CDA Example Task Force

SDWG formed the CDA template example task force to collect and share member submitted samples. The committee is currently hosting bi-weekly meetings on Thursdays from 12-1 PM Eastern. Subscribe to the SDWG listserv for more information.

Current Task Force Work

Up Next - Review progress on upgrade to R2, review new samples noted as on deck (ON)

Samples under consideration for C-CDA R2
	Consider for R2	Ready for R2	Owner
No Medications	Y	Y	Ed Donaldson
Single administration of medication (at single point in time)	Y	Y	John D'Amore
Patient prescribed oral antibiotic with a dosing regimen that varies over course of prescription (loading or tapered dosing)	Y	Y	John D'Amore
Patient prescribed medication every 4 to 6 hours	Y	Y	John D'Amore
Unknown Patient Immunization Status	Y	Y	Brett
Result which requires translation for its unit represented in UCUM	Y	Y	John D'Amore
No Information Problems Section	Y	Y	Brett
Patient with No Known Problems - Problem Section	Y	Y	Brett
Allergy to specific drug - Allergy Section	Y	Y	John D'Amore
Allergy to drug class - Allergy Section	Y	Y	John D'Amore

Summary: 17 samples approved by SDWG, 4 samples approved by Task Force but not yet by SDWG, 15 samples not yet approved, 1 sample withdrawn

Samples Under Review
	4/3	4/10	4/17	4/24	5/1	...	5/22	5/29	6/5	6/12	6/26
Unknown Smoking Status										ON
Former Smoking Status										ON
Current Smoking Status										ON
Result with an unstructured string as the value (e.g. urine color)									ER
Result with coded ordinal value (e.g. infectious disease)
Result with less than a specified value				ON	ON
Result with greater than a specified value				ON	ON
Medication PRN – covering several scenarios (5 scenarios by G Cole)
Patient prescribed basal insulin administered at bedtime
Antibiotic Administered with Normal Saline
Patient Reported Medication without Reported Brand/Dose
Complaint of No foot pain - Problem Section
No Complaint of foot pain - Problem Section
Coverage Activity referencing the holder's employer
Food allergy (Egg)			TFAP	SD/ER	ON
Examples below already approved
No Medications (full sample)		SDAP
Single administration of medication (at single point in time)		SDAP
Patient prescribed oral antibiotic with a dosing regimen that varies over course of prescription (loading or tapered dosing)		SDAP
Allergy to drug class (penicillins)	ER	TFAP		SDAP
Allergy to specific drug (penicillin)	ER	TFAP		SDAP
Result with a pending component				ON/ER	TFAP		SDAP
No UCUM unit available				ON	TFAP		SDAP
Problem which has been resolved/completed								TFAP	SDAP
Propensity to adverse reaction to substance (Latex)			TFAP	SD/ER	ON		TFAP	SDAP
Drug intolerance with multiple reactions (epinephrine)			TFAP	SD/ER	TFAP		SDAP
Drug intolerance with multiple reactions (codeine)			TFAP	SD/ER	TFAP		SDAP
Procedures Activity Procedure in Procedures Section							TFAP	SDAP
Procedure Activity Observation in Procedures Section							TFAP	SDAP
Procedure Activity Act in Procedures Section							TFAP	SDAP
Vital Sign Panel with Metric Units								TFAP	SDAP
Vital Sign Panel with Mixed Metric/Imperial Units								TFAP	SDAP

Legend
ON	ER	SD	TFAP	SDAP
On deck for task force	Edits requested by task force	Review planned for Structured Documents	TF Approved	SDWG Approved

Formatting of CDA Template Samples

PROTOTYPIC TEMPLATE

Meaningful template example name

• Approved by: (list all approving bodies, including approval date)
• C-CDA 1.1 (link to CDA Implementation Guide) Implementation Guide Example
  • TemplateId(s) illustrated: TemplateId Name(s) (OID Number(s), e.g. 2.16.840.1.113883.10.20.22.1.2)
  • Link to C-CDA 1.1 Example in hosted repository, e.g. GitHub
• C-CDA 2.0 (link to CDA Implementation Guide, when available) Implementation Guide Example
  • TemplateId(s) illustrated: TemplateId Name(s) (OID Number(s), e.g. 2.16.840.1.113883.10.20.22.1.2.2)
  • Link to C-CDA 1.1 Example in hosted repository, e.g. GitHub
• Known bad example?: Explain if this is a deliberately created bad example.
• Reference to full CDA sample: Full example of validated document (hyperlinked)
• Custodian: Name, email address and repository username of the steward for the referenced sample
• Validation location: list of all validators tested against
• Comments: free text comments about the example

Examples - Organized by Section

ALLERGIES, ADVERSE REACTIONS OR ALERTS

No Known Allergies with Author Timestamp

• Approved by: Task force on 1/9/2014. Approved by SDWG 1/16/2014.
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7)
  • No Known Allergies with Author Timestamp(Github)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example
• Reference to full CDA sample: No Known Allergies in compliant MU2 Sample (via GitHub)
• Custodian: Brett Marquard, brett@riverrockassociates.com (GitHub: brettmarquard)
• Validation location: SITE Validator TOC Ambulatory
• Comments: This is an example of how an author can record a patient has no known allergies.

