CSCR-062 Add reference to ActReference

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Submitted by: Harry Solomon	Revision date: 2006/05/11
Submitted date: 2006/05/11	Change request ID: CSCR-062

Issue

The ActReference act needs to optionally have the attribute text:ED [0..1] to enable a reference pointer to the referenced act, and the attribute code:CD [0..1] to enable identification of the type of referenced act.

Recommendation

• Add text:ED [0..1] to ActReference.
• Add code:CD [0..1] to ActReference.

Rationale

While it is true that theoretically the Referenced Act Instance ID should be sufficient to locate and retrieve a referenced act, this requires a resource location service that has knowledge of every II in the world. In fact, this is unlikely to be true in the forseeable future.

As a practical approach, the creator of an external ActReference likely has knowledge of where the referenced act is stored, but the receiver of the clinical statement probably does not. As an example, a reference to an image stored in some PACS is used in a radiology report about a patient seen in an emergency situation while on vacation; that report is then sent to the patient's primary care physician, whose EMR system has no clue where that uniquely identified image is. That system could begin a search for the image - assuming that there are indeed resource location services attached to the PACS and available to the EMR that might be able to respond to the query. If instead the radiology report provided a URL to the referenced image, such a search would be unnecesssary.

It should therefore be optional for the ActReference to include text:ED to convey the location and access method to a referenced act external to the current message context.

Similarly, it is theoretically possible for the receiver of an external ActReference to retrieve the referenced act and see it in its full context. Again, however, as a practical matter it may not be feasible for the receiver to retrieve the referenced act, or to retrieve it in a timely manner, and the receiver is therefore completely in the dark about its nature and content (except its actClass and mood). While there are certainly strong arguments that in general the content of the referenced act should not be replicated into the ActReference, it would be extremely useful for at least the code attribute to be replicated for external ActReferences.

Discussion

16 June 2006 Consider using the mechanism used by CDA or pursuade CDA to use this mechanism. Consider including the CDA approach into Clinical Statement.

Recommended Action Items

16 June 2006 Suggest for Harry to follow-up with CDA first to determine how their approach may fit and then ensure with Bob Dolin and Harry on the line we resolve this within Clinical Statement.