C-CDA R2.1 Comment Submission

SDWG completed an update to Consolidated CDA R2.0 to enable a C-CDA 2.1 instance to be created that can be used without requiring change to the product supporting C-CDA 1.1. A full description of the project is available on Project Insight Consolidated CDA DSTU 2013 Update (1014). The C-CDA R2.1 20150701_Review_Posting is available to HL7 members for review prior to reconciliation and publication. As a minor DSTU update, this new version will not go through the usual HL7 balloting process but will use the DSTU Update process with industry review on the HL7 wiki.

Before submitting comments, please review the C-CDA R2.1 Approved Compatibility Principles

Updates open for comment are identified by yellow highlighting.

• Volume 1 - If the heading is highlighted, the entire section is open for comment.
• Volume 2 - The specific conformance statements updated are highlighted. Templates that are only updated to reference a contained template that has been versioned (extension="2015-08-01") are not open for comment. Figures with updated conformance statements are open for review.

3 approaches to find edits: Word advanced find - highlight search, High-level change-log Volume 1 (page 43), Excel comparison files (CDA R1.1 vs 2.0 Reviews) included in the review zip.

During the comment period 7/1/2015 - 7/13/2015, please submit your comments on this wiki page using the table below. A template for adding a row is available at the top of the wiki table when in edit mode. Thank you.

Comments

CONF#	Name	Summary of Issue	Existing Wording	Proposed Wording	Comments
9045	Example Person	Short problem statement	This text is how the issue is currently documented in the IG	This text is the proposal for how the issue could be documented differently in the IG	This is why the issue is important or tells why the proposed wording is beneficial
1198-9045, 1198-32848	Sarah Gaunt	Example needs fixing	Example has the LOINC code in the code and the SNOMED code in the translation	Constraints state this should be the other way round
1198-7504, 1198-10085	Sarah Gaunt	Missing open brackets	SHALL contain 1..1] low (CONF:1198-7504), SHALL contain 1..1] high (CONF:1198-10085)	SHALL contain [1..1] low (CONF:1198-7504), SHALL contain [1..1] high (CONF:1198-10085)	You probably need to escape those brackets like "[[]"
1198-5402	VK	Mis-match on conformance Cardinality	If country is US, this addr SHALL contain zero to one [1..1] state, which SHALL be selected from ValueSet StateValueSet 2.16.840.1.113883.3.88.12.80.1 DYNAMIC (CONF:1198-5402). Note: A nullFlavor of ' UNK' may be used if the state is unknown.	If country is US, this addr SHALL contain exactly one [1..1] state, which SHALL be selected from ValueSet StateValueSet 2.16.840.1.113883.3.88.12.80.1 DYNAMIC (CONF:1198-5402). Note: A nullFlavor of ' UNK' may be used if the state is unknown.	Cardinality specified in the statement is not matching with the notation specified in the bracket
1198-32901	VK	New Conformance	This patient MAY contain zero or more [0..*] sdtc:ethnicGroupCode, which SHALL be selected from ValueSet Detailed Ethnicity urn:oid:2.16.840.1.114222.4.11.877 DYNAMIC (CONF:1198-32901).		Is this added as part of the errata? I am not seeing this conformance in the R1.1 and latest R2.0 CDAR2_IG_CCDA_CLINNOTES_R2_D1_2014NOV_ V2_Templates_and_Supporting_Material
1198-8651	VK	Missing ValueSet table definition	SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet AdvanceDirectiveTypeCode urn:oid:2.16.840.1.113883.1.11.20.2 STATIC 2006-10-17 (CONF:1198-8651).		Hyperlink for the ValueSet AdvanceDirectiveTypeCode is not working
1198-8558	VK	Missing Social History Type ValueSet table definition	SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet Social History Type urn:oid:2.16.840.1.113883.3.88.12.80.60 STATIC 2008-12-18 (CONF:1198-8558).		Hyperlink for the ValueSet Social History Type is not working
N/A	Dan Brown	Duplicate/invalid type for template in High-Level Change Log.	Section Consultation Note (V3) 2.16.840.1.113883.10.20.22.1.4:2015-08-01	None	The template is a document not a section. It is listed with the documents as well so was not missed. It is a duplicate in an incorrect location and should be removed
N/A	Dan Brown	Missing template in High-Level Change Log.	None	Hospital Admission Diagnosis (V3) 2.16.840.1.113883.10.20.22.4.34:2015-08-01 Updated to reference a contained template that has been versioned.	The template was versioned in R.2.1 (V2 -> V3) but is missing from the High-Level Change log. It should be added.
N/A	Dan Brown	Minor template name change in High-Level Change Log.	Admissions Medications Section (entries optional) (V3) 2.16.840.1.113883.10.20.22.2.44:2015-08-01	Admission Medications Section (entries optional) (V3) 2.16.840.1.113883.10.20.22.2.44:2015-08-01	Listed as Admissions Medications Section (plural) instead of Admission (singular).
N/A	Dan Brown	Extra/incorrect template should be removed in High-Level Change Log.	Hospital Admission Diagnosis Section (V3) 2.16.840.1.113883.10.20.22.4.34:2015-08-01	None	The template is an R1.1 original template name. The V2 version in R2.0 does not include the 'Hospital' prefix and is instead 'Admission Diagnosis Section (V2)'. This is why it is not listed as a template in either the 2.0 or 2.1 'Template Ids in This Guide'. This was an erratum confusing the refactor to remove 'Hospital' as there is an Admission Diagnosis Section (V2) in R2.0 / urn:hl7ii:2.16.840.1.113883.10.20.22.2.43:2014-06-09 and an Admission Diagnosis Section (V3) in R2.1 / urn:hl7ii:2.16.840.1.113883.10.20.22.2.43:2015-08-01. Since Admission Diagnosis Section (V3) is listed already (first section template in the table), the 'Hospital' version can be removed. In addition, the templateID root given (.34) is for Hospital Admission Diagnosis (V3) which is for an entry, not a section, and is already listed in the entries part of the table. Proposing to remove the (Hospital Admission Diagnosis Section (V3) 2.16.840.1.113883.10.20.22.4.34:2015-08-01) template from the table altogether.
1198-10085	HL7 PCWG	. It is not rare for a patient to have a resolution of an allergic condition therefore recommend the removal of the note due to clinical inaccuracy. It is generally accepted in the field of allergy practice that most childhood food allergies are outgrown by adulthood. Approximately 10% of the US Population has documentation in their medical record of penicillin allergy. The references at the two links that follow suggest that approximately 90% of those individuals with a documentation of penicillin allergy in their record have no reaction to penicillin on evaluation and challenge. [1][2]	"Note: It is clinically rare for an allergy to be "resolved", and therefore for the Concern to be resolved, even for patients undergoing allergy desensitization. As a result, effectiveTime/high will generally not be present."		This statement is not correct and should be removed.