Skip to end of metadata
Go to start of metadata



To record your attendance at the SDWG Conference Call, click the sign-on button to the right:


Facilitator:

Austin Kreisler


Date:


Call Details:


 Click for Call Details

Zoom Information

https://us02web.zoom.us/j/465862913?pwd=cUllR1BndVpYNVpyR3dzc3VIUERTZz09

Meeting ID: 465 862 913

Passcode: 310940

Phone Information:

+1 312 626 6799 US (Chicago)
+1 929 436 2866 US (New York)
+1 301 715 8592 US (Germantown)
+1 346 248 7799 US (Houston)
+1 669 900 6833 US (San Jose)
+1 253 215 8782 US (Tacoma)
Find your local number: https://us02web.zoom.us/u/kb1hK2eKvz




Attendees:


 Click here to expand...

Meeting Attendance

To add your name to the attendance, exit Edit mode for this page and then click on the Submit button at the top of the page. Once you have submitted your attendance, the screen will indicate that you have already signed-in. Thank you!

Edit

Name

Name

Affiliation

E-mail

Owned By

Export Records: 0

Agenda:


10:00am EST

  1. Call to order 
    1. Call for Attendance


  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. Approve minutes from 2020-06-25 Agenda and Minutes

    3. HL7 (20 min)
  3. External Updates - ONC and others (5 min)
  4. Project Updates
    1. Other Project Updates?

  5. Additional Items
    1. NIB for HAI Sarah Gaunt  
    2. Issue 1946 which has been a problem with the language/country/region coding used and the related ValueSet Didi Davis (10min)
    3. STU Comments - Nick Radov (25min) (Expand C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm to find Nick's issues)
      1. STU Comments - HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm
        1.  Click here to expand...

          STU

          Last Updated

          Commenter

          Issue

           

          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.

11:00am EST

  1. Payer Related Alternate Identifier: sdtc:extension to CDA R2 to add an alternateIdentifier  Lisa R. Nelson Linda Michaelsen (5 min)
    1. CDAR3_RMIM.jpg
  2. Update on CDA Quality Criteria Lisa R. Nelson (5 min)
  3. PACP Comment #12 (Lisa R. Nelson) (10 min)

     Personal Advanced Care Plan

    CDAR2_IG_PERSADVCAREPLAN_R1N1_2019SEP_almalgamated_20200416_20200620 reopen comments.xls

    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.

    • This item was re-opened by vote on  for additional discussion to consider whether the change to SHALL was made in haste.
  4. CDA Templates to Structured Definition Lisa R. Nelson (10 min) C-CDA Templates to StructureDefinition.pptx
  5. STU Updates - Matt Szczepankiewicz(25min) (expand HL7 CDA® R2 Implementation Guide: C-CDA Templates for Clinical Notes Companion Guide, Release 2 STU - US Realm )
    1.  Click here to expand...

      STU

      Last Update

      Commenter

      Comment

      1983   

       

      Order fulfillment conformance statement that are contradictory

       

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

       

      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.

       

      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?

       

      Appendix B UDI
      1.1 UDI Organizer 

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

       

      (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).

       

      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):

       

      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.
  6. Adjournment (5min)


  1. 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.
  2. STU Comments - HL7 CDA® R2 Implementation Guide International Patient Summary, Release 1
    1.  Click here to expand...

      STU

      Last Update

      Commenter

      Issue

      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

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

      STU

      Last Updated

      Commenter

      Issue

      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.)
  4. STU Comments - HL7 CDA® R2 Implementation Guide: Exchange of C-CDA Based Documents; Periodontal Attachment, Release 1 - US Realm
    1.  Click here to expand...

      STU

      Last Updated

      Commenter

      Issue

      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.

Notes/Minutes:


10:00am EST

  1. Call to order 
    1. 10:05am EST by Austin Kreisler  
    2. Call for Attendance


  2. Business Updates (10 min)
    1. Additions/modifications to the agenda
    2. Approve minutes from 2020-06-25 Agenda and Minutes

      1. Minutes approved by consensus
    3. HL7 (20 min)
  3. External Updates - ONC and others (5 min)
    1. @keith carlson from ONC is reminding us that there are updates on ONC.gov.
    2. Lisa R. Nelson wants to remind us that you can now sign up for the IAT 
  4. Project Updates
    1. Other Project Updates?

