Details
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Technical Correction
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Resolution: Persuasive
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Highest
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C-CDA Templates Clinical Notes (CDA)
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NULL
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Structured Documents
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TBD [deprecated]
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Correction
Description
Specification - Extended HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes DSTU Release 2.1 - US Realm
Document Description extended per extended per TSC tracker 12437, again with 14128 and jira.hl7.org/browse/TSC-38
Existing WordingThe Advance Directives Section (entries required) (V3) template says: If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer: 7. SHALL contain at least one [1..*] entry (CONF:1198-30235) such that it a. MAY contain zero or one [0..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:1198-30236). b. MAY contain zero or one [0..1] Advance Directive Organizer (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01) (CONF:1198-32420). c. This entry SHALL contain EITHER an Advance Directive Observation (V2) OR an Advance Directive Organizer (CONF:1198-32881). So: it's definitely okay to have multiple entries, each with, say, one organizer (like in Figure 58). It's definitely NOT okay to have both an organizer and an observation in a single entry (since you have to pick one or the other). But what about having multiple entries, one of which has an organizer and another of which has an observation? Narrative Text Currently the ONC validator considers this an error, so we're looking for clarification in the IG about whether it should be allowed or not.
Proposed WordingAssuming the XML scenario above is indeed something we want to allow, I'm not exactly sure what the best way to clarify this is. Maybe we should modify the XML example? Or maybe we should just explicitly say: If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer. If more than one entry is present, some may contain an Advance Directive Observation and others may contain an Advance Directive Organizer as long as each entry contains only one or the other (but not both).
Existing WordingThe Advance Directives Section (entries required) (V3) template says: If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer: 7. SHALL contain at least one [1..*] entry (CONF:1198-30235) such that it a. MAY contain zero or one [0..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:1198-30236). b. MAY contain zero or one [0..1] Advance Directive Organizer (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01) (CONF:1198-32420). c. This entry SHALL contain EITHER an Advance Directive Observation (V2) OR an Advance Directive Organizer (CONF:1198-32881). So: it's definitely okay to have multiple entries, each with, say, one organizer (like in Figure 58). It's definitely NOT okay to have both an organizer and an observation in a single entry (since you have to pick one or the other). But what about having multiple entries, one of which has an organizer and another of which has an observation? Narrative Text Currently the ONC validator considers this an error, so we're looking for clarification in the IG about whether it should be allowed or not.
Proposed WordingAssuming the XML scenario above is indeed something we want to allow, I'm not exactly sure what the best way to clarify this is. Maybe we should modify the XML example? Or maybe we should just explicitly say: If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer. If more than one entry is present, some may contain an Advance Directive Observation and others may contain an Advance Directive Organizer as long as each entry contains only one or the other (but not both).
