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Published:  


Open issues

ART-DECOR release

This is the Wave 5 release containing change proposal implementations (CP-38, CP-41 and CP-50) and bug fixes.

The latest release is available through this page: https://art-decor.ehdsi.eu/publication/epSOS/

The ART-DECOR Release and Archiving Manager (ADRAM) handles the Release Publication and/or Archiving (keep versions) of our project.

A publication in ART-DECOR typically includes the following artefacts derived from a DECOR project:

  • An HTML Online extract that acts as a “freeze” of the current specifications in the DECOR project; it contains project and version information scenarios and transactions, value sets, templates, issues and a summary of the compilation process. The HTML is published at a specific site, known in the project definition as the “Publication location”; Along with the HTML online version, also a downloadable HTML Package is created
    that typically also works offline.

  • A Schematron Runtime Environment containing the generated ISO schematrons from the templates, including all necessary other artefacts like value sets and pointers back from error messages to the published specification (according to the “see” instructions in the generated schematron);

  • A generic (or customized) PDF Publication generated upon request for download, containing all desired artefacts rendered in an appropriate form;

v5.0.0 - Release Details

1. CP-038: Duplicate OID issue


CP link

Analysis and designAffected templatesOverview of impacted template OIDs
CP-038: Duplicate OID issuehttps://ec.europa.eu/cefdigital/wiki/x/foViEMultiple
 Click here to expand...
impacted template OIDs

1.1. Impact

Since in total the template OIDs of 31 templates have been changed, this CP will have a big impact on the national implementation. In the tables below, all impacted templates are listed with the old and new OIDs.

To visualize the relationship and hierarchy of the impacted templates, the diagram above can be a good help. In the diagram the new template OIDs are shown.

1.2. Section level templates

Old OID

New OID

Name

Conformance

1.3.6.1.4.1.19376.1.5.3.1.1.5.3.2

1.3.6.1.4.1.12559.11.10.1.3.1.2.6

eHDSI Vital Signs

Optional

1.3.6.1.4.1.19376.1.5.3.1.1.5.3.4

1.3.6.1.4.1.12559.11.10.1.3.1.2.7

eHDSI Pregnancy History

Optional

1.3.6.1.4.1.19376.1.5.3.1.1.9.50 

1.3.6.1.4.1.12559.11.10.1.3.1.2.8

eHDSI Health Maintenance Care Plan

Optional

1.3.6.1.4.1.19376.1.5.3.1.3.6

1.3.6.1.4.1.12559.11.10.1.3.1.2.9

eHDSI Active Problems

Required

1.3.6.1.4.1.19376.1.5.3.1.3.8

1.3.6.1.4.1.12559.11.10.1.3.1.2.10

eHDSI History of Past Illness

Optional

1.3.6.1.4.1.19376.1.5.3.1.3.12

1.3.6.1.4.1.12559.11.10.1.3.1.2.11

eHDSI List of Surgeries

Required

1.3.6.1.4.1.19376.1.5.3.1.3.13

1.3.6.1.4.1.12559.11.10.1.3.1.2.12

eHDSI Allergies and Other Adverse Reactions

Required

1.3.6.1.4.1.19376.1.5.3.1.3.16.1

1.3.6.1.4.1.12559.11.10.1.3.1.2.13

eHDSI Social History

Optional

1.3.6.1.4.1.19376.1.5.3.1.3.17

1.3.6.1.4.1.12559.11.10.1.3.1.2.14

eHDSI Functional Status

Optional

1.3.6.1.4.1.19376.1.5.3.1.3.23

1.3.6.1.4.1.12559.11.10.1.3.1.2.15

eHDSI Immunizations

Optional

1.3. Entry level templates

Old OID

New OID

Name

Conformance

1.3.6.1.4.1.19376.1.5.3.1.4.1 

1.3.6.1.4.1.12559.11.10.1.3.1.3.8

eHDSI Severity

Optional containment in the following templates:

  • eHDSI Allergies And Intolerances
  • eHDSI Problem

1.3.6.1.4.1.19376.1.5.3.1.4.1.1

1.3.6.1.4.1.12559.11.10.1.3.1.3.9

eHDSI Problem Status Observation

Optional containment in the following template:

  • eHDSI Problem

1.3.6.1.4.1.19376.1.5.3.1.4.1.2

1.3.6.1.4.1.12559.11.10.1.3.1.3.10

eHDSI Health Status Observation

Optional containment in the following template:

