NHCS R1.2 Comments

Instructions

July 14 - 21, 2016 - HL7 CDA® R2 Implementation Guide: National Health Care Surveys Release 1, DSTU Release 1.2 - US Realm - Available for Comments

This wiki page will support review and feedback for proposed updates to the HL7 CDA® R2 Implementation Guide: National Health Care Surveys Release 1, DSTU Release 1.2 - US Realm. This IG consist of two volumes: Volume 1 provides narrative introductory and background material pertinent to this implementation guide, including information on how to understand and use the templates in Volume 2. Volume 2 contains the Clinical Document Architecture (CDA) templates for this guide along with lists of templates, code systems, and value sets used.

Comments

Enter your comments below this line by clicking on the Comments (edit) link.

• [George Cole] A one week comment period is completely insufficient for a qualitative review of new work. Our concerns about the version distinctions and differences required for 2015 Certification vs what is acceptable in production today lead us to suggest that this most recent version should be given wider publicity and more consideration than a one week, not usual HL7 ballot process. If reconsideration for a full ballot cycle is out of the question, and we'd have to wonder why that would be the case, then at least extend the comment period to some respectable and reasonable amount of time.
  • Disposition: Persuasive
  • Disposition Comment: We have extended the comment period until July 29th 2016
• [George Cole] STU Comment 924, which resulted in this text being added to the guide in the Problems Section (V3): "If no other means of determination is possible, use first listed diagnosis as the primary diagnosis."
  • We feel that this is really bad advice, and is asking vendors to make claims that are not documented. If CDC wants to internally implement this business rule, for whatever reason, so be it, but asking the industry to declare something as a primary diagnosis when it is not documented that way by a clinician goes too far, and asks for data to be misrepresented. Please remove this guidance from the guide.
  • Disposition: Persuasive
  • Disposition Comment:
    • Primary Diagnosis Observation (V2) template:
      • Remove the wording “If no other means of determination is possible, use first listed diagnosis as the primary diagnosis." from the description.
      • Remove the XML comment "" from the template example and sample files
    • Problems Section (V3) template:
      • Add the wording “If a primary diagnosis is available, it must be recorded in the Primary Diagnosis Observation. All problems, diagnoses, symptoms and conditions, including the primary diagnosis, must be recorded in the Problem/Diagnosis/Symptom/Condition Observation.” to the description".
      • Update constraint 3256-74 from “SHALL contain exactly [1..1]” to “SHOULD contain zero or one [0..1]” as follows:

          SHOULD contain zero or one [0..1] entry (CONF:3256-74) such that it
                       SHALL contain exactly one [1..1] Primary Diagnosis Observation (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.34.3.6:2015-04-01) (CONF:3256-75).

• Update constraint 3256-332 from “SHOULD contain zero or many [0..*] to “SHALL contain one or many [1..*]” as follows:

           SHALL contain at least one [1..*] entry (CONF:3256-332) such that it
                       SHALL contain exactly one [1..1] Problem/Diagnosis/Symptom/Condition Observation (V2) (identifier: urn :hl7ii:2.16.840.1.113883.10.20.34.3.1:2015-04-01) (CONF:3256-333).

• [George Cole] Regarding section 3.9 Clinical Note and External Document Reference

Thanks for the clarifications, based on STU Comment 800.

However, there is no STU comment that would add additional constraints on the CDA externalDocument content. While we agree with the concept that either a code or text should be used to represent the external document, we believe that this constraint is too restrictive:

• a. The text, if present, SHALL contain exactly one [1..1] @mediaType (CONF:3256-1187).
• and should be: a. The text, if present, MAY contain one [0..1] @mediaType (CONF:3256-1187). because it should be possible to reference content with a URL as with:

<externalDocument> <id root='…' extension='…'/> <text><reference value='https://…'/></text> </externalDocument>

• • Disposition: Persuasive
  • Disposition Comment:
    • Change constraint 3256-1187 from “SHALL contain exactly [1..1] @mediaType” to “SHOULD contain exactly [1..1] @mediaType”.
    • Add a note stating “Unless the reference is a URL, mediaType SHALL be present.”