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  1. CDA Specification Feedback
  2. CDA-20004

Resolve coding inconsistencies, and alignment problems for encounter disposition

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: Medium Medium
    • C-CDA Templates Clinical Notes (CDA)
    • 2.1.0.6 [deprecated]
    • Structured Documents
    • Value sets [deprecated]
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      This template will only bind to the value set that uses the FL17 Codes. Add template tag because reference to the CodeSystem 2.16.840.1.113883.12.112 HL7 Discharge Disposition (CONF:1198-32177) needs to be removed.

      The correct binding should be SHOULD for binding strength and DYNAMIC for binding stability to the value set

      NUBC UB-04 FL17 Patient Status 2.16.840.1.113883.3.88.12.80.33

       

      A note should be added to point out that this is a value set requires a license with the AHA to access these codes.  (See CARIN BB IG for example language.)

       

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      This template will only bind to the value set that uses the FL17 Codes. Add template tag because reference to the CodeSystem 2.16.840.1.113883.12.112 HL7 Discharge Disposition (CONF:1198-32177) needs to be removed. The correct binding should be SHOULD for binding strength and DYNAMIC for binding stability to the value set NUBC UB-04 FL17 Patient Status 2.16.840.1.113883.3.88.12.80.33   A note should be added to point out that this is a value set requires a license with the AHA to access these codes.  (See CARIN BB IG for example language.)  
    • Natasha K / Lisa N : 21 - 2 - 0
    • Correction
    • Compatible, substantive

    Description

      The Encounter Activity entry template currently includes these value set binding constraints:

      MAY contain zero or one [0..1] sdtc:dischargeDispositionCode (CONF:1198-32176).
      Note: The prefix sdtc: SHALL be bound to the namespace �urn:hl7-org:sdtc�. The use of the namespace provides a necessary extension to CDA R2 for the use of the dischargeDispositionCode element

      • This sdtc:dischargeDispositionCode SHOULD contain exactly [0..1] code, which SHOULD be selected from ValueSet 2.16.840.1.113883.3.88.12.80.33 NUBC UB-04 FL17-Patient Status (code system 2.16.840.1.113883.6.301.5) DYNAMIC or, if access to NUBC is unavailable, from CodeSystem 2.16.840.1.113883.12.112 HL7 Discharge Disposition (CONF:1198-32177).
      • This sdtc:dischargeDispositionCode SHOULD contain exactly [0..1] codeSystem, which SHOULD be either CodeSystem: NUBC 2.16.840.1.113883.6.301.5 OR CodeSystem: HL7 Discharge Disposition 2.16.840.1.113883.12.112 (CONF:1198-32377).

      This binding is problematic because it encourages use of a code system that requires a license. The alternative value set uses the same concepts, so may not solve the IP issues.  Also the concepts used for this data element across V2, C-CDA US Core and QRDA are inconsistent and have no feasible mapping

      This issue was discussed with a large group at the January 2021 HL7 WG meeting and there was consensus about the need to overhaul the value set bindings for these data element.  

      Consideration also needs to be given to the interplay with the V2 ADT^02, ADT^06 and ADT^07 event types which focus on internal transfers, and transfers from outpatient to inpatient, or inpatient to outpatient.  This needs to make sense together given the information carried in the required PV1 segment of ADT messages.

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            Unassigned Unassigned
            LisaRNelson Lisa R. Nelson
            Lisa R. Nelson, Rob McClure
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              Created:
              Updated:
              Resolved: