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QRDA Modeling Issues
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Vocabulary Mismatch between C-CDA and its implied QRDA templates
General issue:
- QRDA template implies a C-CDA template
- C-CDA template has an element/attribute that is SHALL bound to a value set
- C-CDA value set is more restricted (fewer codes systems, codes etc.) than what is required for QRDA
Example 1:
- QRDA template Reaction implies C-CDA R2 Reaction Observation template
- Reaction Observation value is SHALL bound to Problem value set which is SNOMED CT
- QRDA does not constrain to SNOMED (can also be ICD 10, ICD 9 etc.)
Example 2:
- QRDA template Procedure Performed implies C-CDA R2 Procedure Activity Procedure template
- targetSiteCode is SHALL bound to Body Site value set which is SNOMED CT
- QRDA does not constrain to SNOMED
(There are others).
Suggested solution for the short term is, if the code doesn't exist in the required value set, to use code (@nullFlavor="OTH", @codeSystem="2.16.840.1.113883.6.96", @codeSystemName="SNOMED CT") and code/translation to hold the QRDA code.
Is this the best solution?
What can we do in the long-term?
QRDA "Substance" templates that are currently mapped to Medication templates
Proposed to create new templates for Substance, Administered, Substance (other templates) that were previously mapped to Medication templates.