Allergy to specific substance (cat hair)

• Approved by: Task force approved 4/10/2014. Withdrawn from consideration since not clinically relevant.
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) Reaction Observation (2.16.840.1.113883.10.20.22.4.9) Severity Observation (2.16.840.1.113883.10.20.22.4.8)
  • Allergy to specific substance (cat hair)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example with one error for act/code (based on DSTU 219 and C-CDA IG 2.0 clarification) and warning since severity only nested within reaction
• Reference to full CDA sample: Allergies in empty CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: TTT Validator
• Comments: This is an example of an allergy to a specific substance (cat hair) using UNII as terminology with information on both allergic reaction and reaction severity. See DSTU 219 for update regarding act/code

Allergy to Specific Drug

• Approved by: Task force approved 4/10/2014.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) Reaction Observation (2.16.840.1.113883.10.20.22.4.9) Severity Observation (2.16.840.1.113883.10.20.22.4.8)
  • Allergy to specific drug (penicillin) C-CDA 1.1
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0]
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30.2) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7.2) Reaction Observation (2.16.840.1.113883.10.20.22.4.9.2) Severity Observation (2.16.840.1.113883.10.20.22.4.8.2)
  • Allergy to specific drug (penicillin) C-CDA 1.1
• Known bad example?: Valid example with one error for act/code (based on DSTU 219 and C-CDA IG 2.0 clarification) and warning since severity only nested within reaction
• Reference to full CDA sample: Allergies in empty CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: TTT Validator
• Comments: This is an example of an allergy to a specific drug (penicillin) using RxNorm as terminology with information on both allergic reaction and reaction severity. For drug allergies, this example illustrates a good practice of encoding the allergen at the ingredient level (penicillin) not administration level (10 mg tablet). See DSTU 219 for update regarding act/code

Allergy to Drug Class

• Approved by: Task force approved 4/10/2014.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) Reaction Observation (2.16.840.1.113883.10.20.22.4.9) Severity Observation (2.16.840.1.113883.10.20.22.4.8)
  • Allergy to drug class (penicillins)
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0]
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30.2) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7.2) Reaction Observation (2.16.840.1.113883.10.20.22.4.9.2) Severity Observation (2.16.840.1.113883.10.20.22.4.8.2)
  • Allergy to drug class (penicillins)
• Known bad example?: Valid example with one error for act/code (based on DSTU 219 and C-CDA IG 2.0 clarification) and warning since severity only nested within reaction
• Reference to full CDA sample: Allergies in empty CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: TTT Validator
• Comments: This is an example of an allergy to a drug class (penicillins) using NDF-RT as terminology with information on both allergic reaction and reaction severity. See DSTU 219 for update regarding act/code

Propensity to adverse reaction to substance (Latex)

• Approved by: Task Force approved 4/17/2014
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) Reaction Observation (2.16.840.1.113883.10.20.22.4.9) Severity Observation (2.16.840.1.113883.10.20.22.4.8)
  • Propensity to adverse reaction to substance (Latex)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example with one error for act/code (based on DSTU 219 and C-CDA IG 2.0 clarification) and warning since severity only nested within reaction
• Reference to full CDA sample: Allergies in empty CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: TTT Validator
• Comments: This is an example of a propensity to substance allergy with information on both allergic reaction and reaction severity. It was based upon discussion with Russ Leftwich and Lisa Nelson in coordination with Patient Care Committee. See DSTU 219 for update regarding act/code

Food allergy (Egg)

• Approved by: Task Force approved 4/17/2014
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) Reaction Observation (2.16.840.1.113883.10.20.22.4.9) Severity Observation (2.16.840.1.113883.10.20.22.4.8)
  • Food allergy (Egg)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example with one error for act/code (based on DSTU 219 and C-CDA IG 2.0 clarification) and warning since severity only nested within reaction
• Reference to full CDA sample: Allergies in empty CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: TTT Validator
• Comments: This is an example of a food allergy with information on both allergic reaction and reaction severity. It was based upon discussion with Russ Leftwich and Lisa Nelson in coordination with Patient Care Committee. See DSTU 219 for update regarding act/code

