Simplify Graphics Referencing in CDA

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Submitted by: Rick Geimer	Revision date: October 14, 2008
Submitted date: October 14, 2008	Change request ID:

Issue

CDA defines several "levels" that identify the expected amount of computable data in a clinical document. Any document with "entry" elements is assumed to be a level 3 CDA.

However, the current approach for referencing graphics in the narrative block requires the use of an entry element as follows:

 <text>Erythematous rash, palmar surface, left index finger.
     <renderMultiMedia referencedObject="MM1"/>
 </text>
 <entry>
     <observationMedia classCode="OBS" moodCode="EVN">
         <value mediaType="image/gif">
             <reference value="lefthand.gif"/>
         </value>
     </observationMedia>
 </entry>

This means that any document with a graphic is "level 3".

And also it seems like we are forcing people to jump through hoops just to reference a gif.

Recommendation

• Something like the following would be preferable:

  <renderMultiMedia mediaType="image/gif" value="lefthand.gif"/>
  ... or if we decide to allow XHTML in the body:
  <xhtml:img src="lefthand.gif"/> 

Resolution

March 09, 2010: For attested images, we need full RIM context. For non attested images, there is a simpler way to reference, using established narrative block markup. abstain: 0; opposed: 0; in favor: 8.