  • eHDSI Problem

1.3.6.1.4.1.19376.1.5.3.1.4.2

1.3.6.1.4.1.12559.11.10.1.3.1.3.11

eHDSI Comment

Optional containment in the following templates:

  • eHDSI Immunizations
  • eHDSI Problem

1.3.6.1.4.1.19376.1.5.3.1.4.3

1.3.6.1.4.1.12559.11.10.1.3.1.3.12

eHDSI Patient Medication Instructions

Optional containment in the following template:

  • eHDSI Substance Administration

1.3.6.1.4.1.19376.1.5.3.1.4.3.1

1.3.6.1.4.1.12559.11.10.1.3.1.3.13

eHDSI Medication FulFillment Instructions

Optional containment in the following template:

  • eHDSI Substance Administration
  • eHDSI Medication Item

1.3.6.1.4.1.19376.1.5.3.1.4.4.1

1.3.6.1.4.1.12559.11.10.1.3.1.3.14

eHDSI Internal Reference

Optional containment in the following template:

  • eHDSI Procedure

1.3.6.1.4.1.19376.1.5.3.1.4.5.2

1.3.6.1.4.1.12559.11.10.1.3.1.3.15

eHDSI Problem Concern

containment in the following templates:

  • eHDSI Active Problem
  • eHDSI History Of Past Illness

1.3.6.1.4.1.19376.1.5.3.1.4.5.3

1.3.6.1.4.1.12559.11.10.1.3.1.3.16

eHDSI Allergy and Intolerance Concern

containment in the following template:

  • eHDSI Allergies and Other Adverse Reactions

1.3.6.1.4.1.19376.1.5.3.1.4.6

1.3.6.1.4.1.12559.11.10.1.3.1.3.17

eHDSI Allergies And Intolerances

containment in the following template:

  • eHDSI Allergy And Intolerance Concern

1.3.6.1.4.1.19376.1.5.3.1.4.7.2

1.3.6.1.4.1.12559.11.10.1.3.1.3.18

eHDSI Immunization Product

containment in the following template:

  • eHDSI Immunizations

1.3.6.1.4.1.19376.1.5.3.1.4.12

1.3.6.1.4.1.12559.11.10.1.3.1.3.19

eHDSI Immunization

containment in the following template:

  • eHDSI Immunizations

1.3.6.1.4.1.19376.1.5.3.1.4.13

1.3.6.1.4.1.12559.11.10.1.3.1.3.20

eHDSI Simple Observation

No use

1.3.6.1.4.1.19376.1.5.3.1.4.13.1

1.3.6.1.4.1.12559.11.10.1.3.1.3.21

eHDSI Vital Signs Organizer

containment in the following template:

  • eHDSI Vital Signs

1.3.6.1.4.1.19376.1.5.3.1.4.13.2

1.3.6.1.4.1.12559.11.10.1.3.1.3.22

eHDSI Vital Signs Observation

containment in the following template:

  • eHDSI Vital Signs Organizer

1.3.6.1.4.1.19376.1.5.3.1.4.13.4

1.3.6.1.4.1.12559.11.10.1.3.1.3.23

eHDSI Social History Observation

containment in the following template:

  • eHDSI Social History

1.3.6.1.4.1.19376.1.5.3.1.4.13.5

1.3.6.1.4.1.12559.11.10.1.3.1.3.24

eHDSI Pregnancy Observation

containment in the following template:

  • eHDSI Pregnancy History

1.3.6.1.4.1.19376.1.5.3.1.4.13.6

1.3.6.1.4.1.12559.11.10.1.3.1.3.25

eHDSI Blood Group

containment in the following template:

  • eHDSI Coded Results

1.3.6.1.4.1.19376.1.5.3.1.4.19

1.3.6.1.4.1.12559.11.10.1.3.1.3.26

eHDSI Procedure

containment in the following template:

  • eHDSI List of Surgeries

never used but contained in template:

  • eHDSI Coded Results

1.3.6.1.4.1.19376.1.5.3.1.4.4

1.3.6.1.4.1.12559.11.10.1.3.1.3.27

eHDSI External Reference

never used but contained in template:

  • eHDSI Coded Results
2.16.840.1.113883.10.20.1.461.3.6.1.4.1.12559.11.10.1.3.1.3.28eHDSI Position Of Vaccination

Only reuse of a CCD template

containment in the following template:

  • eHDSI Immunizations


2. CP-041: Relax mandatory constraints


2.1. Impact

Since we are only relaxing mandatory constraints, the possibility is introduced to remove some templateId references.