Drug intolerance with multiple reactions (epinephrine)

• Approved by: Task Force approved 4/17/2014
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) Reaction Observation (2.16.840.1.113883.10.20.22.4.9) Severity Observation (2.16.840.1.113883.10.20.22.4.8)
  • Drug intolerance with multiple reactions (epinephrine)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example with one error for act/code (based on DSTU 219 and C-CDA IG 2.0 clarification) and warning since severity only nested within reaction
• Reference to full CDA sample: Allergies in empty CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: TTT Validator
• Comments: This is an example of a propensity to drug adverse event with information on multiple allergic reactions each with reaction severity. It was based upon discussion with Russ Leftwich and Lisa Nelson in coordination with Patient Care Committee. See DSTU 219 for update regarding act/code

Drug intolerance with multiple reactions (codeine)

• Approved by: To be reviewed
  • C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Allergy Concern Act (2.16.840.1.113883.10.20.22.4.30) and Allergy Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) Reaction Observation (2.16.840.1.113883.10.20.22.4.9) Severity Observation (2.16.840.1.113883.10.20.22.4.8)
  • Drug intolerance with multiple reactions (codeine)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example with one error for act/code (based on DSTU 219 and C-CDA IG 2.0 clarification) and warning since severity only nested within reaction
• Reference to full CDA sample: https://github.com/LisaRNelson/LRN_HL7_CDA_Examples/blob/master/Allergy_Intolerance_Observation_Codeine.xml Allergies in empty CCD]
• Custodian: Lisa R. Nelson LisaRNelson@cox.net (GitHub: lisarnelson)
• Validation location: TTT Validator
• Comments: This is an example of a propensity to drug adverse event with information on multiple allergic reactions each with reaction severity. It was based upon discussion with Rob Hausam and John D'Amore and Russ Leftwich in coordination with Patient Care Committee. This sample replaces the Epinephrine sample which had less clinical accuracy/relevance. See DSTU 219 for update regarding act/code

GENERAL PATTERN - NO INFORMATION

No Information Problems Section

• Status: Approved on task force 1/30/2014; Approved by SDWG on 2/6/2014.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Problem Section with Coded Entries(2.16.840.1.113883.10.20.22.2.5.1)
  • No Information Problems Section R1.1 (via GitHub)
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: Problem Section with Coded Entries(2.16.840.1.113883.10.20.22.2.5.1.2)
  • No Information Problems Section R2 (via GitHub)
• Known bad example?: Valid example
• Reference to full CDA sample: No Information Problem section
• Custodian: Brett Marquard, brett@riverrockassociates.com (GitHub: brettmarquard)
• Validation location: SITE Validator TOC Ambulatory
• Comments: This is an example of how an author can record a section contains No Information. This is an exceptional case and does not cover 'No Known' scenarios. See No Known Allergies with Author Timestamp (GitHub) for an example of 'No Known'. See DSTU Comment 384: http://www.hl7.org/dstucomments/showdetail_comment.cfm?commentid=384

IMMUNIZATIONS

Unknown Patient Immunization Status

• Approved by: Task force on 11/21/2013. Approved by SDWG 12/5/2013.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Immunization Activity (2.16.840.1.113883.10.20.22.4.52)
  • Unknown Patient Immunization Status C-CDA R1.1 (via GitHub)
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: Immunization Activity (2.16.840.1.113883.10.20.22.4.52.2)
  • Unknown Patient Immunization Status C-CDA R2 (via GitHub)
• Known bad example?: Valid example
• Reference to full CDA sample: Immunization section in compliant MU2 C-CDA sample
• Custodian: Brett Marquard, brett@riverrockassociates.com (GitHub: brettmarquard)
• Validation location: SITE Validator TOC Ambulatory
• Comments: This is an example of how an author can record they do now know whether the patient has received any vaccinations.

MEDICATIONS

Patient prescribed oral medication QID PRN without precondition specified

• Approved by: Task force on 1/9/2014.
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Medication Activity Medication Information Precondition for Substance Administration (Trifolia Log-in Required)
  • Patient prescribed oral medication QID PRN without precondition specified
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example when PRN but no precondition specified
• Reference in full CDA Sample: Results Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated December 18, 2013
• Keywords: Precondition, Pre-coordinated medication code, dose frequency
• Comments: This is an example of a medication which is QID and PRN (as needed) but with no precondition specified. It was generated based on SDWG list-serv discussion in December 2013. It also demonstrated a pre-coordinated generic medication coded at the SDC level (generic 600mg Oral Tablet) in RxNorm hierarchy.

