Not Possible to Create a Valid 1.0 document

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dan venton

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Aug 23, 2016, 11:30:14 AM8/23/16

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http://cda-validation.nist.gov/cda-validation/muNHCS.html

IG:

MAY contain zero or one [0..1] entryRelationship (CONF:1106-467) such that it
a. SHALL contain exactly one [1..1] @typeCode="RSON" Has reason (CodeSystem:
HL7ActRelationshipType 2.16.840.1.113883.5.1002) (CONF:1106-473).
b. SHALL contain exactly one [1..1] External Document Reference (identifier:
urn:hl7ii:2.16.840.1.113883.10.20.22.4.115:2014-06-09) (CONF:1106-
468).
Note: Form Element: Was Patient Referred
c. If the document is a National Ambulatory Medical Care Survey (templateId:
2.16.840.1.113883.10.20.34.1.2) or a National Hospital Ambulatory Medical Care
Survey - OPD (templateId: 2.16.840.1.113883.10.20.34.1.3) then this entry MAY be
present (CONF:1106-743).

Validator Says:

cvc-complex-type.2.4.a: Invalid content was found starting with element 'externalDocument'. One of '{"urn:hl7-org:v3":realmCode, "urn:hl7-org:v3":typeId, "urn:hl7-org:v3":templateId, "urn:hl7-org:v3":sequenceNumber, "urn:hl7-org:v3":seperatableInd, "urn:hl7-org:v3":act, "urn:hl7-org:v3":encounter, "urn:hl7-org:v3":observation, "urn:hl7-org:v3":observationMedia, "urn:hl7-org:v3":organizer, "urn:hl7-org:v3":procedure, "urn:hl7-org:v3":regionOfInterest, "urn:hl7-org:v3":substanceAdministration, "urn:hl7-org:v3":supply}' is expected.

The validator is correct. <externalDocument> elements are not allowed in <entryRelationship> they belong in <reference> elements.

I can either make a valid CDA document by putting it where it belongs but violate the IG. OR I can honor the IG and make an invalid CDA (schema) I can't do both.

NHCSED.xml

Andrew McCaffrey

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Aug 23, 2016, 3:02:51 PM8/23/16

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Hi,

Interestingly, the table and example in the IG for Current Visit
Constraints states to use an "act" element instead of an
"externalDocument" element, but I'm not sure that's going to satisfy the
rest of the requirements either. I'll take a deeper dive and let you
know what is decided.

Thanks,
-Andrew

On 08/23/2016 11:30 AM, dan venton wrote:
> http://cda-validation.nist.gov/cda-validation/muNHCS.html
>
> IG:
> *MAY *contain zero or one [0..1] *entryRelationship *(CONF:1106-467)
> such that it
> a. *SHALL *contain exactly one [1..1] *@typeCode*="RSON" Has reason

> (CodeSystem:
> HL7ActRelationshipType 2.16.840.1.113883.5.1002) (CONF:1106-473).

> b. *SHALL *contain exactly one [1..1] *External Document Reference
> *(identifier:

> urn:hl7ii:2.16.840.1.113883.10.20.22.4.115:2014-06-09) (CONF:1106-
> 468).
> Note: Form Element: Was Patient Referred
> c. If the document is a National Ambulatory Medical Care Survey (templateId:
> 2.16.840.1.113883.10.20.34.1.2) or a National Hospital Ambulatory
> Medical Care
> Survey - OPD (templateId: 2.16.840.1.113883.10.20.34.1.3) then this

