Diff between LOTS and CDAPRO Versions of C-CDA CCD Baseline C-CDA Samples Note June 9, 2013
Header No changes
Allergy Section Allergy Section Header 1) You added a content tag on the word Allergies. See 6) below Allergy Problem Act 2) You added a text element under act pointing to the section text. Comment: No real objection, but I want to hear more about your thinking here. The C-CDA IG doesn’t call (even at a “MAY” level) for the text element here (though CDA does of course support it). I want to keep this “baseline” minimal so want to make sure I understand why this needs to be here. 3) You put today’s date as the high for effectiveTime Comment: We can debate this a bit and in the end we might have to propose both options here to the “higher powers”. My read of CONF 7498 is that putting in a high implies that something ended, as is inconsistent with the statusCode of “active”. While it doesn’t really say that (it just says that “completed” must have a high), I still think that once something has a nonnullFlavor value in high – it means it has ended. Allergy – Intolerance Observation
4) You put today’s date as the high for effectiveTime Comment: Similar to 3) above. The whole observation is fictitious. “I have no information” which means I have no idea if there was an observation. So how can I say something about when it took place? A better designed C-CDA would say that once I put “NI” on an entry, its contents go away unless they directly support explaining what the “NI” refers to. 5) You put the SNOMED code for “Allergy to substance” in the code, where I just had nullFlavor=“NI” Comment: I have to go with your approach because my approach violates CONF 9139. Curious that the validator didn’t call me on this? Of course, I don’t agree with the design (why do I have to put in the code for an allergy that I know nothing about – including not knowing whether any allergy exists or doesn’t exit). But, until someone changes the rules, we have to play by them… But see comment later on 10) which I think is an even better approach here as well. 6) You reference your new content tag that point to “Allergies” instead of the existing one that points to “No Information About Allergies” in value/originalText. Comment: I need to hear your explanation about this and I am pretty sure I will agree with you once I do. 7) You suggested taking out originalText under participant/participantRole/playingEntity/code with this comment: I don't Copyright © 2013 Brian Weiss. ® ALL RIGHTS RESERVED Worldwide. The reproduction of this material in any form is strictly prohibited without the written permission of the author and publisher.
Diff between LOTS and CDAPRO Versions of C-CDA CCD Baseline - C-CDA Samples Note think this is needed in this case. I would only have used it if you still populated a table structure. That was always present, even if all the columns of the single row said NI. Comment: I need to hear more about your view on maintaining a table structure. In terms of whether we need this at all, CONF 7424 makes it a SHOULD so following the rule here that “SHOULD is in” (and no warning messages) it has to be there. If we don’t go with that rule, then I would take out participant entirely (which in itself is only a SHOULD – and makes no sense in an “NI” context as per my comment in 4) above. Reaction Observation
8) You copied in and commented out adding originalText under code with the same comment as in 7) above. Comment: See 7) above. In this case, there is no SHOULD so I left it out. 9) On the text element you commented that you didn’t think it was needed. Comment: Similar to 7) above, CONF 7330 makes it a SHOULD. Now that I see your comment later in Problems (see 26 below), maybe what you meant is the XML element should be there but it should be empty. If so, I agree. 10) For value, you left in the codeSystem as SNOMED but replaced my bogus code with a nullFlavor=”NI” entry. Comment: I really like this approach for all those places where we are forced to put in a code even though this is an ”NI” situation. Can we adopt this exact approach in 5) above, as well? Severity Observation (for the reaction)
11) You added “for the Reaction” to my comment for the template Comment: Agree this is important to clarify the presence of two Severity Observations, see 15), below. 12) In code, you took out the nullFlavor and added in the codeSystem and codeSystemName. Comment: I agree. 13) On the text element you commented: I disagree that this text element should be used. Comment: I’m OK to use a different element (what?). If you are suggesting taking it out entirely we are back to the same issue as 8) and 7) above. CONF 7350 makes it a SHOULD. 14) You used the same approach for value as in 10) above. Comment: As noted in 10) above, I like it! Severity Observation (for the Allergy)
15) You added the comment “for the Allergy” to my comment for the template Comment: As per 11) above, I agree! 16) – 18) Identical to 12) – 14) above (same template, same issues)
© 2013 Brian Weiss. All Rights Reserved Worldwide.