Patient Prescribed Medication Every 4-6 Hours

• Approved by: Task force 1/30/2014. Approved by SDWG on 2/6/2014.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.2.1.1, 2.16.840.1.113883.10.20.22.4.16, 2.16.840.1.113883.10.20.22.4.23
  • Patient prescribed medication every 4 to 6 hours
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.2.1.1.2, 2.16.840.1.113883.10.20.22.4.16.2, 2.16.840.1.113883.10.20.22.4.23.2
  • Patient prescribed medication every 4 to 6 hours
• Known bad example?: Valid example
• Reference in full CDA Sample: Results Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated February 12, 2014
• Keywords: Dose frequency, pre-coordinated medication
• Comments: This is an example of a medication (Sudafed) which to be administered every 4-6 hours, a common dosing pattern. Representing the range of potential of hours is done through a low and high child element of the period within effectiveTime of PIVL_TS.

Patient Prescribed Oral Antibiotic with Dosing Regimen that Varies Over Prescription Course (Loading or Tapered)

• Approved by: Task force on 3/6. Approved by SDWG on 4/10/2014.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.2.1.1, 2.16.840.1.113883.10.20.22.4.16, 2.16.840.1.113883.10.20.22.4.23
  • Patient prescribed oral antibiotic with a dosing regimen that varies over course of prescription (loading or tapered dosing)
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.2.1.1.2, 2.16.840.1.113883.10.20.22.4.16.2, 2.16.840.1.113883.10.20.22.4.23.2
  • Patient prescribed medication every 4 to 6 hours
• Known bad example?: Valid example
• Reference in full CDA Sample: Results Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated February 12, 2014
• Keywords: Pre-coordinated medication code, dose frequency, tapered dose, loading dose
• Comments: This is an example of a common pattern for antibiotic administration which is complex (double dose on day 1, commonly known as Z-PAK). There was SDWG discussion of an appropriate means to structure this information in February 2014. This dosing regimen may be characterized as a loading dose, but a similar approach could be used for a tapered dose as well.

Patient prescribed basal insulin administered at bedtime

• Approved by: Not yet approved
• C-CDA 1.1 Example
  • TemplateId(s) illustrated: Medication Activity Medication Information
  • Patient prescribed basal insulin administered at bedtime
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example
• Reference in full CDA Sample: Results Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated February 27, 2014
• Keywords: Pre-coordinated medication code, dose frequency
• Comments: This is an example of a subcutaneous dose of a common basal insulin. Please note that this insulin dosage does not vary. This dose is administered at bedtime so the dosing frequency utilizes EIVL_TS type to denote this.

Single Administration of Medication (at Single Point in Time)

• • Approved by: Task force on 3/13. Approved by SDWG on 4/10/2014.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.2.1.1, 2.16.840.1.113883.10.20.22.4.16, 2.16.840.1.113883.10.20.22.4.23
  • Single administration of medication (at single point in time)
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.2.1.1.2, 2.16.840.1.113883.10.20.22.4.16.2, 2.16.840.1.113883.10.20.22.4.23.2, 2.16.840.1.113883.10.20.22.4.119
  • Single administration of medication (at single point in time)
• Known bad example?: Valid example
• Reference in full CDA Sample: Results Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: This timing information will not currently validate since it does not use IVL_TS type.
• Keywords: Pre-coordinated medication code, single administration, point in time
• Comments: This is an example of two baby aspirin being administered at a single point in time. At the January 2014 San Antonio meeting of HL7, this approach was decided as appropriate for medication timing of a point in time. This will not currently validate, but C-CDA 1.1 DSTU 423 states that changes will be made to accommodate value within time effectiveTime element (not just low/high children).

No Medications

• Approved by: Task force on 3/13. Approved by SDWG on 4/10/2014.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Medication Activity (2.16.840.1.113883.10.20.22.4.16)
  • No Medications R1.1
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: Medication Activity (2.16.840.1.113883.10.20.22.4.16.2)
  • No Medications R2
• Known bad example?: Valid example
• Reference to full CDA sample: No Medications in compliant MU2 C-CDA R1.1 sample
• Custodian: Brett Marquard, brett@riverrockassociates.com (GitHub: brettmarquard)
• Validation location: SITE Validator TOC Ambulatory
• Comments: .
• Alternate Opinion: 1 Task Force member voted against approving this samples. In her opinion, the narrative text did not convey the same semantic meaning as the information represented in the structured data. For additional information on this point of view, see the sample titled, "XXXXX" in the "Unapproved Samples" area below.

