Planned Procedure templateId for USCDI V3

[Danny Wise]

The HL7® CDA® R2 Implementation Guide: C-CDA Templates for Clinical Notes STU Companion Guide, Release 4.1 - US Realm defines a new V3 of the Planned Procedure template with an updated templateId/@extension value:

However, for the Alice Newman scenarios, the USCDI V3 validator also seems to expect the Planned Procedure V2 <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2014-06-09" /> and will generate errors for documents that only assert conformance to V3:

       <templateId root="2.16.840.1.113883.10.20.22.4.41" />
       <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2022-06-01" />

Result Description: The Comparing Planned Procedure data for code 467771000124109 , Template Id Comparison : : element - template id, Root Value = 2.16.840.1.113883.10.20.22.4.41 and Extension Value = 2014-06-09 is not present in the submitted CCDA's

Interestingly, the validator also generates an error if a document only asserts conformance to V2:

       <templateId root="2.16.840.1.113883.10.20.22.4.41" />

       <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2014-06-09" />

Result Description: The Comparing Planned Procedure data for code 467771000124109 , Template Id Comparison : : element - template id, Root Value = 2.16.840.1.113883.10.20.22.4.41 and Extension Value = 2022-06-01 is not present in the submitted CCDA's

To avoid these errors altogether, the document must assert conformance to both V2 and V3 of the Planned Procedure template simultaneously:

       <templateId root="2.16.840.1.113883.10.20.22.4.41" />
       <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2014-06-09" />
       <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2022-06-01" />

Is this expected behavior?  This requirement for asserting conformance to multiple versions of templates doesn't seem to be present for any other templates.

[Mat Davis]

Hey Danny, great display of details here.

To my understanding, this is expected behavior and is mainly done for backwards compatibility.

Am I 100% sure on this?

No - but it's how I've always seen it done.

Should it be changed?

I think the backwards compatibility expectations are being loosened in future IGs for C-CDA and FHIR but not sure if that means they should or will do the same here in this situation.

Thanks - Mat

[Danny Wise]

Thanks Mat -- I just realized I missed your previous response from a few weeks ago.  My concern about the backward compatibility consideration is that it's not consistently enforced by the validator.  In fact, Planned Procedure seems to be the only template where multiple C-CDA R2.1 versions are expected -- asserting conformance to the only the latest version seems to pass without error for all other templates....

Note that this is distinct from also asserting the C-CDA R1.1 templateId (that does not have any @extension attribute).  I would expect there to be 2 templateId assertions -- one with an @extension attribute (for C-CDA R2.1) and one without (for C-CDA R1.1):

       <templateId root="2.16.840.1.113883.10.20.22.4.41" />
       <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2022-06-01" />

...but Planned Procedure is unique in that the validator seems to expect 3 templateId assertions instead -- 1 for C-CDA R1.1 and 2 for C-CDA R2.1:

       <templateId root="2.16.840.1.113883.10.20.22.4.41" />
       <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2014-06-09" />
       <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2022-06-01" />

[Mat Davis]

No problem at all Danny.

"My concern about the backward compatibility consideration is that it's not consistently enforced by the validator. "

• I agree
• The most recent changes for Template IDs in the past few months were also a doozy
• But then I had to also accept those validations once I saw the Template rules mentioned it and there were HL7 patches related to it, if I recall, yet, it wasn't previously enforced

"asserting conformance to the only the latest version seems to pass without error for all other templates"

• This makes sense as well

"but Planned Procedure is unique in that the validator seems to expect 3 templateId assertions instead -- 1 for C-CDA R1.1 and 2 for C-CDA R2.1"

• This makes sense as well
• This is where the SITE Validator enforcement may differ or diverge based on some rules that can be reviewed or need to be clarified with documentation for a source of truth for the enforcement

Thanks - Mat Davis (Community Supporter)