2.2. Section Level Templates

Template Name

OID (after implementation of CP-038)

Template OID references that can be omitted

eHDSI Active Problems

1.3.6.1.4.1.12559.11.10.1.3.1.2.9

IHE-PCC: 

  • IHE Active Problems Section: 1.3.6.1.4.1.19376.1.5.3.1.3.6

eHDSI Allergies and Other Adverse Reactions

1.3.6.1.4.1.12559.11.10.1.3.1.2.12

IHE-PCC: 

  • IHE Allergies and Other Adverse Reactions Section: 1.3.6.1.4.1.19376.1.5.3.1.3.13

CCD: 

  • Alerts section: 2.16.840.1.113883.10.20.1.2
eHDSI Coded Results

1.3.6.1.4.1.12559.11.10.1.3.1.2.5

-
eHDSI Dispensation

1.3.6.1.4.1.12559.11.10.1.3.1.2.2

CCD

  • Medication section: 2.16.840.1.113883.10.20.1.8
eHDSI Functional Status

1.3.6.1.4.1.12559.11.10.1.3.1.2.14

IHE-PCC: 

  • IHE Functional Status Section: 1.3.6.1.4.1.19376.1.5.3.1.3.17

CCD: 

  • Functional status section: 2.16.840.1.113883.10.20.1.5
eHDSI Health Maintenance Care Plan1.3.6.1.4.1.12559.11.10.1.3.1.2.8

IHE-PCC: 

  • IHE Health Maintenance Care Plan Section: 1.3.6.1.4.1.19376.1.5.3.1.1.9.50
  • IHE Care Plan Section: 1.3.6.1.4.1.19376.1.5.3.1.3.31
eHDSI History Of Past Illness1.3.6.1.4.1.12559.11.10.1.3.1.2.10

IHE-PCC: 

  • IHE History of Past Illness Section: 1.3.6.1.4.1.19376.1.5.3.1.3.8
eHDSI Immunizations1.3.6.1.4.1.12559.11.10.1.3.1.2.15

IHE-PCC: 

  • IHE Immunizations Section: 1.3.6.1.4.1.19376.1.5.3.1.3.23
eHDSI List of Surgeries1.3.6.1.4.1.12559.11.10.1.3.1.2.11

IHE-PCC:

  • IHE List of Surgeries section: 1.3.6.1.4.1.19376.1.5.3.1.3.11
  • IHE Coded List of Surgeries section: 1.3.6.1.4.1.19376.1.5.3.1.3.12
eHDSI Medical Devices

1.3.6.1.4.1.12559.11.10.1.3.1.2.4

IHE-PCC: 

  • IHE Medical Devices Section: 1.3.6.1.4.1.19376.1.5.3.1.1.5.3.5

eHDSI Medication Summary

1.3.6.1.4.1.12559.11.10.1.3.1.2.3

-
eHDSI Pregnancy History1.3.6.1.4.1.12559.11.10.1.3.1.2.7

IHE-PCC: 

  • IHE Pregnancy History Section: 1.3.6.1.4.1.19376.1.5.3.1.1.5.3.4
eHDSI Prescription

1.3.6.1.4.1.12559.11.10.1.3.1.2.1

-
eHDSI Social History1.3.6.1.4.1.12559.11.10.1.3.1.2.13

IHE-PCC:

  • IHE Coded Social History Section: 1.3.6.1.4.1.19376.1.5.3.1.3.16.1
  • IHE Social History Section: 1.3.6.1.4.1.19376.1.5.3.1.3.16
eHDSI Vital Signs1.3.6.1.4.1.12559.11.10.1.3.1.2.6

IHE-PCC:

  • IHE Coded Vital Signs Section: 1.3.6.1.4.1.19376.1.5.3.1.1.5.3.2
  • IHE Vital Signs Section: 1.3.6.1.4.1.19376.1.5.3.1.3.25

2.3. Entry Level Templates

Template Name

OID  (after implementation of CP-038)

Template OID references that can be omitted

eHDSI Allergies And Intolerances

1.3.6.1.4.1.12559.11.10.1.3.1.3.17

IHE-PCC: 