Patient Reported Medication without Reported Brand/Dose

• Approved by: Not yet approved
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Medication Activity (2.16.840.1.113883.10.20.22.4.16)
  • Patient reported oral medication no brand/dose
• C-CDA 2.0 Example: none yet created
• Known bad example?: Valid example
• Reference to full CDA sample: Medications in skeleton CCD
• Custodian: John D'Amore jdamore@diameterhealth.com GitHub: jddamore)
• Validation location: NIST TTT VDT Ambulatory validated June 4, 2014
• Comments: Patients often report medications that they are taking, either self-prescribed or by another provider, and know the drug name but do not know any specific brand or dose. This is an example of how to record an herbal supplement (echinicea) that a patient has reported taking using the informant to denote that this is patient reported.

Antibiotic Administered with Normal Saline (i.e. in hospital)

• Approved by: Not yet approved
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Medication Activity (2.16.840.1.113883.10.20.22.4.16) Drug Vehicle (2.16.840.1.113883.10.20.22.4.24)
  • Penicillin administered via IV infusion
• C-CDA 2.0 Example: none yet created
• Known bad example?: Valid example. Returns one warning since no PIVL_TS or EIVL_TS included
• Reference to full CDA sample: Medications in skeleton CCD
• Custodian: John D'Amore jdamore@diameterhealth.com GitHub: jddamore)
• Validation location: NIST TTT VDT Ambulatory validated June 4, 2014
• Comments: Many medications administered in hospital are done through IV infusion with another agent. In this example, a loading dose of penicillin is administered via IV infusion with normal saline.

PROBLEMS

Patient with No Known Problems

• Approved by: Task force on 2/27, SDWG on 3/6.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Problem Section, Problem Concern Act, Problem Observation
  • Patient with No Known Problems R1.1 - Problem Section 2.16.840.1.113883.10.20.22.2.5.1 (via GitHub)
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: Problem Section, Problem Concern Act, Problem Observation
  • Patient with No Known Problems R2 - Problem Section 2.16.840.1.113883.10.20.22.2.5.2 (via GitHub)
• Known bad example?: Valid example
• Reference to full CDA sample: Full Sample No Known Problems
• Custodian: Brett Marquard
• Validation location: TTT VDT Ambulatory
• Comments:

Complaint of no foot pain - Problem Section

• • Status: Not Yet Reviewed
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Problem Section, Problem Concern Act, Problem Observation
• (Complaint of No foot pain - Problem Section 2.16.840.1.113883.10.20.22.2.5.1 (via GitHub)
• C-CDA 2.0 Example: None yet posted
• Reference to full CDA sample: https://github.com/LisaRNelson/LRN_HL7_CDA_Examples/blob/master/Doc-No%20Known%20Problems%2020140203.xml
• Custodian: Lisa R. Nelson LisaRNelson@cox.net
• Validation location: TTT
• Comments: This one shows use of Observation.ValueNegationInd

No Complaint of foot pain - Problem Section

• • Status: Not Yet Reviewed
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Problem Section, Problem Concern Act, Problem Observation
  • No Complaint of foot pain - Problem Section 2.16.840.1.113883.10.20.22.2.5.1 (via GitHub)
• C-CDA 2.0 Example: None yet posted
• Reference to full CDA sample: https://github.com/LisaRNelson/LRN_HL7_CDA_Examples/blob/master/Doc-No%20Known%20Problems%2020140203.xml
• Custodian: Lisa R. Nelson LisaRNelson@cox.net
• Validation location: TTT
• Comments: This one shows use of Act.NegationInd

Problem which has been resolved/completed

• Approved by: Task force approved May 30, 2014. SDWG approved June 5, 2014
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Problem Section, Problem Concern Act, Problem Observation
  • Problem which has been resolved/completed
• C-CDA 2.0 Example: None yet posted
• Reference to full CDA sample: https://github.com/jddamore/HL7-Task-Force-Examples/blob/master/PROBLEM_Examples_in_empty_CCD.xml
• Custodian: John D'Amore jdamore@diameterhealth.com
• Validation location: TTT, April 17, 2014
• Comments: This example illustrates how to structure a resolved problem, both by having a biological resolution date and a completed status of the concern.