> entry *MAY *be

> present (CONF:1106-743).
>
>
> Validator Says:
> cvc-complex-type.2.4.a: Invalid content was found starting with element
> 'externalDocument'. One of '{"urn:hl7-org:v3":realmCode,
> "urn:hl7-org:v3":typeId, "urn:hl7-org:v3":templateId,
> "urn:hl7-org:v3":sequenceNumber, "urn:hl7-org:v3":seperatableInd,
> "urn:hl7-org:v3":act, "urn:hl7-org:v3":encounter,
> "urn:hl7-org:v3":observation, "urn:hl7-org:v3":observationMedia,
> "urn:hl7-org:v3":organizer, "urn:hl7-org:v3":procedure,
> "urn:hl7-org:v3":regionOfInterest,
> "urn:hl7-org:v3":substanceAdministration, "urn:hl7-org:v3":supply}' is
> expected.
>
>
> The validator is correct. <externalDocument> elements are not allowed in
> <entryRelationship> they belong in <reference> elements.
>
> I can either make a valid CDA document by putting it where it belongs
> but violate the IG. OR I can honor the IG and make an invalid CDA
> (schema) I can't do both.
>
>

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dan venton

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Aug 23, 2016, 4:05:50 PM8/23/16

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I noticed that, but I was willing to let that go as a typo, since the externalDocument template isn't an act. Nor could an act be an externalDocument template.

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Andrew McCaffrey

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Aug 23, 2016, 5:12:13 PM8/23/16

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Indeed. I also notice that the entryRelationship/act language doesn't
exist in the 1.1 version of the IG. I will let you and the group know
what I hear back and whether any updates will be made to the tooling.

Thanks,
-Andrew

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Andrew McCaffrey

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Sep 13, 2016, 12:36:04 PM9/13/16

to dan venton, National Health Care Survey Testing Tool

Hi,

My understanding is that a meeting about this is occurring today. I'll
inform the group if/when a change to the tool will take place.

Thanks,
-Andrew

On 09/12/2016 02:32 PM, dan venton wrote:
> Any news?

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Andrew McCaffrey

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Sep 14, 2016, 10:51:10 AM9/14/16

to dan venton, National Health Care Survey Testing Tool

Hi,

The rules will be relaxed/removed from the tool. I will inform the
group when there is an update available. Thanks for bringing this to
our attention.

Thanks,
-Andrew

dan venton

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Sep 15, 2016, 8:22:10 AM9/15/16

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Does this mean that you are going to change the HL7 CDA schema rules to allow the <entryRelationship> OR change the IG rules to move the <externalDocument> to the wrapper it belongs in (like it's defined in 1.1)?

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Andrew McCaffrey

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Sep 15, 2016, 10:28:29 AM9/15/16

to dan venton, National Health Care Survey Testing Tool

Hi,

The HL7 schema will not be changed. The schematron statements that
force the XML to violate the underlying CDA schema will be removed.

Thanks,
-Andrew

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Andrew McCaffrey

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Sep 15, 2016, 4:23:47 PM9/15/16

to dan venton, National Health Care Survey Testing Tool

Hi,

Following up on this, the rules that make use of the act are conditional
within the MAY the describes the link to the external document. The
rules in the template itself that define the external document never
actually state that it must be contained within an act.

Therefore I was able to construct an XML snippet that follows the 1.1
method (using a externalDocument within a reference) but which doesn't
actually violate any specific rule within the 1.0 specification:

<reference typeCode="REFR">
<externalDocument classCode="DOCCLIN" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.115"
extension="2014-06-09" />
<id root="1.3.6.1.4.1.22812.18.1.1.12" extension="2" />
<code code="54094-08" codeSystem="2.16.840.1.113883.6.1"/>
<text>
<reference value="#_663a623b-21cc-4df7-a633-f56eddc98d26"/>
</text>
</externalDocument>
</reference>

Are you able to replicate this pattern and pass through the tool without
an error being raised?

Thanks,
-Andrew

dan venton

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Sep 16, 2016, 8:26:07 AM9/16/16

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Yes, placing them in <reference> elements where they belong no longer raises the error.

But I can't arbitrarily change the code because the IG says to do it differently. I'll punt this to by BA to see if this thread is enough justification to change the output or if they feel a published errata will be required.

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Andrew McCaffrey

unread,

Sep 16, 2016, 10:38:59 AM9/16/16

to dan venton, National Health Care Survey Testing Tool

Hi,

There may be a published errata for this issue coming, but I don't have
confirmation on that yet.

Thanks,
-Andrew

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