  • IHE Problem Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.5
  • IHE Allergies And Intolerances Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.6

CCD: 

  • Alert observation: 2.16.840.1.113883.10.20.1.18
  • Problem observation: 2.16.840.1.113883.10.20.1.28

Allergy and Intolerance Concern

1.3.6.1.4.1.12559.11.10.1.3.1.3.16

IHE-PCC: 

  • IHE Allergy and Intolerance Concern Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.5.3
  • IHE Concern Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.5.1

CCD: 

  • Problem act: 2.16.840.1.113883.10.20.1.27

Blood Group

1.3.6.1.4.1.12559.11.10.1.3.1.3.25

IHE-PCC:

  • IHE Blood Type Observation: 1.3.6.1.4.1.19376.1.5.3.1.4.13.6
eHDSI Comment1.3.6.1.4.1.12559.11.10.1.3.1.3.11

IHE-PCC:

  • IHE Comment Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.2

eHDSI Device

2.16.840.1.113883.3.1937.777.11.10.129

-
eHDSI Dispenser Credentialing Organization2.16.840.1.113883.3.1937.777.11.10.149-
eHDSI External Reference1.3.6.1.4.1.12559.11.10.1.3.1.3.27

IHE-PCC:

  • IHE External Reference Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.4
eHDSI Health Status Observation1.3.6.1.4.1.12559.11.10.1.3.1.3.10

IHE-PCC

  • IHE Health Status Observation: 1.3.6.1.4.1.19376.1.5.3.1.4.1.2

CCD

  • Problem healthstatus observation: 2.16.840.1.113883.10.20.1.51


eHDSI Immunization Material

2.16.840.1.113883.3.1937.777.11.10.145

-
eHDSI Immunization Product1.3.6.1.4.1.12559.11.10.1.3.1.3.18

IHE-PCC

  • IHE Product Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.7.2
eHDSI Immunization1.3.6.1.4.1.12559.11.10.1.3.1.3.19-
eHDSI Internal Reference1.3.6.1.4.1.12559.11.10.1.3.1.3.14

IHE-PCC

  • IHE Internal Reference Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.4.1
eHDSI Manufactured Product

1.3.6.1.4.1.12559.11.10.1.3.1.3.1

-
eHDSI Material

2.16.840.1.113883.3.1937.777.11.10.143

-
eHDSI Medical Device

1.3.6.1.4.1.12559.11.10.1.3.1.3.5

-
eHDSI Medication FulFillment Instructions

1.3.6.1.4.1.12559.11.10.1.3.1.3.13

IHE-PCC

  • IHE Medication FulFillment Instructions: 1.3.6.1.4.1.19376.1.5.3.1.4.3.1

eHDSI Medication Item

1.3.6.1.4.1.12559.11.10.1.3.1.3.4

IHE-PCC: 

  • IHE Medications Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.7

eHDSI Participant (Body)

2.16.840.1.113883.3.1937.777.11.10.134

-
eHDSI Patient Medication Instructions

1.3.6.1.4.1.12559.11.10.1.3.1.3.12

IHE-PCC

  • IHE Patient Medication Instructions: 1.3.6.1.4.1.19376.1.5.3.1.4.3

eHDSI Performer (Body)

2.16.840.1.113883.3.1937.777.11.10.136

-

eHDSI Playing Entity

2.16.840.1.113883.3.1937.777.11.10.128

-
eHDSI Position Of Vaccination1.3.6.1.4.1.12559.11.10.1.3.1.3.28

CCD: 

  • Medication series number observation: 2.16.840.1.113883.10.20.1.46
eHDSI Pregnancy Observation1.3.6.1.4.1.12559.11.10.1.3.1.3.24-
eHDSI Problem

1.3.6.1.4.1.12559.11.10.1.3.1.3.7

IHE-PCC: 

  • IHE Problem Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.5

CCD: 

  • Problem observation: 2.16.840.1.113883.10.20.1.28
eHDSI Problem Concern1.3.6.1.4.1.12559.11.10.1.3.1.3.15

IHE-PCC: 

  • IHE Concern Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.5.1
  • IHE Problem Concern Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.5.2
eHDSI Problem Status Observation1.3.6.1.4.1.12559.11.10.1.3.1.3.9

IHE-PCC:

