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)

[SHANNU]

Hi mat Davis,

Yes, you are correct - this is a warning, not an error. Thank you for clarifying and detailed explanation.

Our team will review the observatoins and templates internally and they work on it. I will share an update once when its done.

Regards,

Shannu

[Mat Davis]

No problem at all Shannu.

Much appreciated on the updates and clarification.

Thanks - Mat Davis (Community Supporter)

[Shannu]

Hi Mat Davis,

Thank you for your response.

Our team reviewed the warnings based on your guidance. As shown in the attached screenshot, there are still multiple validation warnings remaining that we would like to close and resolve.

Please review our full C-CDA XML and advise what specific changes are required to address these warnings to be closed.

Regards,
Shannu

[Mat Davis]

Hi Shannu.

I'm only a Community Supporter, volunteering my time to assist those who I can help while also receiving help from those who may be more knowledgeable than me on a particular topic.

For any warnings, please do your best to review the previously mentioned resources to resolve these issues on your own.

For any errors, I'll review in my free time if I feel like I can be of assistance.

Thanks - Mat Davis (Community Supporter)

[Ilayaraja Periasamy]

Hi Mat Davis,

We are facing the same issue for the Scenario:  170.315_g9_APIAccess_Amb and File: 170.315_g9_api_access_amb_svap_uscdiv3_sample3_v1.pdf. We tried both

1. Sex: Patient sex unknown (184115007, Code System – SNOMED-CT)    

2.  Sex: Female (248152002, Code System – SNOMED-CT)  

For both cases https://site.healthit.gov/c-cda/uscdi-v3 validator throws the following error,

Result Description: The scenario contains Sex Observation data with code 248152002 , however there is no matching data in the submitted CCDA.

Can you guide us on this, I am from Enable HealthCare Inc.

[Ilayaraja Periasamy]

My bad, I have totally missed the nullFlavor="NI" added in the SOCIAL HISTORY - 2.16.840.1.113883.10.20.22.2.17. After removing the nullFlavor, the validator is able to identify the  Sex: Female (248152002, Code System – SNOMED-CT) .

Hope this may help someone needed.

Thank you all.

[nagesh.bashyam (Dragon)]

Hello

We will not be able to review full XML files and provide support. 

If there is a specific issue with the tool where the tool is not behaving as per the Implementation Guide / Companion Guides or the Test Data guidance, please bring it to our attention and we will look into the issue.

Thanks

Dragon