PROCEDURES

Procedure Activity Procedure Example in Procedures Section

• Approved by: Approved by task for 5/22
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Procedure Section, Procedure Activity Observation
  • Procedure Activity Procedure Example in Procedures Section
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example, although validator returns warning since performer not included in example
• CDA Implementation Guide where template(s) is(are) defined: C-CDA R1.1
• Reference to full CDA sample: https://github.com/jddamore/HL7-Task-Force-Examples/blob/master/PROCEDURE_Examples_in_empty_CCD.xml
• Custodian: John D'Amore jdamore@diameterhealth.com
• Validation location: TTT, April 30, 2014
• Comments: This example illustrates how a procedure which "alters the physical state" of the patient and should be classified as a procedure

Procedures Activity Observation Example in Procedures Section

• Approved by: Approved by task for 5/22
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Procedure Section, Procedure Activity Procedure
  • Procedures Activity Observation Example in Procedures Section
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example, although validator returns warning since performer not included in example
• CDA Implementation Guide where template(s) is(are) defined: C-CDA R1.1
• Reference to full CDA sample: https://github.com/jddamore/HL7-Task-Force-Examples/blob/master/PROCEDURE_Examples_in_empty_CCD.xml
• Custodian: John D'Amore jdamore@diameterhealth.com
• Validation location: TTT, April 30, 2014
• Comments: This example illustrates how an observation within a procedure section.

Procedure Activity Act Example in Procedures Section

• Approved by: Approved by task for 5/22
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Procedure Section, Procedure Activity Act
  • Procedure Activity Act Example in Procedures Section
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example, although validator returns warning since performer not included in example
• Reference to full CDA sample: https://github.com/jddamore/HL7-Task-Force-Examples/blob/master/PROCEDURE_Examples_in_empty_CCD.xml
• Custodian: John D'Amore jdamore@diameterhealth.com
• Validation location: TTT, April 30, 2014
• Comments: This example illustrates an act within a procedure section.

RESULTS

Result with less than a specified value

• Approved by: Reviewed with SDWG on 12/5/2013. Patrick will review with OO and report back.
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.1 (Trifolia Log-in Required) 2.16.840.1.113883.10.20.22.4.2 (Trifolia Log-in Required)
  • Result with less than a specified value (via GitHub)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example
• Reference to full CDA sample: Result Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated December 18, 2013
• Comments: This is an example of how to encode "less than" a specific range when returned from lab equipment. The example is for BNP, an immunoassay where the lower threshold for detection is often 5 pg/mL. The lower bound of the interval is zero in this example, even though this is none may be specified, since zero is the lower bound for measures of physical quantity. This example also includes a structured reference range.

Result with greater than a specified value

• Approved by: Not yet reviewed. Based on SDWG request from Kumara February 2014.
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.1 (Trifolia Log-in Required) 2.16.840.1.113883.10.20.22.4.2 (Trifolia Log-in Required)
  • Result with greater than a specified value (via GitHub)
• C-CDA Example: none yet posted
• Known bad example?: Valid example
• Reference to full CDA sample: Not yet completed
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: Not yet validated
• Comments: This is an example of how to encode "greater than" a specific range when returned from lab equipment. The example is for a point-of-care glucometer, which measures blood sugar for diabetics. Often these devices may have an upper bound, 500 mg/dL is shown in this example. The upper bound of the interval is positive infinity in this example. This example also includes two structured reference ranges for normal and high.

Result panel with the display of two ordinal values of negative/positive

• Approved by: Task force on 11/21/2013. Ready for SDWG review.
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.1 (Trifolia Log-in Required) 2.16.840.1.113883.10.20.22.4.2 (Trifolia Log-in Required)
  • Result panel with the display of two ordinal values of negative/positive
• Known bad example?: Valid example
• Reference to full CDA sample: Result Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated December 18, 2013
• Comments: This is an example of how to encode positive and negative, which are common data types returned form lab equipment. While some technologies may represent this as a type of ST (string), it is logical and easily possible to encode this information using SNOMED-CT. This would allow structured examination of this information downstream as well as comparison to a structured reference range, as shown in the example.

Result with an unstructured string as the value (e.g. urine color)

• Approved by: Not yet approved
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.1 (Trifolia Log-in Required) 2.16.840.1.113883.10.20.22.4.2 (Trifolia Log-in Required)
  • Result with an unstructured string as the value (e.g. urine color)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example
• Reference to full CDA sample: Result Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated December 18, 2013
• Comments: This is an example of a value from a lab result that may not be structured.

Result Which Requires Translation for its Unit Represented in UCUM

• Approved by: Task force on 2/27, SDWG on 3/6.
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.1 (Trifolia Log-in Required) 2.16.840.1.113883.10.20.22.4.2 (Trifolia Log-in Required)
  • Result which requires translation for its unit represented in UCUM
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 2.0
  • TemplateId(s) illustrated: [2.16.840.1.113883.10.20.22.4.1.2, 2.16.840.1.113883.10.20.22.4.2.2]
  • Result which requires translation for its unit represented in UCUM
• Known bad example?: Valid example
• Reference to full CDA sample: Result Packaged in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated February 12, 2014
• Comments: This is an example of a value from a lab which requires a translation for its unit. All units for physical quantities should be represent in UCUM.