  • IHE Problem Status Observation: 1.3.6.1.4.1.19376.1.5.3.1.4.1.1
eHDSI Procedure1.3.6.1.4.1.12559.11.10.1.3.1.3.26

IHE-PCC: 

  • IHE Procedure Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.19
eHDSI Related Prescription

2.16.840.1.113883.3.1937.777.11.10.144

-
eHDSI Severity1.3.6.1.4.1.12559.11.10.1.3.1.3.8

IHE-PCC: 

  • IHE Severity Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.1

CCD: 

  • Severity observation: 2.16.840.1.113883.10.20.1.55
eHDSI Simple Observation

1.3.6.1.4.1.12559.11.10.1.3.1.3.20


eHDSI Social History Observation

1.3.6.1.4.1.12559.11.10.1.3.1.3.23


eHDSI Substance Administration

1.3.6.1.4.1.12559.11.10.1.3.1.3.2

IHE-PCC: 

  • IHE Medications Entry: 1.3.6.1.4.1.19376.1.5.3.1.4.7
eHDSI Supply

1.3.6.1.4.1.12559.11.10.1.3.1.3.3

-
eHDSI Vital Signs Observation1.3.6.1.4.1.12559.11.10.1.3.1.3.22-
eHDSI Vital Signs Organizer1.3.6.1.4.1.12559.11.10.1.3.1.3.21-


3. CP-047: Enable the exchange of Original Clinical Documents



4 new document level template definitions are created to cover the original clinical documents:

New OID

Name

1.3.6.1.4.1.12559.11.10.1.3.1.1.8eHDSI OrCD Laboratory Result
1.3.6.1.4.1.12559.11.10.1.3.1.1.9

eHDSI OrCD Hospital Discharge Report

1.3.6.1.4.1.12559.11.10.1.3.1.1.10

eHDSI OrCD Medical Imaging Report

1.3.6.1.4.1.12559.11.10.1.3.1.1.11

eHDSI OrCD Medical Images

4 Value Sets for the OrCD service:

  • eHDSIHospitalDischargeReportType
  • eHDSILaboratoryReportType
  • eHDSIMedicalImagesType
  • eHDSIMedicalImagingReportType

4. CP-050: CDA IG Wave 5 Improvements


4.1. Patient Summary

4.1.1. Add valid concern code for the concern templates.

CDA template

eHDSI Problem Concernhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.19376.1.5.3.1.4.5.2-2020-04-16T132635.html

eHDSI Allergy and Intolerance Concernhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.19376.1.5.3.1.4.5.3-2020-04-16T123031.html

Problem

Currently the hl7:code in the concern templates contains a textual constraint to put a nullFlavor='NA'. This is not correct since an HL7 code exists to represent a concern.

Ideally this code needs to be set as the classCode of the hl7:act, but this is not compliant with the HL7 CDA specifications (2005 version).

Since the hl7:code is set to the concept ‘CONC’ from the HL7ActClass in both the C-CDA and the IPS CDA IGs, it is proposed to proceed the same way in our CDA IGs.

Solution

The code 'CONC' from the HL7ActClass (2.16.840.1.113883.5.6) need to be set as a fixed value.

This is how it is supposed to be done:

This is the current situation:

Also the examples must be adapted.

Impact

The @code and @codeSystem attribute values need to be adapted for every use of the concern template.

4.1.2. Add binding to eHDSI-AbsentOrUnknownAllergies value set.

CDA template

eHDSI Allergies And Intoleranceshttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.19376.1.5.3.1.4.6-2020-04-16T122945.html

Problem

In the case the patient has no known allergy or there is no information about allergies for the patient, the hl7:value element must contain a code from the eHDSIAbsentOrUnknownAllergies value set.

Currently, no binding can be set from the hl7:value element to the eHDSIAbsentOrUnknownAllergies value set, apart from a textual constraint.

Solution

Add the binding but also keeping the opportunity to present a valid hl7:value element for the case there is a known allergy.

Impact

A value set check will be added.

4.1.3. Set binding to doseQuantity element.

CDA template

eHDSI Medication Itemhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.12559.11.10.1.3.1.3.4-2020-04-15T151545.html

Problem

For the doseQuantity, there is no binding specified to the eHDSIUnit value set. This binding is available for the eHDSI Substance Administration (used for eP).

Solution

Add a binding to the eHDSIUnit value set.

