Content Validation issue which is confusing.

[wratho...@gmail.com]

I am submitting a TOC Ambulatory Sample 2 (Patient is Jeremy Bates) against the SiteNV validator and I see this error:

 

• ONC 2015 S&CC Reference C-CDA Validation Error
  • Description: The scenario contains problem observation for Problem , however there is no matching observation in the submitted CCDA.
  • xPath: /ClinicalDocument
  • Document Line Number (approximate): 0

The error describes that the scenario expects a problem observation, but this patient's test data (attached) show Problems:  No known problems.

Can you take a look and let me know your thoughts?  (CCDA Attached)

[Nagesh Bashyam]

This is because the document does not contain “No Known Problems” per the test data instructions specified in Section

 

C) Problems: No known Problems

 

Hence the issue is being reported. Please let us know if you have questions.

 

Thanks

Dragon

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[wratho...@gmail.com]

Thank you, that was some help  However, I was able to determine that it wasn't as much concerned with the exact wording "No Known Problems" as it was with the SNOMED Codes.  See the screenshot below.  The example on the right passed the validator and the example on the left was the one that our system generated.  Can you please explain the difference between the examples?

[dan venton]

I'd also be interested to know, why the code matters when a placeholder is being specified, a no known, a "nothing to see here" message.

Also why is the validator not expecting the "nullFlavor" section as called out by the IG when there is no data to specify?

MAY contain zero or one [0..1] @nullFlavor="NI" No information (CodeSystem:
HL7NullFlavor urn:oid:2.16.840.1.113883.5.1008) (CONF:1198-32864).

On Monday, August 8, 2016 at 9:35:49 AM UTC-4, nagesh.bashyam (Dragon) wrote:

[Nagesh Bashyam]

These are good questions and here are things to consider.

 

·        No Information is different than “No Known Problems”

·        The validator is not looking at the Text content. It is enforcing the HL7 Example for “No Known Problems” from section 2.12.1 vs the “No Information” example in section 2.5.1

o   You can find the above at this link.

o   http://wiki.hl7.org/index.php?title=CDA_Example_Task_Force

o   So following the example it is trying to locate the value element with the right code from SNOMED-CT

o   In summary it is looking for concept called “Problem” with code – 55607006 from SNOMED-CT.

 

A validator bug was preventing this validation before and was accepting either notation prior to the last build.

 

Please let us know if there are concerns.

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[wratho...@gmail.com]

When I used the SNOMED code of 55607006 I was able to get past this validation issue.  However, this problem was listed in our system as being called "Unlisted problem", "No healthcare proxy" etc. We have a separate SNOMED for "no known problem" and that wasn't working.  This could be an issue for our SNOMED codes and I can follow up with our Problems team here to find more detail.

[Nagesh Bashyam]

Hmm..I see, so the validator is only checking the one code as listed in the HL7 Example,  I have not looked into other possible codes for the same concept in SNOMED, if that is the case then we will have to relax that validation. Let us know what you find.

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[georged...@gmail.com]

We suggest 55607006 is not the SNOMED CT to describe No Known Problem. It should be 160245001 however there are other codes as well and the list of acceptable codes should be expanded.

[George Cole]

Agree that 55607006 does not by itself mean No Known Problem, but when the use of the negationInd="true" is used the code in the value element is negated, which does give us the desired No.

This pattern of a negationInd="true" on the object (observation, substanceAdministation, procedure, ...) with a generic, positive assertion code in the value element, has been approved by the HL7 Example Task Force as the manner to represent No xxx.

Should there be the possibility of additional, allowed, positive assertion code values for these?  Perhaps, there are some use cases where other codes are appropriate, but they should not be the codes whose meaning is No..., otherwise we're negating a negative and saying No No......

[George Dixon]

Outside of the ref material this is also a workflow issue as providers actively document no problem by making an entry that there are no problems. They would not enter a problem called "Problem". 

Will the validate be relaxed to accept other no problem entries?

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[dan...@gmail.com]

Hi All, I realize this is an old thread but I did not see a resolution to this posted.

We are also facing an issue with the problems section that is impeding certification.  The b1_SendCreate sample2 scenario asks us to enter a problem entry of ‘Problem’ with a negationInd and SNOMED code 55607006.  While this is in line with the published C-CDA specification, we feel it does not make the most clinical sense for our users.  Our users expect the problems section to be populated with ‘No Current Problems’ with a SNOMED code of 160245001 to represent that the patient is assessed as having no problems.  We feel this this SNOMED code should be accepted by the validator as it is still meeting the concept of having no recorded problems.

Is there any further information or guidance available in regards to this?

Thanks,

Roland Burzynski

Varian Medical Systems

[Nagesh Bashyam]

Roland

 

The validator is still following the example from HL7 Task Force.

 

http://hl7-c-cda-examples.herokuapp.com/examples/view/7353a215efda8dfe3fbacb19abbb90756ce14bab

 

It would be good to pick up the discussion with the HL7 Task force on what other codes could be used, maybe a new value set needs to be created…

 

Let us know if you need any further information .

 

Thanks

Dragon

 

From: edge-te...@googlegroups.com [mailto:edge-te...@googlegroups.com] On Behalf Of dan...@gmail.com
Sent: Thursday, July 06, 2017 5:12 PM
To: Edge Test Tool (ETT)
Subject: Re: Content Validation issue which is confusing.

 

Hi All, I realize this is an old thread but I did not see a resolution to this posted.

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