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This annual value set update cycle will produce an published Value Set Expansion Package that is downloadable from the NLM VSAC website. Here are some key dates for the cycle:

Project Schedule

March 31: Final date for STU Comments collected for consideration.  New STU Comments may be added to create an audit trail of changes made during the review and change execution work.

May 11:  All changes finalized

May 31: C-CDA team submits final and error-free specification spreadsheet template and finalized value sets, including all desired intensional value sets, and any updates needed for download page:

June 3-7: NLM creates the new C-CDA release structure in My Program Releases

June 7-14: C-CDA reviews My Program Releases; C-CDA makes any needed manual ‘Assign Release’ (e.g., Problem Type value set)

June 21: NLM provides pre-release downloadable spreadsheets for C-CDA to review

June 25: Deadline to approve pre-release downloadable files

June 28: NLM C-CDA publication date, assuming error-free C-CDA submission on 5/31

Change Governance and Meeting Info

Changes will be addressed within two focused meetings added for this purpose. Issue that require a vote may be addressed within the working group provided that 1 or more SDWG co-chairs are present and a quorum of 5.  Other voting issues or issue requiring escalated review will be discussed at the Thursday 10am SDWG call. Participation is welcome and assistance doing reviews and making Value Set Definition changes is appreciated.

Meeting: Mondays 4:00pm - 5:00pm ET

United States: +1 (872) 240-3212

- One-touch: tel:+18722403212,,917033717#

Access Code: 917-033-717

Meeting: Wednesdays 5:00pm - 6:00pm ET

United States: +1 (312) 757-3121

- One-touch: tel:+13127573121,,660773077#

Access Code: 660-773-077

Working Documents

Phase 0 - address outstanding STU Comments

2019-03-25 Proposed Block (Voted on 2019-04-04) DSTUComments Disposition Proposals 20190325.xlsx

2019-04-11 SDWG votes to resolve open (New) STU Comments that impact the Value Set Update for June 2019 DSTUComments Disposition Proposals 20190411.xlsx

On 4/11/2019 Final call for consideration of STU Comments placed before 3/31/2019 was sent to the PC, ASIPP, and SDWG list serves with a deadline of 4/18 for any additional STU Comments to be considered.

Phase 1 - prioritize issues for consideration

Prioritized List of STU Comments for Value Set Update consideration.

DSTUComments Disposition Proposals 20190325.xlsx

DSTUComments Disposition Proposals 20190404.xlsx

DSTUComments Disposition Proposals 20190410.xlsx

4/11/2019 - Proposed List of Priority Value Set Definition changes  - to be finalized on 4/18/2019 DSTUComments Disposition Proposals 20190411.xlsx

Defined Priorities:

1 - Must Do

2 - Will Do after Must-Do’s are completed

3 - Will work on these last, some may not get done if time does not permit

4 - Will work on the need to find value sets defined as extensional, but really need to be changes to an intensional definition

Documents to support to need to update STATIC Bindings to DYNAMIC

This document shows the STATIC Bindings in C-CDA R2.1 that SDWG has determined are excluded from the motion to change all STATIC Bindings to DYNAMIC. CCDA-ValueSet-Static-Bindings.xlsx

This document shows the current set of STATIC value set binding contraint-id's in C-CDA R2.1.  StaticBoundValueSetsInCCDA.xlsx

On April 18, 2019 SDWG voted to permit existing STATIC bindings to remain "as is" in the C-CDA R2.1 IG even if they are not well-formed.  The issue of how to correct the static binding constraints will be addressed in the future. This task will only correct the static value set bindings that have been permitted to be converted to dynamic bindings.

