contain historical procedures which actually altered the patient's state. However the Value Set: ProcedureAct statusCode urn:oid:2.16.840.1.113883.11.20.9.22 includes concept codes for "aborted", "active", and "cancelled". If the procedure is still active then it isn't yet historical. If the procedure was aborted or cancelled then presumably it didn't alter the patient state.

      This is creating confusion among implementers. We have received documents from multiple EHRs containing procedure entries with statusCode/@code="active".

       

      Figure 161: Immunization Activity (V3) Example
      (page 550)

      <code code="33" codeSystem="2.16.840.1.113883.6.59" displayName="Pneumococcal polysaccharide vaccine" codeSystemName="CVX">

      Figure 224: Substance Administered Act Example
      (page 846)

      <code code="43" codeSystem="2.16.840.1.113883.6.59" displayName="Hepatitis B Vaccine" codeSystemName="CVX" />
      1942

       

      Comment Activity
      urn:oid:2.16.840.1.113883.10.20.22.4.64

      5. SHALL contain exactly one [1..1] text (CONF:81-9430).
      a. This text SHALL contain exactly one [1..1] reference (CONF:81-15967).
      i. This reference SHALL contain exactly one [1..1] @value (CONF:81-15968).
      1. This reference/@value SHALL begin with a '#' and SHALL point to its corresponding narrative (using the approach defined in CDA Release 2, section 4.3.5.1) (CONF:81-15969).
      b. This text SHALL contain exactly one [1..1] reference/@value (CONF:81-9431).

      The order of these conformance statement is confusing. It seems like 5.a.i would make more sense under 5.b
      1946

       

      Table 6 found on page 63 in CDAR2_IG_CCDA_CLINNOTES_R1_DSTU2.1_2015AUG_Vol2_2019JUNwith_errata.pdf has the following text:

      Table 6: Language Value Set: Language urn:oid:2.16.840.1.113883.1.11.11526

      A value set of codes defined by Internet RFC 5646. Use 2 character code if one exists. Use 3 character code if a 2 character code does not exist. Including type = region is allowed

      See http://www.iana.org/assignments/language-subtag-registry/language-subtag-registry
      Value Set Source: http://www.loc.gov/standards/iso639-2/php/code_list.php

      While the table states Including type = region is allowed - the value set source does not list any valid regions. Also, the two sample provided as follows need to be corrected:

      The Figure 1: US Realm Header (V3) Example shows <languageCode code="en-US" />
      which SHOULD be <languageCode code="en" />

      The Figure 2: recordTarget Example shows <languageCommunication> <languageCode code="eng" />
      which SHOULD be <languageCommunication> <languageCode code="en" /> because Table 6 (Page 63) states to use the 2 digit code if there is one.

      Lastly, this value set is not included in VSAC. Should it be?
      1945

       

      Encounter Diagnosis (V3)
      [act: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.80:2015-08-01 (open)]

      This template wraps relevant problems or diagnoses at the close of a visit or that need to be followed after the visit. If the encounter is associated with a Hospital Discharge, the Hospital Discharge Diagnosis must be used. This entry requires at least one Problem Observation entry.

       

      1.1.1 Properties

      ...

      8. SHALL contain exactly one [1..1] confidentialityCode, which SHOULD be selected from ValueSet HL7 BasicConfidentialityKind urn:oid:2.16.840.1.113883.1.11.16926 STATIC (CONF:1198-5259).
      1885

       

      @sueann svabySHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet Social History Type urn:oid:2.16.840.1.113883.3.88.12.80.60 DYNAMIC (CONF:1198-8558).
      a. If @codeSystem is not LOINC, then this code SHALL contain at least one [1..*] translation, which SHOULD be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:1198-32951).
      1873

       

      Encounter Diagnosis (V3)
      [act: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.80:2015-08-01 (open)]

      The template is missing a binding for statusCode.

      Figure 144 shows a statusCode of "active". This provides the wrong guidance.
      1859

       

      Please REMOVE/DEPRECATE this commentIn the errata release from June 2019,Figure 162 is wrong and needs to be updated to use the correct Code System OID for CVX 2.16.840.1.113762.1.4.1010.6. It currently shows as 2.16.840.1.113762.12.292
      1860

       

      In the errata release from June 2019,Figure 161 is wrong and needs to be updated to use the correct Code System OID for CVX "2.16.840.1.113883.12.292". It currently shows as 2.16.840.1.113762.6.59

       

      Care Plan (V2)
      [ClinicalDocument: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.1.15:2015-08-01 (open)]

      The CDA Care Plan represents an instance of this dynamic Care Plan at a point in time. The CDA document itself is NOT dynamic.
      Key differentiators between a Care Plan CDA and CCD (another “snapshot in time” document): There are 2 required sections:
      o Health Concerns o Interventions
      There are 2 optional sections:
      o Goals o Outcomes

      • Provides the ability to identify patient and provider priorities with each act • Provides a header participant to indicate occurrences of Care Plan review A care plan document can include entry references from the information in these sections to the information (entries) in other sections.
      Please see Volume 1 of this guide to view a Care Plan Relationship diagram and story board.

