CSCR-001 Act Reference

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Submitted by: Heath Frankel	Revision date: 24-Nov-04
Submitted date: 30-Oct-04	Change request ID: CSCR-001

(Copied from HL7 Website Meeting Minutes and original Change Request)

Issue

Messages with a large amount of clinical information (clinical statements) are likely to relate to statements already present within the message or within a system. Rather than requiring to duplicate these statements with the potential of inconsistencies and duplication it would be more appropriate to reference the existing statement.

Visio Diagram

Recommendation

Include into the clinical statement a ActReference clone of Act which contains only the classCode, moodCode and id attributes. This clone should be constrained to be only a leaf of a clinical statement and should not allow any further ActRelationship associations.

Rationale

ActRef is used to refer to a full instance of any clinical statement. The classCode and moodCode of the reference shall have the same values as the act to which reference is being made. According to the context of use the referenced Act may be in the current communication or in a previously communicated message and available from a shared repository (PSIS)

Discussion

3-Nov-04 Proposal is to add ActRef to the choice box as identified in the visio diagram. There is a "typo" in the visio diagram that the SourceOf/TargetOf should be SourceOf to the inner one, the TargetOf the outer one, and the entry point is the outer one. Concern is that this proposal introduces a discrepancy with entity references and the classes are already in the choice box. Education on how referencing is done. Is the proposal addressing something that is broken that needs to be fixed or addresses something what is missing? ActRef to be used to reference other acts inside the message or elsewhere where only an identifier is necessary. There were some XML concerns, but update mode should not be a problem.

23-Nov-04 Concern that the proposed ActRef location (inside the choice box) is not seen as the best location to ensure ActRef cannot be referenced. Source/TargetOff between inner boxes only and specific relationship between inner box and ActRef. Tools should be capable of handling choice-within-choice. Principle is to allow entry to go straight into ActRef. Cannot go anywhere else then. Do not want to open the door for other constructs, e.g., outbound relationship. Is there an issue with the conduction relationship indicator? There is a question that the ActRef should be in the outer choice box or outside the box altogether. To put it inside the outer choice box a clear use case and description is required. It is felt that keeping it outside the box would still create consistency. Consider including the condition statement into the Clinical Statement Pattern. No problem with it being part of the outer choice box, but should not be able to conduct context to it.

Recommended Action Items

Since there were not enough participants at the time we concluded the topic, we could not vote. However, there is positive support from the participants. Final vote to occur when we have quorum.

Resolution

Motion (Heath, Dan): ActRef as concept should be in Clinical Statement pattern. Against: 0; Abstain: 0; In Favor: 9

Motion (Heath, David Rowed): ActRef is part of the outer choice box and we’ll sure that there is no context conduction allowed. Use Case/Descriptions are necessary to further complete the definition to ensure users know how to use it. Against: 0; Abstain: 2; In Favor: 7

Charlie Bisshops, Andrew Perry, Bob Dolin, Steven Chu, Heath Frankel, Dan Russler, David Rowed, Hans Buitendijk, David Markwell