Documents showing the Value Sets included in published C-CDA R2.1 Supplemental and Companion Guides

The 2019 C-CDA Value Set Release Package will include new value sets required by companion and supplemental IGs:

C-CDA Companion Guide Companion Guide VSs.pdf

Supplemental Templates for Nutrition Supplement - Nutrition VSs.pdf

Supplemental Templates for Pregnancy Supplement - Pregancy Status VSs.pdf

Supplemental Templates for Advance Directives (Template Updates) Supplement - Advance Directives VSs.pdf

Add Value Sets needed for the Companion Guide Update - to ballot in July 2019

The 2019 C-CDA Value Set Release Package will include new value sets required by the C-CDA R2.1 Companion Guide Update IG :

Care Team Member Function 2.16.840.1.113762.1.4.1099.30 This is a new, transitional Value Set Grouping that combines the historically used ParticipationFunction value set and the new Care Team Member Function (SNOMEDCT) 2.16.840.1.113762.1.4.1099.27 value set developed by the Care Team Member Project in HL7 LHS WG (2018).

Phase 2 - Consider needed action and implement any agreed upon changes (Work will be addressed in the established priority order set in Phase 1.)

Worklist of Value Set Changes for June 2019 Release Package to be incorporated into the 2019 update.


VSAC Release Package Submission - FINAL 20190523 20190628 VSAC release template-FINAL 20190523.xlsx

VSAC Release Package Additional Information - FINAL Data Dowload page update content.docx

Notes for Implementers: For a full list of the value set expansions THAT WILL BE PRODUCED in the 20190628 VSAC release package, download the FINAL submission package file linked above.  

This new release package will be available from VSAC after 6/30/2019.  The list below is by no means an exhaustive list of changed value sets in this release.

VS NameVS OIDIn VSAC?Notes to Implementers  - At this time, the NLM VSAC tooling does not offer an option to produce a DIFF report to summarize what has changed between value set expansions.
Ability2.16.840.1.113883. #1413: this value set got a new definition
AgePQ_UCUM2.16.840.1.113883. with this release
Care Plan Document Type2.16.840.1.113762.1.4.1099.10YesLegacy code for Overall Plan of Care 52521-2 (LOINC 2.54) has been addressed in the new intensional value set definition. This code must also be in the expansion profile, so we must make sure that all legacy codes are recorded on the Legacy Code Tab.
Encounter Planned2.16.840.1.113883. value set should be re-confirmed in the future
EncounterTypeCode2.16.840.1.113883. #1477 - two inactive codes will be created by the expansion against the new version of code system (CPT) 2019-05-15 RM - final decision is to keep these two codes so they are added explicitly to the intensional definition that was modified per emai thread.
Extended Pregnancy Status2.16.840.1.113762.1.4.1099.24
New with Errata Release
HealthcareServiceLocation2.16.840.1.113883.1.11.20275Yes uses a different oid for defining a value set that includes the full code list for the HSLOC (NHSN Healthcare Service Location Codes) code system. This other equivalent value set  (2.16.840.1.113883.13.19) is used in the NHSN HAI IG. 

No Change is needed in the June 2019 update.
LOINC Imaging Document Codes1. has 2 inactivated codes that were added to the Legacy codes.
Nutrition Focused Physical Findings Grouping2.16.840.1.113762.1.4.1095.49YesOne inactive code added to legacy codes
Problem Type (LOINC)2.16.840.1.113762.1.4.1099.28YesThis value set was created to disambiguate it from the Problem Type (SNOMEDCT) value set.  For more information
see STU Comment #1697
This value set is to be used as a translation for the Problem Type (SNOMEDCT) value set below. It was previously just a different version of the same value set (had the same OID).
Note: this value set needs the legacy code 75324-4 from LOINC 2.54
Problem Type (SNOMEDCT)2.16.840.1.113883. value set was updated to disambiguate it from the Problem Type (LOINC) value set.  For more information
see STU Comment #1697
This value set is the primary Problem Type value set and retains the OID that has been used from the beginning. See Problem Type (LOINC) above.
Vaccine Clinical Drug2.16.840.1.113762.1.4.1010.8Yes

Many inactive codes will be eliminated. This value set needs to be reconsidered. 2019-05-16 as of this release decided to NO LONGER MAINTAIN THIS VALUESET as an issue to be discussed.