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Diff between LOTS and CDAPRO Versions of C-CDA CCD Baseline - C-CDA Samples Note
Medication Section Medication Section Header No Changes Medication Activity No Changes Medication Information
19) Same comment as 7) for originalText under manufacturedMaterial/code. Comment: See 7) above. CONF 7413 makes it a SHOULD
Problems Section Problems Section Header 20) Similar content tag add as in 1) and 6) above Comment: Same as in 1) and 6) above Problem Concern Act 21) You added an empty text tag. Comment: Not sure why you didn’t follow the same pattern here as in 2) above? 22) You changed statusCode to “completed” Comment: This is one we will debate along the same lines as 3). Not sure why you didn’t object to “active” in the Allergy Problem Act as well. My view on “no information” is that “the state of ‘no information’ is active until there is information”. It is not “complete” and has no high value in effectiveTime. We are not saying “we don’t have any active concerns” and we are not saying “we have active concerns”. We are saying “we don’t know” and so that is what the “act” is (the “act” of not knowing) and as such, it is active. 23) You set the high value of effectiveTime the same as in 3) above. Comment: Same as in 3) above. Problem Observation
24) You removed nullFlavor on the observation. Comment: This is mostly just a general desire of mine to get “NI” in here as quickly as possible. But I agree with you, it doesn’t belong here. 25) Changed code from nullFlavor=”NI” to SNOMED code for “Problem” Comment: Same as 5) above. See my comment 10) above which is what I think is the preferred approach both here and in 5) above. 25) Added originalText under code, with a reference to the new content tag in 20), above. Comment: Similar to 7). But note that for Problem Observation originalText is not required by the IG here. So, do we need to put it in at all? 26) Comment that text does not need to be populated. Comment: Agree. It has to be there (as CONF 9185 makes it a SHOULD). But I’m fine for it to be empty. © 2013 Brian Weiss. All Rights Reserved Worldwide.
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Diff between LOTS and CDAPRO Versions of C-CDA CCD Baseline - C-CDA Samples Note 27) As per 3), 4) and 23) above, you set high to today in effectiveTime. Comment: Same comments from me as 3), 4) and 23)
Procedures Section Procedures Section Header No Changes Procedure Activity Act => Procedure Activity Procedure 28) You changed the Procedure Activity Act to a Procedure Activity Procedure Comment: Since this is all fictitious – and as per my comment in 5), I think this is all a result of a bad design decision and we are just formally ticking boxes in the spec – I chose what looked to me to be the smallest/simplest template. But, I do agree with you. 29) You change effectiveTime to have low/high (because that is what is needed for a Procedure instead of an Act) and, as usual, put in today’s date for high. Comment: I of course agree with the change to the time range as per the change from Procedure Activity Act to Procedure Activity Procedure. And of course I have my standard comment as per 3), 4), 23) and 27) above… 30) You added targetSiteCode as per the change to Procedure Activity Procedure Comment: Agreed.
Results Section Results Section Header No Changes Result Organizer 31) You changed my effectiveTime Comment: Not sure where my weird value came from and fine with the change to low/high format. Usual comment on high being today as opposed to “NI” as per 3), 4), 23), etc. above Results Observation
32) Removed nullFlavor from the observation. Same as 24). Comment: Same as 24). 33) Put in a nullFlavor in code and take out the specific code and displayName. Same approach as 10) above, and elsewhere. Comment: As in other places above, I like this approach. 34) effectiveTime change to have low/high and usual placement of today’s date in high. Comment: Same comment as 4) above and many other places above. If we end up taking my approach on “NI” for both low and high, I think we can use the single-value form of effectiveTime.
Plan of Care Section No Changes
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Diff between LOTS and CDAPRO Versions of C-CDA CCD Baseline - C-CDA Samples Note
Social History Section Social History Section Header No Changes Smoking Status Observation 35) Removed nullFlavor from the observation. Same as 24) and 32), above. Comment: Same as 24) and 32). 36) Added templateId element Tobbaco Use template. Comment: Agreed – though it doesn’t have a CONF number and the validator doesn’t flag it. 37) Added text element with reference pointer. Comment: OK – though note that it is not called out in a CONF statement and the validator doesn’t flag it. 38) Today’s date in high element within effectiveTime . Comment: As per 3), 4), 23), etc… debate here on high in effectiveTime on things with no information. 39) Add nullFalvor=”NI” and remove code and displayName from value. Same as in 10) above and multiple other places. Comment: As in other places above, I like this approach.
Vital Signs Section Vital Signs Section Header No Changes Vital Signs Organizer 40) effectiveTime change to have low/high and usual placement of today’s date in high. Comment: Same comment as 4) above and many other places above. If we end up taking my approach on “NI” for both low and high, I think we can use the singlevalue form of effectiveTime. Vital Signs Observation
41) Added originalText under code. Comment: Similar to 7). But note that for Vital Signs Observation originalText is not required by the IG here. Do we really need it? 42) effectiveTime change to have low/high and usual placement of today’s date in high. Comment: Same comment as 4) above and many other places above. If we end up taking my approach on “NI” for both low and high, I think we can use the single-value form of effectiveTime.
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