Result with a pending component

• Approved by: Approved by Task Force 5/1/14 Approved by SDWG 5/22/14
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.1 (Trifolia Log-in Required) 2.16.840.1.113883.10.20.22.4.2 (Trifolia Log-in Required)
  • Result with a pending component
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Valid example
• Reference to full CDA sample: Result in C-CDA Section
• Custodian: Ed Donaldson, ed.donaldson@greenwayhealth.com (GitHub: donaldson-ed)
• Validation location: NIST TTT validator for Clinical Office Visit Summary - Clinical Summary validated March 5, 2014
• Comments: Result with a pending component.

PAYER

Coverage Activity referencing the holder's employer

• Approved by: Sample not yet reviewed
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.61 (Trifolia Log-in Required) 2.16.840.1.113883.10.20.22.4.61 (Trifolia Log-in Required)
  • Coverage Activity referencing the holder's employer(via GitHub)
• C-CDA 2.0 Example: none yet posted
• Known bad example?: Sample not yet reviewed
• Reference to full CDA sample:
• Custodian: Lisa R. Nelson, lisarnelson@cox.net (GitHub: lisarnelson)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated December 18, 2013
• Comments: This is an example of how to encode the policy holder's employer through which the insurance is provided - Finding major issues with the Coverage Activity and Policy Activity Templates. See C-CDA R1.1 DSTU Comment #994.

SOCIAL HISTORY (SMOKING)

Unknown Smoking Status

• Approved by: Not yet approved
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Social History Section (2.16.840.1.113883.10.20.22.2.17) Smoking Status (2.16.840.1.113883.10.20.22.4.78)
  • Unknown Smoking Status
• C-CDA 2.0 Example: none yet created
• Known bad example?: Valid example.
• Reference to full CDA sample: Social History (Smoking Status)in skeleton CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT VDT Ambulatory validated June 11, 2014
• Comments: This is an example of unknown smoking status. There is a major variation in how no information is managed for smoking status. C-CDA 1.1 explicitly guides to not utilize a nullFlavor for this information. Instead a SNOMED code should be used as demonstrated in the example. A best practice to avoid confusion is for each social history section to only include a single smoking status.

Former Smoker in Smoking Status

• Approved by: Not yet approved
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Social History Section (2.16.840.1.113883.10.20.22.2.17) Smoking Status (2.16.840.1.113883.10.20.22.4.78)
  • Former Smoking Status
• C-CDA 2.0 Example: none yet created
• Known bad example?: Valid example.
• Reference to full CDA sample: Social History (Smoking Status)in skeleton CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT VDT Ambulatory validated June 11, 2014
• Comments: This is an example of a former smoker in smoking status. There is a variation in how effectiveTime/high is used since this represents when the patient stopped smoking, not when they stopped being a former smoker. C-CDA 1.1 explicitly guides to this usage of effectiveTime. A best practice to avoid confusion is for each social history section to only include a single smoking status.

Current Smoker in Smoking Status

• Approved by: Not yet approved
• CDA Implementation Guide where template(s) is(are) defined: C-CDA 1.1
  • TemplateId(s) illustrated: Social History Section (2.16.840.1.113883.10.20.22.2.17) Smoking Status (2.16.840.1.113883.10.20.22.4.78)
  • Current Smoking Status
• C-CDA 2.0 Example: none yet created
• Known bad example?: Valid example.
• Reference to full CDA sample: Social History (Smoking Status)in skeleton CCD
• Custodian: John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT VDT Ambulatory validated June 11, 2014
• Comments: This is an example of current smoking status. This example also includes a coordinating social history observation to convey the amount of smoking using a SNOMED code. This SNOMED code in the accompanying observation is not acceptable since smoking status, which is constrained by HL7 and Meaningful Use value set requirements. A best practice to avoid confusion is for each social history section to only include a single smoking status.

VITAL SIGNS

Panel of Vital Signs in Metric Units

• Approved by: Task force approved May 30, 2014. SDWG approved June 5, 2014
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Vital Sign Organizer 2.16.840.1.113883.10.20.22.4.26, Vital Sign Observation 2.16.840.1.113883.10.20.22.4.27
  • Vital sign panel in metric units
• C-CDA 2.0 Implementation Guide Example: none yet posted
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated May 29, 2014
• Reference to full CDA sample: Vital Signs in C-CDA Skeleton
• Comments: This is panel of the nine common vital signs collected on an adult in metric units. Note that body surface area (BSA), head circumference and height (lying) are not included.

