We are learning that there is some ambiguity as to the meaning of “and” highlighted in italic/bold/underscore in the statement “Certifying Servers and Clients SHALL support options 1 and 2 as Additional USCDI Requirements.”  This could mean that for any procedure both 1) and 2) must be addressed.  Yet, the intent is that for a procedure either 1) or 2) is used and that for certain procedures one only ever would use 2) as no ServiceRequest would be have been created (e.g., surgeries), while for other procedures typically 1) would be used (e.g., SDOH interventions).  We note that the SDOH guidance referenced in “The Gravity Project and its SDOH Clinical Care HL7 Implementation Guide address the screening process and related interventions to address Social Determinant of Health (SDOH). Those efforts helped guide US Core 5.0.1 updates to meet the USCDI v2 SDOH data elements for Assessments, Goals, Interventions, and Problems/Health Concerns.” further clarifies that SDOH interventions would be expected to typically have ServiceRequest that can provide the reason for the intervention.

To clarify the necessary flexibility depending on the types of procedures made available through Procedure and the actual use of ServiceRequests, we suggest the following update that does not change the original intent: Replace “Certifying Servers and Clients SHALL support options 1 and 2 as Additional USCDI Requirements.” with “Depending on the procedure documented, certifying Servers and Clients SHALL support options 1 and 2 as Additional USCDI Requirements.  For example, SDOH procedures would typically be based on service requests, thus would use 1) to reference the reason already documented on the ServiceRequest, while procedures such as surgeries may not have an explicitly documented service request thus use 2) to document the reason.”

Note this is a refinement of the already resolved https://jira.hl7.org/browse/FHIR-42136