       

      Section 1.1.17.4.iv doesn't include ICD-10-PCS as an allowed code system. It has now supplanted ICD-9 in the US realm.
      1802

       

      Smoking Status - Meaningful Use (V2) (urn:hl7ii:2.16.840.1.113883.10.20.22.4.78:2014-06-09)

      . This value SHALL contain exactly one [1..1] @code, which SHALL be selected from ValueSet Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38 DYNAMIC (CONF:1098-14817).

      1800 

      1801

       

      We have trouble adding new Social History Observations when the US Gov't identifies the observation using LOINC. We really should be using LOINC in the code ("the question").

      I recommend creating a Grouping Value Set that combines the original set of concepts using SNOMEDCT (Social History Type (SNOMEDCT)) and then agree to put all new/additional social history observation codes in the Social History Type (LOINC) value set. Use the existing OID for the new Grouping VS and make two new value sets for the parts of the grouping VS.
      1798

       

      On page 392, Section 3.61.1, the last three sentences of the text read as follows:

      "Procedure act is for procedures that alter the physical condition of a patient (e.g., splenectomy). Observation act is for procedures that result in new information about a patient but do not cause physical alteration (e.g., EEG). Act is for all other types of procedures (e.g., dressing change)."

      This is different from the wording on page 390, Section 3.61 Procedures Section (entries optional) (V2). Updated language is in the proposed section below.

       

      Currently the Referral Note (V2) document type doesn't include a Payers section. We should add that as an optional section because sometimes the "Referred From" provider needs to tell the "Referred To" provider which insurance coverage the patient has. And in some cases the provider needs to route a copy of the document to the patient's insurance company so they also need a way to indicate which plan the patient is on (or at least which plan they believe the patient to be on).
      1793

      3.41 Immunization Medication Information (V2) includes SHALL have a manufactureMaterial where this code MAY contain zero or more [0..*] translation, which MAY be selected from ValueSet Vaccine Clinical Drug urn:oid:2.16.840.1.113762.1.4.1010.8 DYNAMIC (CONF:1098-31543).

       

      3.41 Immunization Medication Information (V2) includes SHALL have a manufactureMaterial where this code MAY contain zero or more [0..*] translation, which MAY be selected from ValueSet Vaccine Clinical Drug urn:oid:2.16.840.1.113762.1.4.1010.8 DYNAMIC (CONF:1098-31543).

       

      We have seen real-world implementation defects where planned future encounters appear in the Encounters section rather than the Plan of Treatment section where they should be. I think some developers are just querying their database encounter tables for all encounters for a particular patient and sticking everything in the Encounters section regardless of whether they are past or future. Let's introduce a new conformance rule to ensure each Encounter activity ends before the document header effectiveTime.

       

      In section 3.81 Procedure Activity Procedure (V2) the Procedure.code (CONF:1098-7656) doesn't mention HCPCS as a possible code system. I think that code system should be explicitly listed because it is in common use in the US realm along with CPT-4. There are many procedures which are in HCPCS but not in CPT-4.

      This @code SHOULD be selected from LOINC (CodeSystem: 2.16.840.1.113883.6.1) or SNOMED CT (CodeSystem: 2.16.840.1.113883.6.96), and MAY be selected from CPT-4 (CodeSystem: 2.16.840.1.113883.6.12) or ICD10 PCS (CodeSystem: 2.16.840.1.113883.6.4) or CDT-2 (Code System: 2.16.840.1.113883.6.13) (CONF:1098-19207).

       

      Section 3.23, page 483:

      Table 272: EncounterTypeCode
      Value Set: EncounterTypeCode urn:oid:2.16.840.1.113883.3.88.12.80.32
      This value set includes only the codes of the Current Procedure and Terminology designated for Evaluation and Management (99200 – 99607) (subscription to AMA Required
      Value Set Source: http://www.amacodingonline.com/

       

      <!-- ************************ ENCOUNTERS *********************** -->
      <component>
      <section>
      <!-- *** Encounters section (entries required) (V3) *** -->
      <templateId root="2.16.840.1.113883.10.20.22.2.22.1" extension="2015-08-01"/>
      <templateId root="2.16.840.1.113883.10.20.22.2.22.1"/>

      I think there is a problem with the sample CCD file C-CDA_R2-1_CCD.xml included in this package.

    1.  
  1. Adjournment
    1. Next Meeting on 2020-07-02
    2. Gay Dolin adjourned the meeting @11:58am EST

 


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