How to best represent "no available data" for a CCD section?

[Michael LaRocca]

Hello fellow PCC implementors,

What's the best way to represent that no data is available for a particular CCD section?  At IHE connectathon, many of us were doing something like this for XDS-MS and XPHR tests:
    <component>
        <section>
            <templateId root="2.16.840.1.113883.3.88.11.83.116"/>
            <templateId root="2.16.840.1.113883.10.20.1.1"/>
            <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.34"/>
            <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.35"/>
            <code code="42348-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="ADVANCE DIRECTIVES"/>
            <title>Advance Directives</title>
            <text>This patient has no known advance directives.</text>
        </section>
    </component>

Please note, I use Advance Directives purely as a convenient example — my question really concerns any CCD section.

My example above seems to be ok for IHE validation, but when I try to validate this same type of content against the HITSP schematron (I most recently tried C32 v2.5), I get this error:
    Error: HITSP/C83 Clinical Document, the Advance Directives section SHALL include entries from the Advance Directive module. See HITSP/C83 Section 2.2.1.16, rule C83-[CT-116-2].

I can omit the section altogether to pass the HITSP validation, but I seem to remember that causing different XDS-MS validation problems as though the XDS-MS and C32 schematron tests had conflicting requirements.  

So what’s the best way to represent "no known data" in a way that satisfies both IHE and HITSP validation?

Thank you for your help,

-Mike

--
You received this message because you are subscribed to the Google Groups "IHE PCC Implementors" group.
To post to this group, send email to ihe-pcc-im...@googlegroups.com.
To unsubscribe from this group, send email to ihe-pcc-implemen...@googlegroups.com.
For more options, visit this group at http://groups.google.com/group/ihe-pcc-implementors?hl=en.

[Andrew McCaffrey]

I'm not aware of any universal rule for this sort of thing (and I
haven't seen anything specifically for Advance Directives), but some
information is available on a case-by-case basis.

For instance, the CCD spec states the following about no known
allergies: "CONF-268: The absence of known allergies SHOULD be
represented in an alert observation by valuing Observation / value with
160244002 'No known allergies' 2.16.840.1.113883.6.96 SNOMED CT STATIC."

For medications, CCD simply states: "CONF-299: The absence of known
medications SHALL be explicitly asserted." ... without more guidance as
to how that shall be assserted. However, from IHE PCC Medications we
are told to use one of the following three SNOMED-CT codes in this
situation:

182904002 -- Drug Treatment Unknown -- To indicate lack of knowledge
about drug therapy
182849000 -- No Drug Therapy Prescribed -- To indicate the absence of
any prescribed medications
408350003 -- Patient Not On Self-Medications -- To indicate no treatment

I don't have any experience with other sections, but hopefully someone
on this list can fill in the gaps...

--
Andrew McCaffrey
andrew.m...@nist.gov
----
The words above do not necessarily reflect the opinions of my employers
or any organization I may be associated with. In fact, by the time you
read them, they may not even reflect my own opinions anymore.
----
Any mention of commercial products within NIST web pages or email is
for information only; it does not imply recommendation or endorsement
by NIST.

[Andrew McCaffrey]

Actually, looking through the IHE PCC spec for Problems, there are a few
more codes to be found (see template 1.3.6.1.4.1.19376.1.5.3.1.4.5).

396782006 -- Past Medical History Unknown -- To indicate unknown medical
history
407559004 -- Family History Unknown -- To indicate that the patient's
family history is not known.
160243008 -- No Significant Medical History -- To indicate no relevant
medical history
160245001 -- No current problems or disability -- To indicate that the
patient has no current problems (as distinct from no history).

And the following three give further refinement to the Allergies section
recommendation I previously mentioned:

409137002 -- No Known Drug Allergies -- To indicate that there are no
known Drug allergies for this patient.
160244002 -- No Known Allergies -- To indicate that there are no known
allergies for this patient.
64970000 -- Substance Type Unknown -- To indicate the state where there
is a known allergy or intollerance to an unknown substance

HTH.

[Michael LaRocca]

Thank you Andrew for this.  After your response, I attempted to go through each of our CCD section exports and put the appropriate clinical statements and “no data” observations in.  I found it was a real rats nest for two reasons:
    1. Many CCD entries don’t formalize codes as are done for your examples below
    2. Creating CCD entries that did support the “no data” concept unveiled further validation problems for required fields that aren’t available in no-data scenarios

Is it reasonable to request a change proposal for any relevant PCC or HITSP constructs to allow a CCD section to declare “no data” without requiring a coded entry?  Maybe by supporting new section templateIds that make the claim, or by simply omitting the entry collection as I did in my example below?

Thanks for your help,

-Mike

[Michael LaRocca]

Hi everyone,

We currently use <informant> to describe the department and facility that’s reporting content, but what’s the best way to represent the actual application source within that department/facility that created the content?

Looking at the CDA schema, I’d think the best place is to put this in <author><assignedAuthor><assignedAuthoringDevice><softwareName>.  However, this approach seems to conflict with a CCR-to-CCD mapping document at:

http://www.google.com/url?sa=t&source=web&ct=res&cd=1&ved=0CBcQFjAA&url=http%3A%2F%2Fcontinuityofcaretaskgroup.pbworks.com%2Ff%2FCCD.06Dec2006_Info_BallotDec7.doc&ei=TCzkS9DwOMSAlAetvMTGAg&usg=AFQjCNF4t_9R4qrww2UkCyEwSC4Vner74A&sig2=2kp-jc3EQpVkGh3JFnxL4A

According to this document (Section 5.2, CONF-519), we should instead be using a “source of information observation”.

What do you think is best?

Thanks a lot,

-Mike

[Bob Yencha]

Hi Mike,

 

I didn’t check the specific conformance statement to see if there is a change in it, but suggest you use the final ballot document from HL7, dated April 7, 2007 as the normative document and benchmark for your work. The version you are referring to is an older informative ballot.

 

Bob Yencha

Alschuler Associates, LLC

Spring workshop is sold out!

Sign up to receive fall workshop announcement

[Ruth Berge]

I have this same question for CCDA sections, especially those marked as optional or should.  I didn't see any further replies on this topic.  Can someone comment from NIST on how they might test this for a CCD 1.1. document if the Immunizations section (as an example) were populated in a similar way.  Another question is whether I can assume for a CCD that this would apply only to the encounter being summarized- no one would assume that the patient never had any immunizations.  The wording in CCDA say "...relevant to the time period being summarized.".  I interpret that to mean only the immunizations that were given for the encounter/visit that is being summarized- not a complete lifelong history of patient immunizations.

<section>

  <templateId root="2.16.840.1.113883.10.20.22.2.2"/>

  <!--  ********  Immunizations section template   ******** -->

  <code code="11369-6"

        codeSystem="2.16.840.1.113883.6.1"

        codeSystemName="LOINC"

        displayName="History of immunizations"/>

  <title>Immunizations</title>

  <text>No immunizations were ordered or administered </text>

To unsubscribe from this group, send email to ihe-pcc-implementors+unsub...@googlegroups.com.