CDA R3 Support full RIM content

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Submitted by: Lloyd McKenzie	Revision date: <<Revision Date>>
Submitted date: 2009-02-17	Change request ID: <<Change Request ID>>

Issue

CDA R2 constrains "Entry" content to the classes and attributes that were exposed within Clinical Statement at the time R2 was published. However, Clinical Statement (then and now) does not represent a complete set of data elements that might be necessary to support clinical processes. For example, capturing insurance pre-authorization information with a prescription.

Recommendation

• Rather than basing the Entry model on Clinical Statement, consider using the RIM as a whole. Alternatively, consider two "flavors" or "compliance levels" for CDA R3. One that constraints Entry to only Clinical Statement, and one that allows anything in the RIM.

Rationale

Failure to support the full set of RIM classes forces implementation guides to declare local extensions to the data model in order to support basic clinical data.

Also, the failure to support the full RIM content makes embedding static model content defined by other committees directly in a CDA instance difficult or impossible. Given that the semantic knowledge of key business areas such as lab, pharmacy, consent, etc. resides in other committees, these models should be leveragable within CDA.

Discussion

• StrucDoc call, 20090804:
  • Bob asked why we were considering this, after having decided in Kyoto to create different models based upon the different alternatives suggested at Kyoto. The current plan is to judge the models against the criteria we established in Kyoto.
  • It was proposed that we move forward with the alternative models and either review them prior to or at the Sept meeting. Either way, it was suggested that we would want to discuss this at the Sept meeting.
  • The item was deferred, awaiting the review of the models once they are complete.

Resolution

We've agreed to use entire RIM, except for those portions (yet to be defined) that are clearly out of scope. Those portions NOT used will be described in the CDA R3 ballot, so that folks have an opportunity to weigh in on the decision.