Consolidated CDA July 2012 Suggested Enhancements

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1. Proposal for a new C-CDA Section - "Synopsis"

There is an emerging requirement for a new CDA section that might become required in many, if not most, clinical circumstances. Physicians working in several separate coordination endeavors are calling for a Synopsis section. This would be unstructured and would be a place for the author to explain the purpose of the document, what should be done, what portions or items in the document should get special attention, etc. Basically they want the brief cover note that they write to the next provider. Thus far, those proposing this new section strongly resist any suggestions to add any structure to the synopsis.

Thomson Kuhn (American College of Physicians)

2.SHALL contain exactly one [1..1] value="77386006" Pregnant with@xsi:type="CD" (CodeSystem: SNOMED-CT 2.16.840.1.113883.6.96 STATIC)(CONF:457). This implies that "value" should directly contain the indicated string (i.e. <value xsi:type='CD'>77386006</value>) when what is wanted is value/@code="string" (i.e. <value xsi:type="CD" code="77386006"/>)

3.SHALL contain exactly one [1..1] value with @xsi:type="ANY"="182904002" Drug treatment unknown (CodeSystem: SNOMEDCT 2.16.840.1.113883.6.96) (CONF:7564). This implies that "value" should directly contain the indicated string (i.e. <value xsi:type='ANY'>182904002</value>) when what is wanted is value/@code="string" (i.e. <value xsi:type="CD" code="182904002"/>) Assume the xsi:type="ANY" is meant to say xsi:type="CD"

4. SHALL contain exactly one [1..1] code, which SHALL be selected from ValueSet HealthcareServiceLocation 2.16.840.1.113883.1.11.20275 STATIC (CONF:16850). This resulted in a question posed at the IHE Copnnectathon recently: is a nullFlavor permitted here for "code". My interpretation was "yes", because (a) it is not specifically excluded, and (b) the constraint is on "code" not "@code". Can this be clarified in the IG? (there are probably other like it).