Can an html tag of <pre> be used in the textual section?

[Lagen McLachlan]

Hello,

We are trying to use the html tag <pre> in the plan of care section, but we are receiving the following error:

0|cvc-complex-type.2.4.a: Invalid content was found starting with element 'pre'. One of '{"urn:hl7-org:v3":content, "urn:hl7-org:v3":linkHtml, "urn:hl7-org:v3":sub, "urn:hl7-org:v3":sup, "urn:hl7-org:v3":br, "urn:hl7-org:v3":footnote, "urn:hl7-org:v3":footnoteRef, "urn:hl7-org:v3":renderMultiMedia, "urn:hl7-org:v3":paragraph, "urn:hl7-org:v3":list}' is expected.

Is the html tag <pre> not valid?

Thank you,

Lagen McLachlan

[Lagen McLachlan]

I forgot to add the plan of care section.  It is shown below:

<component>

    <section>

        <templateId root = "2.16.840.1.113883.10.20.22.2.10"></templateId>

        <code

            codeSystemName = "LOINC"

            codeSystem = "2.16.840.1.113883.6.1"

            code = "18776-5"

            displayName = "Treatment plan">

        </code>

        <title>Plan of Care</title>

        <text>

            <table width = "100%" border = "1">

                <thead>

                    <tr>

                        <th>Plan Of Care</th>

                    </tr>

                </thead>

                <tbody>

                    <tr>

                        <td>

                            <pre>

                                Patient plan

                                

                                Plan Details

                                General

                                Test

                                

                                Prescription Orders

                                Rx Cart - Apr 28 2013 12:32

                                Poly-Vitamin Oral Drops, 1.25 cap(s) By Mouth Daily, 1 ml(s), No refills

                                Cart Status: Submitted  Route: Fax

                                Rx Cart Order Notes: Fax prescriptions to Data Court First Floor Mail Room Fax phone: fax: 

                                563-585-4547

                                

                                Message for Pharmacy: Here is a prescription for MARY WEDNESDAY from A. Abaton A A.. This 

                                prescription was transmitted by Support, Abaton A.

                                

                                

                                Lab Orders

                                Blood Glucose, Fingerstick test (POL) (Ordered - Hypertrophic cardiomyopathy)

                                

                                Procedure Orders

                                Colonoscopy test (Accessioned - Family history of malignant neoplasm of gastrointestinal tract), 

                                Procedure Site: Colon

                                

                                

                                Immunization Orders

                                DTP vacc, IM (Closed - Neoplasm of pelvic bone)

                                

                                Preventive Care

                                General, Female:  Recommended pharmacological therapy for tobacco use cessation

                                Diet and Exercise:  Referred for weight counseling

                                Immunizations:  Recommended pneumococcal vaccine

                                

                                Patient Education:  The patient understands and agrees with plan as discussed

                            </pre>

                        </td>

                    </tr>

                </tbody>

            </table>

        </text>

    </section>

</component>

[Benjamin Flessner]

No. The section <text> element is a restricted set of elements that looks similar to, but is not quite exactly HTML.  <pre> is not one of the allowed elements. Additionally, white space (especially line breaks) is often lost in transmission/translation of CDA documents, so it's better to ensure your line-breaks are transmitted via <br/> tags. You'll want to take a look at the NarrativeBlock schema in the CDA Release 2 download located here:
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7

If you really want to enforce mono-spaced text, there's really not a good way to do that in CDA today. You could use a custom styleCode such as "monospace" or "pre" and your own XSL transform to render the narrative with monospaced fonts, but not many other systems would understand that. (For the record, Epic recognizes both of these style codes and translates them into monospaced font)

-Benjamin Flessner