  5. Additional Items
    1. NIB for HAI Sarah Gaunt  
      1. TypeMotion
        Motion

        Motion to approve both of these NIBs

        By
        Second
        Date

         

        Ref #
        For27
        Neg00
        Abs00
        Status

        IN-PROGRESS

        Tally27-00-00 
        Discussion

        Action

        Sarah Gauntwill send to Austin Kreisler to advance the NIBs

    2. Issue 1946 which has been a problem with the language/country/region coding used and the related ValueSet Didi Davis (10min)
      1. language codes are not in VSAC with the region codes. 
      2. It's not in VSAC, not made available in VSAC. need to point implementers to it. FHIR source is suspect and small. No source that Rob is aware of. There are tools that say if you construct one, is it valid. We do not want a ValueSet of all of these codes. What we want is a validator. 
      3. The valueset is not the one that we pointed Didi Davisto.
      4. Rob McClure and Didi Davis will take it offline.
    3. STU Comments - Nick Radov (25min) (Expand C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm to find Nick's issues)
      1. STU Comments - HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm
        1. 1997

          1. TypeMotion
            Motion

            Motion to table the issue

            By
            Second

            N/A

            Date

             

            Ref #1997
            For24
            Neg00
            Abs00
            Status

            IN-PROGRESS

            Tally24-00-00 
            Discussion

            David Riddle if included, effectiveTime/low or effectiveTime/@value should be in the past
            From David Riddle to Everyone: 10:02 AM
            If the status is active, then the effective time high SHALL be in the past relative to the document creation time sorry, that was wrong If the status is active, then the effective time high SHALL not be present

            Action
        2.  Click here to expand...

          STU

          Last Updated

          Commenter

          Issue

           

          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.

11:00am EST

  1. Payer Related Alternate Identifier: sdtc:extension to CDA R2 to add an alternateIdentifier  Lisa R. Nelson Linda Michaelsen (5 min)
    1. CDAR3_RMIM.jpg
    2. two weeks ago, Austin Kreisleridentified the schema that has the structures for this. We could move forward with this. None of the actual work has been done. Austin Kreisler has the artifacts for it. Austin Kreislercan forward the artifacts to others. The typeCode does not exist in the current schema. the roleClass does exist. Austin will forward the artifacts on to Jean Duteauand Sarah Gaunt.
    3. Andrew Statler to point Lisa R. Nelson to the extensions pages on the SD pages.
  2. Update on CDA Quality Criteria Lisa R. Nelson (5 min)
    1. reconciliation from the draft for comment. applying the reconciliation to the document.
    2. may be a couple days of focused effort. some of the changes were to reorganize the document. Its all draft for comment. 
    3. Russell Ott will offer to help. a Small group of people slug it out.
    4. Need an editor to work on it.
    5. Andrew Statler will reach out to Russ on it.
  3. PACP Comment #12 (Lisa R. Nelson) (10 min)

    1. suggested that it should be a shall. Did not intend to make it a requirement that every person have a guardian.
    2. TypeMotion
      Motion

      Motion to approve the new disposition as Not persuasive with Mod

      By
      Second
      Date

       

      Ref ##12
      For26
      Neg00
      Abs00
      Status

      IN-PROGRESS

      Tally26-00-00 
      Discussion

      Action
    3.  Personal Advanced Care Plan

      CDAR2_IG_PERSADVCAREPLAN_R1N1_2019SEP_almalgamated_20200416_20200620 reopen comments.xls

      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.

      • This item was re-opened by vote on  for additional discussion to consider whether the change to SHALL was made in haste.
    4. CDA Templates to Structured Definition Lisa R. Nelson (10 min) C-CDA Templates to StructureDefinition.pptx
    5. STU Updates - Matt Szczepankiewicz(25min) (expand HL7 CDA® R2 Implementation Guide: C-CDA Templates for Clinical Notes Companion Guide, Release 2 STU - US Realm )
      1.  Click here to expand...

        STU

        Last Update

        Commenter

        Comment

        1983   

         

        Order fulfillment conformance statement that are contradictory

         

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

         

        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.

         

        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?

         

        Appendix B UDI
        1.1 UDI Organizer 

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

         

        (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).

         

        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):

         

        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.
    6. Adjournment (5min)
      1. Meeting adjourned at 11:00am EST by Austin Kreisler


  1. 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.
    2. STU Comments - HL7 CDA® R2 Implementation Guide International Patient Summary, Release 1
      1.  Click here to expand...

        STU

        Last Update

        Commenter

        Issue

        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

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

        STU

        Last Updated

        Commenter

        Issue

        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.)
    4. STU Comments - HL7 CDA® R2 Implementation Guide: Exchange of C-CDA Based Documents; Periodontal Attachment, Release 1 - US Realm
      1.  Click here to expand...

        STU

        Last Updated

        Commenter

        Issue

        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.

 


*Tip


Copyright © Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher.