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.
• 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. [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>

[George Cole]