QRDA Modeling Issues

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.

Is this the best solution?

What can we do in the long-term?

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.