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QRDA Modeling Issues
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Vocabulary Mismatch between C-CDA and its implied QRDA templates
General issue:
- QRDA template implies a C-CDA template
- C-CDA template has an element/attribute that is SHALL bound to a value set
- C-CDA value set is more restricted (fewer codes systems, codes etc.) than what is required for QRDA
Example 1:
- QRDA template Reaction implies C-CDA R2 Reaction Observation template
- Reaction Observation value is SHALL bound to Problem value set which is SNOMED CT
- QRDA does not constrain to SNOMED (can also be ICD 10, ICD 9 etc.)
Example 2:
- QRDA template Procedure Performed implies C-CDA R2 Procedure Activity Procedure template
- targetSiteCode is SHALL bound to Body Site value set which is SNOMED CT
- QRDA does not constrain to SNOMED
(There are others).
Suggested solution for the short term is, if the code doesn't exist in the required value set, to use code (@nullFlavor="OTH", @codeSystem="2.16.840.1.113883.6.96", @codeSystemName="SNOMED CT") and code/translation to hold the QRDA code.
QRDA "Substance" templates that are currently mapped to Medication templates
Proposed to create new templates for Substance, Administered, Substance (other templates) that were previously mapped to Medication templates.
Is this the best solution?
What can we do in the long-term?
