Confirmation on Social History Observation V4 code validation errors

[SHANNU]

Hello Team,

We are facing validation warnings related to Social History Observation V4 while validating our C-CDA document for Sample 1 patient in (B2) of version 3.

Reported errors:

• Consol Social History Observation V4 SHALL contain exactly one [1..1] code, selected from the Social History Type Value Set (OID: 2.16.840.1.113883.3.88.12.80.60)

Affected XPaths:

• /ClinicalDocument/component/structuredBody/component[7]/section/entry[4]/observation

• /ClinicalDocument/component/structuredBody/component[7]/section/entry[5]/observation

• /ClinicalDocument/component/structuredBody/component[7]/section/entry[5]/observation/entryRelationship/observation

Clarification needed:

1. For specialized social history observations (e.g., Gender Identity, Sexual Orientation, Occupation, Tribal Affiliation), is it acceptable to use their specific LOINC codes, or is a generic Social History Type code required?

2. When data is unknown, is using nullFlavor="UNK" sufficient, or must a Social History Type code still be present? or can i skip entire entry?

3. For observations inside entryRelationship, do they also need to strictly use codes from the Social History Type Value Set?

The full Social History section XML is attached for reference.

Any guidance on how to correctly satisfy this requirement would be greatly appreciated.

Thank you,
Shannu

[Mat Davis]

Hi Shannu - Can you clarify if you are asking about an "Error" or a "Warning"?

Issue

• The most important detail here is that you are facing a WARNING not an ERROR based on my testing
• Warnings can be ignored to my knowledge
• They are not required to be resolved to pass validation

Here is the Full WARNING message

Result Description: Consol Social History Observation V4 SHALL contain exactly one [1..1] code (4515-8558), which SHOULD be selected from ValueSet Social History Type Value Set 2.16.840.1.113883.3.88.12.80.60 DYNAMIC (4515-8558)

Valueset Review

• Focusing on the WARNING message, you're using an entry > observation > code that isn't in the mentioned valueset
• Based off your WARNING message and the XML snippet you provided, the issue is with the Tribal Affiliation, Basic Occupation, and Occupation Industry entries
  
• You're asserting 2 Template IDs from what I can see
• Tribal Affiliation IG Snippet - https://www.hl7.org/ccdasearch/pdfs/2.16.840.1.113883.10.20.22.4.38.pdf - scroll to the bottom for an XML example
• Social History Observation Template - https://www.hl7.org/ccdasearch/templates/2.16.840.1.113883.10.20.22.4.38.html

Clarification Review

Clarification needed:

1 - For specialized social history observations (e.g., Gender Identity, Sexual Orientation, Occupation, Tribal Affiliation), is it acceptable to use their specific LOINC codes, or is a generic Social History Type code required?

1. Rules of this nature are defined by the Templates
2. Please navigate to and review the following resources
3. https://www.hl7.org/ccdasearch/index.html > search for each data element you mention (Occupation, etc)
4. https://www.hl7.org/ccdasearch/pdfs/Companion_Guide.pdf
   

2 - When data is unknown, is using nullFlavor="UNK" sufficient, or must a Social History Type code still be present? or can i skip entire entry?

1. To my knowledge, nullFlavor is allowed unless the specific Template explicitly prohibits it
   

3 - For observations inside entryRelationship, do they also need to strictly use codes from the Social History Type Value Set?

1. Rules of this nature are defined by the Templates

Thanks - Mat Davis (Community Supporter)