Potential Bug Validatory: Pregnancy Observation status

[jpd...@gmail.com]

Question: Do you agree that this is as bug in ETT message validator and that the ATL Test Proctor can advise their client to ignore this error during live testing?

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I believe that the validation tool is being too restrictive. Both code values "102874004" and "146799005" are valid in the FHIR referenced valueset. In fact, "146799005" seems more accurate as the patient is feeling pregnant, but it is not yet confirmed as a finding:

https://hl7.org/fhir/us/core/STU6.1/ValueSet-us-core-pregnancy-status.html

This is also an issue of C-CDA and FHIR not being in sync as to versions of value sets used. The C-CDA seems to reference a valueset that does NOT have "146799005":

https://www.healthit.gov/isp/representing-patient-pregnancy-status

I cannot attach the CCD as it is a customer's file. Here is a screenshot of the validation error when using code status  of "146799005". We believe this value should be allowed as the FHIR US Core version supported for G.10 certification includes thin the valueset.

[nagesh.bashyam (Dragon)]

We are not sure based on the screenshot if this is a valid error or not. Can you at least post the  XML snippet for the pregnancy observation, so that we can look into it and guide you appropriately.

[jpd...@gmail.com]

Attached is the file that I used to replicate the issue.

[jpd...@gmail.com]

Any feedback on my post after uploading the file producing the error?

[Mat Davis]

Hi jpd.

1 - Based off what I can tell, the IG to follow is here, not FHIR
https://www.hl7.org/ccdasearch/pdfs/2.16.840.1.113883.10.20.15.3.8.pdf


2 - Are you getting the error for a Patient Specific Scenario testing like b1 Amb or you getting this error when only validating against the IG and Vocab?
• I ran your file thru the Site Validator for IG and Vocab and I'm only getting errors for Sexual Orientation and Gender Identity.
        

        

3 - Have you re-ran your file recently?

4 - Either way, the template has SHALL and SHALL which the SITE Validator is only enforcing
SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHALL be selected from ValueSet Extended Pregnancy Status  2.16.840.1.113762.1.4.1099.24 DYNAMIC (CONF:81-457).

5. I do agree that alignment with FHIR is important so if you feel strongly enough about it, it's usually advised to enter a ticket here - https://jira.hl7.org/projects/CDA/issues/

Thanks - Mat Davis (Community Supporter)