Idea is to add a choice between:

  • Value set binding (eHDSIUnit)
  • Regular expression for UCUM codes (check that the text is between brackets)

Impact

Since the validation rules will be tightened, misuse will cause the validation to fail, where it used to go unnoticed.

4.1.4. [eHDSI Health Status Observation] Fix code element definition

CDA template

eHDSI Health Status Observationhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.19376.1.5.3.1.4.1.2-2020-04-16T123626.html

Problem

For this template, the LOINC code element is defined differently than for other templates. Although it is mentioned that the hl7:code must be present, this is not reflected by the specification:

Solution

Align the code specification with the other templates. Change the datatype from CD to CE.EPSOS and set the @code and @codeSystem to fixed values like in this section level template:

Impact

The @code  and @codeSystem codes are required because of the use of the CD datatype, but this is not reflected in the template definition. The CE.EPSOS datatype requires the @displayName attribute.

4.1.5. [eHDSI Allergies and Intolerances] Restrict cardinality of value element.

CDA template

eHDSI Allergies And Intoleranceshttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.19376.1.5.3.1.4.6-2020-04-16T122945.html

Problem

In the description of the value element, we read: the "value" element shall be given. This is not represented by the cardinality. The minimal occurrence has to be set to 1.

Solution

Change the minimal occurrence to 1.

Impact

Member states that don’t provide a value element will need to adapt their national implementation to set a value.

4.1.6. [eHDSI Medical Devices] Modify effectiveTime element for Medical Device template.

CDA template

eHDSI Medical Deviceshttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.12559.11.10.1.3.1.2.4-2020-04-16T121905.html

Problem

Currently, in the specifications, it is only possible to present the implant date for a medical device and not the date the implant was removed.

In order to support also medical devices from the past, the possibility needs to be added to also contain an optional end date.

Solution

The effectiveTime element has the datatype TS, with a cardinality of 1 ... * and conformance R. This has to be changed to IVL_TS, with a cardinality of 1 ... 1.

Also the CDA Display Tool needs to be modified to support this change.

Impact

It will be possible to present both current implemented devices and devices implemented in the past using the medical devices section.

4.2. ePrescription/eDispensation

4.2.1. Replace specialization to CCD Medication Section template by adaption of CCD Supply activity template.

CDA template

eHDSI Supplyhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.12559.11.10.1.3.1.3.3-2020-04-16T130323.html

Service

eDispensation

Problem

It is a typo that the eHDSI Supply template is a specialization of the CCD Medication Section template (with template OID 2.16.840.1.113883.10.20.1.8). It is a specialization of the CCD Supply activity template (with template OID 2.16.840.1.113883.10.20.1.34)

Template index Continuity of Care Document (CCD): http://art-decor.org/decor/services/TemplateIndex?prefix=ccd1-&format=html&language=&ui=en-US

Solution

Change the specialization relationship into an adaptation relationship.

Impact

No impact

4.2.2. Relax the constraint for the relatedDocument element.

CDA template

eHDSI eDispensationhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.12559.11.10.1.3.1.1.2-2020-04-16T104122.html

Service

eDispensation

Problem

The relatedDocument provides a reference to the national version of the document.

The relatedDocument element is currently mandatory. Some MS don't have a national version of the eDispensation message and immediately generate the file to be exchanged. Currently the unique identifier of the document itself is put in the relatedDocument element. It should be made required, so the MS have the choice to put a nullFlavor if not applicable.

Solution

Modify cardinality/conformance of the relatedDocument element from [1..1] M to [1..1] R.

Impact

The possibility is added to put a nullFlavor when there is no national version of the document.

4.2.3. Limit the @typeCode attribute of the relatedDocument to 'XFRM'.

CDA template

eHDSI eDispensationhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.12559.11.10.1.3.1.1.2-2020-04-16T104122.html

Service

eDispensation

Problem

Currently, the @typeCode attribute of the relatedDocument is bound to the Act Relationship Type code system, that contains 3 concepts:

  • APND
  • RPLC
  • XFRM

In our case only the concept XFRM can be used (“The current document is a transformation of the ParentDocument”), so it makes sense to set it as a fixed value.

Solution

Set the @typeCode attribute to a fixed value ('XFRM')

Impact

If another typeCode attribute is used than “XFRM”, the document will not be valid according to the specifications and validation will fail.

