Clarify Stylesheet Semantics

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Submitted by: Rene Spronk	Revision date: 2009-02-13
Submitted date: <<Submit Date>>	Change request ID: <<Change Request ID>>

Issue

Some implementations of CDA are using stylesheets not just for rendering, but to add clinical data to the data as present in the document.

Recommendation

• Add the following wording to CDA R3: "The use of a particular stylesheet SHALL not add any semantics to the semantics as conveyed in the CDA document. A stylesheet shall only render (extracts of) the semantics as conveyed in the CDA document and not add any semantic data of its own. The only safe place to put clincial content is within the CDA document itself."

Rationale

• the stylesheet is (in principle) not part of the (attested) document
• a receiving system has no vanilla-CDA-conformance-level obligation to use a supplied stylesheet. Once there is an obligation (e.g. as stated in an implementation guide) to use a supplied stylesheet then the stylesheet is ipso facto an integral part of the clinical document, and it becomes perfectly reasonable (although discouraged) to add clinical content to a stylesheet.

Discussion

• See Stylesheet Semantics.

Recommended Action Items

• Implement the reccomdation

Resolution

(Resolution is to be recorded here and in the referenced minutes, which are the authoritative source of resolution).