B2 - Clinical Information Reconciliation and Incorporation (Allergies)

[Jyothi Yella]

This is regarding b2-clinical information reconciliation and incorporation.

 

While validating in Edge Testing Tool – Myra Jones – after reconciliation it is showing error for Allergies à Aspirin à Severity à ‘Mild to Moderate’, we have given as per the test data. Can you please let us know the issue ??

 

I am sharing you the xml file of test data and generated emr xml file.

 

 

Regards,

Jyothi

[kylem...@gmail.com]

It is because the test data is in an older CCDA 1.1 file (which is part of the test for backwards compatibility) and it is using an old Allergy severity value set back when there were 6 different severity options, including "mild to moderate" with SNOMED code 371923003.

However, the current value set for allergy severity only has 3 choices (severe, mild, and moderate) so the tool is erroring out because it is using the older severity value, even though that was what was included in the received CCDA.

I think the proper behavior is to either allow the user to set the new severity value (either moderate or mild) or simply default the incorporation action to use the higher severity (moderate) from a safety standpoint and the clinician can later reduce it if they wish. 

1.1 value set - https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.88.12.3221.6.8/expansion/C-CDA%20R1.1%202016-06-23

Current 2.1 value set - https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.88.12.3221.6.8/expansion/C-CDA%20R3.0%202024-08-09

Kyle Meadors

Chart Lux Consulting

[Jyothi Yella]

Okay, Thank you

[Kyle Meadors]

It is because the test data is in an older CCDA 1.1 file (which is part of the test for backwards compatibility) and it is using an old Allergy severity value set back when there were 6 different severity options, including "mild to moderate" with SNOMED code 371923003.

However, the current value set for allergy severity only has 3 choices (severe, mild, and moderate) so the tool is erroring out because it is using the older severity value, even though that was what was included in the received CCDA.

I think the proper behavior is to either allow the user to set the new severity value (either moderate or mild) or simply default the incorporation action to use the higher severity (moderate) from a safety standpoint and the clinician can later reduce it if they wish. 

1.1 value set - https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.88.12.3221.6.8/expansion/C-CDA%20R1.1%202016-06-23

Current 2.1 value set - https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.88.12.3221.6.8/expansion/C-CDA%20R3.0%202024-08-09

Kyle Meadors

Chart Lux Consulting

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Kyle Meadors
@kylemeadors

[Jyothi Yella]

Hi team,

Thanks for your clarification.

The updated CCDA Reconcile file for Myra Jones patient has Allergy: Aspirin with Severity: Mild. However, even with the updated CCDA test data, the issue still persists.

As you suggested, “simply default the incorporation action to use the higher severity (moderate) from a safety standpoint,” we edited the severity to Moderate, and it is now validating without any warnings or errors.

My question is whether we are allowed to edit the reconcile file after importing it into the EMR, and if this is considered a valid approach.

Please find the attached XML document for reference.  

Best regards,
Joe