4.2.4. [eHDSI Substance Administration] Restrict the unit attribute of the supply element in eP to '1'.

CDA template

eHDSI Substance Administrationhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-1.3.6.1.4.1.12559.11.10.1.3.1.3.2-2020-04-14T145537.html

Service

ePrescription

Problem

In the ePrescription document, the hl7:supply indicates the number of packages and is reused by the portal to generate the eDispensation message.

An issue was discovered in the portal when a unit of measure was used to indicate the number of packages:

Following entry in the eP:

<supply classCode="SPLY" moodCode="RQO">                                   
    <independentInd value="false"/>                                   
    <quantity unit="g" value="100.0"/>                               
</supply>

generates following element in the eD:

<quantity unit="1" value="100.0"/>

So the 'g' is lost. But according to the specifications, the unit must always be set to '1':

The supply entry shall indicate the number of packages available for dispensation on the prescription.

The value attribute shall be present and indicate the number of packages. In prescriptions for overall amount (such as 400 tablets), the value attribute must equal 1, and the overall amount shall be placed in epsos:containerPackageMedicine/epsos:capacityQuantity element. See its description for more information.

The unit attribute shall be present and equal UCUM unit 1.

This constraint has to be added to the eHDSI SubstanceAdministration template. Currently it is just a textual constraint.

Solution

Set a fixed value of '1' for the unit attribute if it is provided.

Impact

Only member states that provided a value for the @unit attribute different than 1 will be impacted, but this was already in conflict with the specifications.

4.3. General

4.3.1. Set patient first and last name to mandatory according to the functional requirements.

CDA template

eHDSI RecordTargethttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-2.16.840.1.113883.3.1937.777.11.10.100-2020-04-16T105800.html

Problem

In the PS and eP functional requirements, the first and the last name of a patient are specified as part of the basic dataset (mandatory for the PS). Currently the first and the last name are set to mandatory, but there is the possibility to provide a nullFlavor for the enclosing hl7:name element, which is in conflict with the requirements.

Solution

Proposed solution is to set the enclosing hl7:name element to mandatory.

Impact

If Member States are putting a nullFlavor for the patient name (which is conflicting with the functional requirements) they need to set the first and given names.

4.3.2. [eHDSI Material] Cardinality of asContent defined in the CDA IGs in conflict with the XSD schema definitions.

CDA template

eHDSI Materialhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-2.16.840.1.113883.3.1937.777.11.10.143-2020-05-18T161130.html

Problem

In the hl7:manufacturedMaterial template the property of type asContent has cardinality 0..* but the XSD files only contain a single value (XSD cardinality is 0..1):

<xs:element ref="epsos:asContent" minOccurs="0" maxOccurs="1"/>
In the IPS, where the pharmacy profile is used, it is also possible to provide multiple asContent elements:


<xs:element ref="pharm:asContent" minOccurs="0"/>

Solution

Align the cardinality of the asContent element with the XSD extended schema definitions.

Further suggestion by the eP cluster:

Should be made a mandatory field (1..1 M) as if the element is missing, the prescribed amount is unclear. 

Impact

If Member States would use multiple occurrences of the ‘asContent’ element, this would have failed the schema validation before.

4.3.3. Restrict the nullFlavor value for Telecom element in author to "NI".

CDA template

eHDSI Authorhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-2.16.840.1.113883.3.1937.777.11.10.102-2020-04-14T130316.html

eHDSI Author Prescriberhttps://art-decor.ehdsi.eu/html/publication/epSOS/epsos-html-20200617T110053/tmp-2.16.840.1.113883.3.1937.777.11.10.103-2020-04-16T105317.html

Problem

From the expand specification, we find in R1.10.8 the following definition:

This is not reflected in the current version of the CDA IGs.

Solution

Since the nullFlavor attribute shall have a value of "NI" in the case of a nullFlavor, a textual constraint can be added as guidance for the implementer.

No hard constraint will be added that will fail the document validation when another nullFlavor value is used than “NI”.

Impact

It will just provide guidance to the implementers.


5. General bugfixes and improvements

TemplateValue setDocumentChangeART-DECOR issue linkImpact on deploying countries implementation
  • All


PS/eP/eD

Add descriptions to all templateId references to indicate the origin:


No impact, just improvement of the descriptions.