Panel of Vital Signs in Mixed Metric/Imperial Units

• Approved by: Task force approved May 30, 2014. SDWG approved June 5, 2014
• C-CDA 1.1 Implementation Guide Example
  • TemplateId(s) illustrated: Vital Sign Organizer 2.16.840.1.113883.10.20.22.4.26, Vital Sign Observation 2.16.840.1.113883.10.20.22.4.27
  • Vital Sign panel with mixed units
• C-CDA 2.0 Implementation Guide Example: none yet posted
• Reference to full CDA sample: Vital Signs in C-CDA Skeleton
• Custodian: John D'Amore, jdamore@diameterhealth.com (GitHub: jddamore)
• Validation location: NIST TTT Message Validator for VDT Ambulatory validated May 29, 2014
• Comments: This is panel of the nine common vital signs collected on an adult in mixed metric/imperial units. Note that body surface area (BSA), head circumference and height (lying) are not included.

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KNOWN BAD EXAMPLES

• Future bad examples will go here.

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FEEDBACK AND AWAITING RESPONSE

• Result with less than a specified value (via GitHub)- Awaiting review from Patrick Lloyd with OO

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COMMUNITY REQUESTS FOR EXAMPLES (include name, email)

• I would like an example of a preliminary lab result (John Doe, JohnDoe@email.com)
• The SMART C-CDA Collaborative generated a list of approximately 50 requested samples here. See the section noted as "Annotated Examples." For more information on the SMART C-CDA Collaborative please visit here. (Ashley Swain, ashley.swain@lantanagroup.com, John D'Amore, jdamore@diameterhealth.com, Josh Mandel, jmandel@gmail.com)

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DRAFT MATERIAL - PLEASE DON'T DELETE

How to Setup an XML example from GitHub

• Sign up for GitHub account. It's free and quick
• Once you've got an account, you will be able to fork repositories and comment on examples through the website
• To post and manage examples, you will likely want to install a graphical user interface for GitHub. Here's where you can download: For Windows or For Mac
• Once you've got the application installed, there are a few steps:
  • Click the "create" button to make a repository where you would like to upload/update to GitHub
  • Once you've created, the repository will exist online and on your local machine
  • On your local machine, place in new or revised files in the local folder (this will generally be under Documents/GitHub). It's good practice to include a text file named README.md, which appears online when people browse your repository. This is a good place to explain what you're working on.
  • Once you've made the edits (or new files) you want to post to GitHub, "commit" the sample entering a description and then hit the "sync" button to upload
  • At this point the changes and new files are posted online publicly
• For an example GitHub repository with C-CDA samples, check out this one from Children's Hospital Boston

• Add instructions for how to upload examples (to github, to other sites)
  • Add examples (to site of your choosing)
  • Add link and metadata too

• enumerated lists
  • validators
  • approving bodies
    • SDWG
    • Infoway
    • NHS

HOW TO PREPARE A SAMPLE FOR APPROVAL BY SDWG

Observing these guidelines will streamline the process for all involved.

• Include XML comments that will:
  • Make assumptions explicit
  • Annotate each lines
  • Highlight choices and key decisions that were made
• Confirm statusCode/moodCode/effectiveTime are in agreement
• Snippet should be in the context of a section
• Confirm narrative to match entries - and content is linked
• Does final sample name accurately reflect the final sample
• Add disclaimer at the top of every sample: SAMPLE DEVELOPED BY HL7 SDWG SAMPLES TASK FORCE - PLEASE SEE http://wiki.hl7.org/index.php?title=CDA_Example_Task_Force FOR ADDITIONAL DETAILS

• Patient with allergies to different substances (via GitHub)
  • Approved by: Not yet approved

• Patient taking pre-coordinated medication (via GitHub)
  • Approved by: Not yet approved

• Copy and paste the template below, and complete for your sample
• Allergy to Substance X
  • Approved by: SDWG (Oct 31, 2013); NHS (Oct 31, 2013)
  • TemplateId(s) illustrated: 2.16.840.1.113883.10.20.22.4.30; 2.16.840.1.113883.10.20.22.4.7
  • CDA Implementation Guide where template(s) is(are) defined: C-CDA R2
  • Reference to full CDA sample: N/A
  • Custodian: John Doe (John.Doe@email.com)
  • Validation location: validator.com
  • Comments: This is the best example EVER!