Vital Sign Result Type2.16.840.1.113883. to add methodless O2 sat per extension to
Country2.16.840.1.113883. in VSAC
DICOMPurposeOfReference2.16.840.1.113883. in VSAC
Health Insurance Type2.16.840.1.113883. in VSAC
Language2.16.840.1.113883.1.11.11526NoNot in VSAC
NUBC UB-04 FL17 Patient Status2.16.840.1.113883. in VSAC
Add the Supplemental and Companion Guide Value Sets:

Care Team Member Function2.16.840.1.113762.1.4.1099.30Yes
Care Team Member Function (SNOMEDCT)2.16.840.1.113762.1.4.1099.27Yes
Add the Supplemental Pregnancy Status Codes:

D(Rh) Sensitized2.16.840.1.113883.
D(Rh) Type2.16.840.1.113883.
Delivery (NCHS) source of truth for this value set is CDC PHIN VADS. Find it at
Estimated Date of Delivery Including Method2.16.840.1.113883.
Estimated Gestational Age Code Including Method2.16.840.1.113883.
Other Pregnancy Outcome2.16.840.1.113883.
Postpartum Status2.16.840.1.113883.

This value set is apparently meant to describe the postpartum state of the patient, described as an intensionally defined value set and consists of the hierarchy of the SNOMED CT code 86569001 |Postpartum state (finding) and all its children. This seems problematic since this set of codes does NOT describe a condition or state, instead they say WHEN the state was observed, therefore the template in which this is used seems to NOT CONTAIN the intended information. This needs to be reviewed by SDWG.

Pregnancy Intention2.16.840.1.113762.1.4.1166.22Yes
Pregnancy Outcome2.16.840.1.113883.
Pregnancy Related Findings2.16.840.1.113883.
Pregnancy Status Determination Method2.16.840.1.113883.
Rho(D) Immune Globulin2.16.840.1.113883.
Advance Directives Template Update Supplement:

Advance Care Planning Services Grouping Value Set2.16.840.1.113883.
ProcedureAct statusCode2.16.840.1.113883.
Planned or Completed moodCode2.16.840.1.113883.
Advance Directives Categories2.16.840.1.113883.
Advance Directive Content Type SCT2.16.840.1.113762.1.4.1115.5Yes
Healthcare Agent or Proxy Choices2.16.840.1.113762.1.4.1046.35Yes
Obligation or Prohibition Instruction Type2.16.840.1.113883.
Nutrition Template Update Supplement:

Diet Item Grouping2.16.840.1.113762.1.4.1095.59yes
Feeding Device2.16.840.1.113762.1.4.1095.61yes
Implantable Medical Device UDI Templates Supplement

Device Implantable Status1. in VSAC
Latex Safety Status2.16.840.1.113883. in VSAC
MRI Safety Status2.16.840.1.113883. in VSAC
UDI Entry Type2.16.840.1.113883.4.642.3.201NoNot in VSAC
Body Site Implantable1. in VSAC
UDI Observation Type1. in VSAC


  1. Treatment for Value Sets used with STATIC bindings
    1. We need to discuss a practical approach for delivering Value Set expansions for statically bound model elements.
      1. Discuss with SDWG and VSAC
      2. Suggest approach is to use the Value Set Definition Meaning as of the date used in the static binding, and create the expansion against the current Code System version
      3. Agree on the syntax for a static binding to a conceptually "fixed" Value Set Definition.
        1. This may need to be an extensional Value Set Definition, or the Expansion of the Value Set at that date.. Practice may need to be that we create the Value Set Definition and Expansion at a specific point in time, then allow the binding to reference that date.  Perhaps the static Value Set binding needs to include a url that  allows anyone to find the statically bound Value Set expansion.
  2. Need for Value Set Expansion differences report/tool from NLM


Proposed IG changes: 2019JUN_C-CDAR2.1_Errata_list.xlsx (Approved by SDWG and CMG on 6/13/2019)

Included STU Comments accepted as errata: DSTUComments Disposition Proposals 20190411.xlsx

List of Value Set Bindings that can be made DYNAMIC CCDA-ValueSet-Static-Bindings.xlsx

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