  • All

PS/eP/eD

Revise all the general eHDSI template descriptions:

  • Update references to OIDs that were changed using CP-038.
  • Update statements where compliancy is stated with IHE-PCC and CCD templates when this is not the case anymore (CP-041)
  • Delete references to epSOS
  • Remove statements that are not valid anymore

No impact, just improvement of the descriptions.
  • eHDSI Blood Group


PS

Incorrect Blood group value data type

The datatype of the Blood group value was CV.EPSOS. This datatype doesn't allow a translation subelement (https://art-decor.org/mediawiki/index.php?title=DTr1_CV.EPSOS). But this value is configured to be transcoded/translated by the transformation manager. In that case a translation subelement is generated and the Gazelle Model Based validation fails because of the CV.EPSOS datatype.

This datatype is a bug and is changed now into CE.EPSOS, which allows a translation subelement.

353

No

  • eHDSI Blood Group

PS

Incorrect Blood group statusCode data type

The statusCode element inside a Blood Group observation has a fixed value of completed. The datatype of this element used to be 'CD', which requires next to a code value also a value for the codeSystem. This is a typo and the datatype is changed to 'CS'

354No
  • eHDSI Immunization
  • eHDSI Immunizations

PSSection level and entry level template for eHDSI Immunizations shared the same name (eHDSI Immunizations). The entry level template is renamed to 'eHDSI Immunization'.
No impact, since the template OIDs are used to reference the templates and these stay the same.
  • eHDSI Medication Item

PSThe examples for the "known absence' and 'no information' scenarios were not aligned with samples provided on the guideline page for Wave 4 (https://ec.europa.eu/cefdigital/wiki/x/GJ5qB)
No impact, just correction of the examples.
  • eHDSI Material


In the eHDSI Material template definition, the epsos:containerPackagedMedicine element has cardinality [1 ... *], where in the extended CDA XSD schema definitions, the cardinality is restricted to 1.

containerPackagedMedicine is an Entity in the Role asContent (“entity playing the role”). Therefore it can not have cardinality greater than one, according to RIM rules. See RIM specification section 3.3.1


The cardinality of the epsos:containerPackagedMedicine element is restricted to 1, where before it was unbounded. 

But it shouldn't be an issue, since the XML schema definitions (XSD) already restricted the element to 1 before.

  • Document level templates

PS/eP/eD

Since the description of the id element was misleading and not aligned with guidelines for the CDA IGs (https://ec.europa.eu/cefdigital/wiki/x/Lwa5Dg), it was decided to align them.

The @root attribute must be a UID, not an OID.


No, just an improvement of the description.



Import of new MVC 5.0.0 concepts in ART-DECOR:

  • eHDSIActiveIngredient

CP-048 automatic update ® the content has been updated to the January 2021 release of the WHO ATC Classification

  • eHDSIDoseForm
    CP-048 automatic update
     
  • eHDSIIllnessandDisorder
    CP-045 First Second COVID-19 Hotfix
    CP-052 Second COVID-19 Hotfix
     
  • eHDSIMedicalDevice
    CP-049 extension of the Value Set for Medical Devices
     
  • eHDSIPackage
    CP-048 automatic update
     
  • eHDSIProcedure
    CP-053 extension of the Value Set for Procedures
     
  • eHDSIRouteofAdministration
    CP-048 automatic update
     
  • eHDSIUnit
    re-introduction of the missing integer “1” with and re-definition of the VS to the UCUM OID (2.16.840.1.113883.6.8)
     
  • eHDSIVaccine
    CP-048 automatic update ® the content has been updated to the January 2021 release of the WHO ATC Classification
    CP-052 Second COVID-19 Hotfix
     
    4 Value Sets for the OrCD service:
     
  • eHDSIHospitalDischargeReportType
  • eHDSILaboratoryReportType
  • eHDSIMedicalImagesType
  • eHDSIMedicalImagingReportType

New concepts are added in ART-DECOR.
  • eHDSI Author

PS

Improvement of description of the hl7:assignedAuthor/hl7:id element.

This description does not properly cover the situation where a document is being created as aggregation by an information system without human involvement or control. In such situation an hl7:assignedAuthoring Device should be used instead of hl7:assignedPerson. 

The description of the the hl7:assignedAuthor/id element now also covers this this situation: Identification of the Healthcare Practitioner that is the author of this document or identification of an authoring device which generated this document.


No impact, just an improved description.
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