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Gay Dolin


Date:


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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 2020-07-09 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. Withdrawal of HAI NIB from September Ballot David DeRoode (5 min)
    2. US Core Errata Package Review Request from International Cross-Group Projects WorkGroup 
      1. The US Core ver 3.1.1 Technical Errata Release For Community Review has been prepared and is open for a 2 week comment period starting today (ending July 29)
    3. Final amalgamated PACP Ballot sheet approval Lisa R. Nelson(2 minutes)
      1. CDAR2_IG_PERSADVCAREPLAN_R1_N1_2019SEP_almalgamated_20200416_20200709.xls
    4. Proposed mapping of value set binding between C-CDA Templates and C-CDA Profiles Lisa R. Nelson(15 minutes)
  6. STU Comments
  7. 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
    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.

  8. 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.

11:00am EST

  1. draft Dental Data Exchange IG Russell Ott (15 min)  Dental Data Exchange 20200716.pptx
  2. Adjournment

Notes/Minutes:


10:00am EST

  1. Call to order 
    1. Call for Attendance


      1. 10:04am


Business Updates (10 min)

  1. Additions/modifications to the agenda
  2. Approve minutes from 2020-07-09 Agenda and Minutes

  3. HL7
  1. External Updates - ONC and others
    1. August 10-12 is the Interop Tech Forum - Virtual - Sign-up for that.
    2. The C-CDA Implementation-a-Thon is on July 29 - please sign up if you haven't already - Implementer-led experience
      1. John DeMoore is doing a session on Life and Death in C-CDA
      2. Linda Michaelson is doing a Payer Session - Rxbin and group number
      3. Jean Duteau is working on the new extension for the alternate identifier
      4. Joe Lamy will be talking about Care Summary and Patient Summary
      5. Emma Jones for implementing Clinical Notes
      6. Author participation from C-CDA from the US Core profiles for Provenance
      7. Use Case Driven Implementation Guides
      8. 10-6pm $99
  2. Project Updates
    1. Value Set Issues

      1. see 11:00am
      2. No Value Set updates
      3. The new VSAC updates are available.
    2. Provenance
      1. No Updates
    3. Other Project Updates
  3. Additional Items
    1. Withdrawal of HAI NIB from September Ballot David DeRoode (5 min)
      1. TypeMotion
        Motion

        Motion to withdraw the NIB for HAI 4

        By
        Second
        Date

         

        Ref #
        For24
        Neg00
        Abs00
        Status

        IN-PROGRESS

        Tally24-00-00 
        Discussion

        Do we need to make changes to the NIB?

        Action

        David DeRoode to send us a link to the NIB

    2. US Core Errata Package Review Request from International Cross-Group Projects WorkGroup 
      1. The US Core ver 3.1.1 Technical Errata Release For Community Review has been prepared and is open for a 2 week comment period starting today (ending July 29)
        1. We will carry this over to next week's agenda  
    3. Final amalgamated PACP Ballot sheet approval Lisa R. Nelson(2 minutes)
      1. CDAR2_IG_PERSADVCAREPLAN_R1_N1_2019SEP_almalgamated_20200416_20200709.xls
        1. TypeMotion
          Motion

          Motion to approve the amalgamated PACP Ballot sheet

          By
          Second
          Date

           

          Ref #CDAR2_IG_PERSADVCAREPLAN_R1_N1_2019SEP_almalgamated_20200416_20200709.xls
          For24
          Neg00
          Abs00
          Status

          IN-PROGRESS

          Tally24-00-00 
          Discussion


          Action
    4. Proposed mapping of value set binding between C-CDA Templates and C-CDA Profiles Lisa R. Nelson(15 minutes)
      1. Lisa showed some examples and there is general consensus that we are on the correct track with our C-CDA mapping using structured definition.
  4. STU Comments
  5. 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
    2. 1997Nick Radovwill work with Gay Dolinoffline to come up with an appropriate statement to put into the guide.
    3. 1806

      1. Proposed errata - correction to update
      2. TypeMotion
        Motion

        Motion to approve the disposition as noted

        By
        Second
        Date

         

        Ref #1806
        For21
        Neg00
        Abs00
        Status

        IN-PROGRESS

        Tally21-00-00 
        Discussion

        Action

        Andrew Statler to update the Errata Sheet

      3. 1995

        TypeMotion
        Motion

        Motion to approve the disposition as noted

        By
        Second
        Date

         

        Ref #1995
        For16
        Neg00
        Abs00
        Status

        IN-PROGRESS

        Tally16-00-00 
        Discussion

        Action

        Andrew Statler to update the Errata Sheet

    4.  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.

  1. 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. carry-over to next week

       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.

11:00am EST

  1. draft Dental Data Exchange IG Russell Ott (15 min)
    1. Russ agreed to include new Payers Section in the publication of the Dental IG they are pursuing.
    2. In the Dental Findings Section, the SNOMED CT and the SNODENT as the translation is recommended but not a SHOULD/SHALL
  2. Adjournment

 


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