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  1. CDA Specification Feedback
  2. CDA-20014

Problem Observation sample XML doesn't include SNOMED CT code phrase

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • C-CDA Templates Clinical Notes (CDA)
    • 2.1.0.6 [deprecated]
    • Structured Documents
    • Figures and Examples [deprecated]
      Templates [deprecated]
    • 3.79
    • Hide
      1. Retain existing example
      2. Change guidance text about using precoordinated codes from "For example, SNOMED CT allows constructing concepts as a combination of multiple codes. SNOMED CT defines a concept "pneumonia (disorder)" (233604007) an attribute "finding site" (363698007) and another concept "left lower lobe of lung (body structure)" (41224006). SNOMED CT allows one to combine these codes in a code phrase, as shown in the sample XML.

                 TO:

                 In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in [HL7 Version 3 Implementation Guide: TermInfo -
      Using SNOMED CT in CDA R2 Models, Release 1|https://www.hl7.org/documentcenter/public/standards/dstu/V3_IG_SNOMED_R1_DSTU_2015DEC.pdf] using the V3 CD Data type 1 style. This is shown in the sample XML. This example represents a family history condition that was elevated to the problem list. Further details about the condition could be present/or retrieved from the family history section, but may avoid loss of important clinical data if Family History was not populated or was not queried for prior to creation of a C-CDA document.

          3. Add New example reflecting this post coordinated concept on observation/value:

                                       <!-- Example of a problem you want on problem list, that is not present in SNOMED CT as a precoordinated concept - but would like on the problem list -->
                                          <value xsi:type="CD" code="281666001 "
                                              codeSystem="2.16.840.1.113883.6.96"
                                              displayName="Family history of disorder">
                                              <qualifier>
                                                  <name code="246090004" displayName="Associated finding"/>
                                                  <value code="254167000" displayName="Bullous ichthyosiform erythroderma"/>
                                              </qualifier>
                                          </value>

      Show
      Retain existing example Change guidance text about using precoordinated codes from "For example, SNOMED CT allows constructing concepts as a combination of multiple codes. SNOMED CT defines a concept "pneumonia (disorder)" (233604007) an attribute "finding site" (363698007) and another concept "left lower lobe of lung (body structure)" (41224006). SNOMED CT allows one to combine these codes in a code phrase, as shown in the sample XML.            TO:            In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in [HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1| https://www.hl7.org/documentcenter/public/standards/dstu/V3_IG_SNOMED_R1_DSTU_2015DEC.pdf ] using the V3 CD Data type 1 style. This is shown in the sample XML. This example represents a family history condition that was elevated to the problem list. Further details about the condition could be present/or retrieved from the family history section, but may avoid loss of important clinical data if Family History was not populated or was not queried for prior to creation of a C-CDA document.     3. Add New example reflecting this post coordinated concept on observation/value:                                  <!-- Example of a problem you want on problem list, that is not present in SNOMED CT as a precoordinated concept - but would like on the problem list -->                                     <value xsi:type="CD" code="281666001 "                                         codeSystem="2.16.840.1.113883.6.96"                                         displayName="Family history of disorder">                                         <qualifier>                                             <name code="246090004" displayName="Associated finding"/>                                             <value code="254167000" displayName="Bullous ichthyosiform erythroderma"/>                                         </qualifier>                                     </value>
    • Gay Dolin / Natasha Kreisle: 12-0-0
    • Clarification
    • Compatible, substantive

    Description

      The Problem Observation (V3) template in section 3.79 item 9.a (page 737) states as follows:

      For example, SNOMED CT allows constructing concepts as a combination of multiple codes. SNOMED CT defines a concept "pneumonia (disorder)" (233604007) an attribute "finding site" (363698007) and another concept "left lower lobe of lung (body structure)" (41224006). SNOMED CT allows one to combine these codes in a code phrase, as shown in the sample XML.

      However the following sample XML in Figure 198 (page 740) doesn't contain a SNOMED CT code phrase. It only contains a single SNOMED CT term. I recommend we update the sample with a SNOMED CT postcoordinated expression. And consider adding an informative link to the HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1.

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            jduteau Jean Duteau
            nradov Nick Radov
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