PHCR eICR R2 STU1.1 Update Comments

November 2016 - HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 1, STU Release 1.1 - US Realm - Available for Comment

This wiki page will support review and feedback for proposed updates to the HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 1, STU Release 1.1 - US Realm.

This IG consists 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.

For commenting prior to reconciliation and publication, the STU update Implementation Guide and its related files are available to HL7 members here: Update_for_Comment_CDAR2_IG_PHCASERPT_R2_D1.1_2016DEC.

As an STU update, this new version will not go through the usual HL7 balloting process but will use the STU Update Process with industry review on the HL7 wiki.

The changes in this update can be summarized as follows:

Volume 1 Typo corrections, non-substantive wording changes were made throughout the document but these changes will not be detailed.

• New chapters/sections/appendices (only the top heading-level of the addition is noted):
  • 1.3 Organization of the Guide
  • 1.6 Current Project
  • 3 CDA R2 Background
  • 5.2 Stand-Alone Templates
  • 5.4 Trigger Code Templates
  • Appendix A — Acronyms and Abbreviations
  • Appendix B — High Level Change Log
  • Appendix C — Extensions to CDA R2
• Updated chapters/sections:
  • 4 Using This Implementation Guide
    • replaced "Conventions used in this implementation guide" section
  • 4.1 Conformance Conventions Used in This Guide
  • 4.2 Templates and Conformance Statements
  • 4.3 XML Conventions Used in This Guide
    • Split chapter "Data Requirements and IG Template Specifications Organization" into the following two chapters:
  • 5 eICR IG Specific Conformance Guidance
  • 6 eICR Data Requirements
    • Updated tables and diagrams to reflect new data elements and added sections (see above)

Volume 2

• Document-Level Templates
  • No new document-level templates were added.
  • Initial Public Health Case Report Document (eICR) was versioned to V2:
    • Added containment for C-CDA R2.1: Plan of Treatment (V2) Section
    • Added containment for Birth Sex Observation
    • Added @sdtc:deceasedInd
    • Updated constraint for @sdtc:deceasedTime
    • Added guidance for using county in an address
    • Updated examples
• Section-Level Templates
  • One new section-level template was added:
    • C-CDA R2.1: Plan of Treatment (V2) Section
  • Entry-Level Templates
    • Five new entry-level templates were added:
    • C-CDA R2.1 Companion Guide: Birth Sex Observation
    • C-CDA R2.1 Based: Initial Case Report Trigger Code Lab Test Order
    • C-CDA R2.1 Based: Initial Case Report Trigger Code Problem Observation
    • C-CDA R2.1 Based: Initial Case Report Trigger Code Result Observation
    • Travel History
• Value Sets
  • Seven new value sets were added:
    • Initial Case Report Trigger Code Result Status
    • ONC Administrative Sex
    • Reportable Conditions Trigger Code Value set
    • Trigger code for condition name (RCTC subset)
    • Trigger code for laboratory test names (RCTC subset)
    • Trigger code for laboratory test orders (RCTC subset)
    • Trigger code for organism or substance (RCTC subset)

Review Note: Travel History template: As this is a new template and not based on any existing template, we encourage detailed review and feedback around the utility and design of this template

During the one week comment period running from November xx-xx, 2016, please submit your comments below including at least your name, item, existing wording, proposed wording, and comment.

Thank you.

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

Comments

Example comment:

Name: HL7 Commenter

Item: Volume 2, Template XXXX

Existing wording: CONF: xxxxx-xx SHOULD contain exactly 1..1

Proposed wording: CONF: xxxxx-xx SHALL contain exactly 1..1

---

Name: Sarah Gaunt

Item: Volume 1: 4.1 Templates and Conformance Conventions

Existing wording: This heading is at the wrong level - it needs to be indented on level so that it is nested under 4.1 Conformance Conventions Used in this Guide

Proposed wording: Indent 4.1 Templates and Conformance Conventions one level so that it is 4.1.1 Templates and Conformance Conventions

Preliminary Disposition: Will fix heading as suggested.

---

Name: George Cole

Item: Volume 2: Section 3.14 Travel History

Existing wording: The participant contains a location (either an address or a coded location)

ii. This participantRole MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Geographical location history urn:oid:2.16.840.1.114222.4.11.3201 DYNAMIC (CONF:3284-263). Note: Coded value of the location

Figure 52: Travel History - Coded Location Example

Proposed wording: The participant may contain a location as an address.

Reason for proposal: The coding and exchange is simplified with only one approach for travel location, and we suggest using addr and removing the coded location text, constraints, and example.

---

Name: George Cole

Item: Volume 2: Section 3.14 Travel History

Existing wording: ....ValueSet Geographical location history... (the hyperlink points to a nonexistent bookmark)

Proposed wording: https://phinvads.cdc.gov/vads/ViewValueSet.action?id=9CE75E17-176B-DE11-9B52-0015173D1785

Preliminary Disposition: Persuasive, will update hyperlink to that suggested.

---

Name: George Cole

Item: Volume 2: Section 3.14 Travel History

Existing wording: 7. SHALL contain exactly one [1..1] effectiveTime (CONF:3284-295). Note: Date(s) spent in the location

Proposed wording: 7. SHALL contain exactly one [1..1] effectiveTime (CONF:3284-295). Note: Date(s) spent in the location, using any format for effectiveTime that is supported by CDA. See Figure 54: effectiveTime Examples

Reason for proposal: Until we saw the examples, we wondered whether or not there were missing constraints on effectiveTime.

Preliminary Disposition: Sarah Gaunt: Persuasive, will change wording to that suggested.

---

Name: George Cole

Item: Volume 2: Section 3.14 Travel History

Existing wording: The participant contains a location

Question (not suggested change): We were a bit surprised to see Travel as an act with participants containing locations. It is a bit hard to see a country as a participant of an act. So, we just have to ask if other constructs were considered. For example, was coded observation with location as a value considered?

Preliminary Answer: Sarah Gaunt: We based this modeling on a SD listserv discussion from 2014 and a subsequent Kieth Boone blog post (http://motorcycleguy.blogspot.com.au/2014/10/on-process-for-rapid-template.html ). I'll send you the listserv discussion for your reference (hard to reference it here!)

---

Name: George Cole

Item: Volume 2: Section 3.11.1 3.11.1 Initial Case Report Trigger Code Result Observation, Figure 45: Initial Case Report Trigger Code Result Observation - Final Result Example

Existing wording: The example shows template ID's with and without extensions, as would be required for C-CDA R2.1

<templateId root="2.16.840.1.113883.10.20.22.4.2" />

<templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01" />

Question (not suggested change): Since this guide publishes Result Observation (V3), and other templates, without the C-CDA R2.1 requirement to have both templateId elements (with and without extension), does that mean that there is no requirement in this guide to publish both templateId elements?

Could Figure 45, and the example file distributed with the guide, be published with only <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01" /> ? What is the thinking on inclusion or not of the unversioned templateId?