Specification - Extended HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2: the Electronic Initial Case Report (eICR), Release 1, STU Release 1.1 - US Realm
Document Description extended per TSC Tracker 12574, extension TSC GF 15952, JIRA TSC-29, TSC-123
Existing WordingAt various locations in the specification, there is the need to include a valueSet and a valueSetVersion from the eICR reportable trigger table. This has several problems. Maintenance is unclear. There is no provided guidance around when updates will occur to the valueSet or the valueSetVersion, how they will be conveyed to the community, or the time scale of their response. It is possible that an organization may respond more quickly than public health and may want to include a blanket trigger for a new or emerging code. It is also possible that public health may find a trend in new codes and may want to update their value set rapidly. Neither of those cases is easily accommodated by including the valueSet and valueSetVersion in the message. As written, the valueSet and valueSetVersion are extremely restrictive, not allowing inclusion as a code that is nullFlavored (narrative, note, etc) or an organism (organizer/cluster level). Additionally, if evaluation of trigger codes and transmission of messages do not happen synchronously, there are many opportunities for failure. For example, a result or problem could be added to a chart but canceled or removed before the message is sent. That results in an invalid message and additional processing.
Proposed WordingRemove the unique template and valueSet/valueSetVersion flagging in the message. The trigger table should still be maintained through appropriate communication between the organization reporting and public health. But the public health side should evaluate all potentially reportable codes in each message to review as to whether the message is reportable for that jurisdiction. That allows public health to respond as quickly as possible if new codes should be checked for. It also allows reporting organizations to update their trigger code list if they have additional values that they want to be considered. It prevents any timeliness issues. Continue allowing a textual field (as is currently allowed as part of a manual trigger) so that more data can be added either manually (in the case of a provider wanting another set of eyes on a case) or automatically (in the case where an organization wants to report certain codes that they are seeing high incidence of that may be concerning to public health).