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Id Issue Status Priority Type Date Assigned To Label
30 CDA-CH EMED represent structured data in level3 entries instead of narrative text Closed Normal Change Request 2021-06-21 09:04:21 Quentin Ligier
 
Change Request CDA-CH EMED represent structured data in level3 entries instead of narrative text
Id chdachpharm-issue-30
Status Closed
Priority Normal
Last Tracking 2021-06-21 09:04:21  by  Patrick Jolo
Current Assignee Quentin Ligier
    
Concerns
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Events
Tracking Closed 2021-06-21 09:04:21 : Tracking by Patrick Jolo
Tracking In Progress 2021-06-14 12:05:58 : Tracking by Quentin Ligier
Description
As discussed with Annatina, we keep the old template id (2.16.756.5.30.1.1.10.4.2) in the new template. The schematron is fixed. Back to testing.
Tracking In Progress 2021-06-11 10:51:27 : Tracking by Quentin Ligier
Edited by Quentin Ligier ( 2021-06-11 10:57:49 )
Description
One last issue to solve for the Annotation Comment template (2.16.756.5.30.1.1.10.4.82): it contains the id of the CH-PCC template (2.16.756.5.30.1.1.10.4.2). Should I change it?
It would allow clients to know if the narrative text is expected or not (one template id for each case), but if we standardise this for all CDA-CH projects in the next version, we would have to change the template id twice for pretty much no use.
(there's also an issue with that id in the schematron, it will be quick and easy to fix: currently, it expects to find the id of the template which does not appear)
Tracking In Progress 2021-06-08 16:47:34 : Tracking by Quentin Ligier
Edited by Quentin Ligier ( 2021-06-09 08:13:51 ) Quentin Ligier ( 2021-06-10 12:30:30 )
Description
The template  2.16.756.5.30.1.1.10.9.1 has been created. It has been included in the following templates:

I've created a local copy of Annotation comment to 2.16.756.5.30.1.1.10.4.82, as discussed. The following templates have been modified to include this local version:
Not yet done:
Check Schematron.
Assignment 2021-06-08 14:06:00 : Assigned To Quentin Ligier by Annatina Foppa
Tracking In Progress 2021-06-08 14:05:31 : Tracking by Annatina Foppa
Description
discussion 8.6.2021: c reate a new "Narrative Text Reference With Content" template to be included in all category 2 items. Include in CH-Pharm
Tracking Open 2021-06-07 09:35:42 : Tracking by Quentin Ligier
Description
EDs with mixed content are accepted by the Schematron, there's no fix to apply. 
About the second category item descriptions: sometimes it's an inclusion of the template  2.16.756.5.30.1.1.10.9.14 , sometimes it's simply defined in the template.
The template 2.16.756.5.30.1.1.10.9.14 is used by other projects too, it's not possible to modify it. Do we create a new "Narrative Text Reference With Content" template to be included in all category 2 items?
I think it's possible to check with Schematron asserts that these elements contain a single, non-blank text node.
Tracking Open 2021-05-12 17:22:03 : Tracking by Oliver Egger
Description
Mixing content with elements and CDATA text in XML is very hard for implementers, so the parsers would need to support also this variation since ED/ST is allowed to be mixed:

<text xsi:type="ED">The actual content.<reference value="#pdf_reference"/></text>


see https://www.hl7.org/documentcenter/public/wg/inm/datatypes-its-xml20050714.htm#dtimpl-ED
Because inline data for ED (and its restricted form, ST) may be encoded as character data, and the content model also includes a thumbnail and reference element, ED has mixed content. An instance of ED may only contain at most one text node.
Tracking Open 2021-05-12 16:14:11 : Tracking by Quentin Ligier
Edited by Quentin Ligier ( 2021-05-12 16:29:16 )
Description
After reviewing the specifications with Stéphane, we came to the conclusion that a change proposal might not be necessary for category 2 references.

PCC says:
6.3.4.16.8 <text><reference value=''/></text>
The URI given in the value attribute of the <reference> element points to an element in the narrative content that contains the complete text describing the medication. In a CDA document, the URI given in the value attribute of the <reference> element points to an element in the narrative content that contains the complete text describing the medication. In an HL7 message, the content of the text element shall contain the complete text describing the medication.
IHE Pharm has the same wording. By example in the PRE profile:
6.3.4.2.3.6 Narrative Text <text><reference value=''/></text>
This element SHALL be present. The URI given in the value attribute of the <reference> element points to an element in the narrative content that contains the complete text describing the medication prescribed.
See PCC TF-2, Medication Entry Module (1.3.6.1.4.1.19376.1.5.3.1.4.7) specification.
So a compliant solution might be to keep the reference AND add the complete text in the text element. The reference can be the same as for category 1. By example:
<text><reference value="#pdf_reference"/>The actual content.</text>
Adding the text to the element is not forbidden by the specs.
One could also argue that the specs don't explicitly require the reference (the only "SHALL" is for the HL7 message, not the CDA document), but that seems to be less compliant with the actual intent of these specifications.
That saves us from creating change proposals to PCC and IHE Pharm MTP, PRE, DIS and PADV profiles.
Tracking Open 2021-05-05 17:21:39 : Tracking by Quentin Ligier
Description
Category 1 description: This element SHALL be present. The URI given in the value attribute of the <reference> element points to an element in the narrative content that contains the complete text describing the medication prescribed/dispensed.
 The narrative text can simply contain a text that refers to the embedded PDF.

Category 3: All the references are optional (as far as I know), so we can just specify that they're unsupported or forbidden.

Category 2: A change proposal should be sent to PCC to allow embedding the actual content in the text tag (as for a message).
Tracking Open 2021-03-17 16:25:24 : Tracking by Quentin Ligier
Edited by Quentin Ligier ( 2021-03-17 16:26:21 )
Description
As for the references that can be found in structured e-medication sections:

Category 1: no associated data
These mandatory ones bind the whole entry to the narrative text. The plan for them would be to target a simple "see pdf" text?

  • substanceAdministration/text/reference (MTP/PRE item)
  • supply/text/reference (DIS item)
  • observation/text/reference (PADV item)
Category 2: data in the narrative text only
These references are the problematic ones, where the data is not present in the structured data but only in the narrative text. That's the ones targeted by the two proposals.

  • observation/text/reference (Treatment Reason Entry Content Module)
  • act/text/reference (Patient Medication Instructions, Fulfillment Instructions, Annotation Comments, Pharmaceutical Advice Concern Entry Content Module)
  • substanceAdministration/precondition/criterion/text/reference (MTP/PRE item)
  • substanceAdministration/text/reference (Dosage Instructions Non Structured Entry Content Module, Dosage Intake Mode Entry Content Module)
Category 3: structured data and narrative text
These optional references bind a structured data to a human representation in the narrative text. If the PDF is required, we could mark them as neither useful nor expected by data consumers (as they would be capable of generating again the human representation from the structured data).

  • substanceAdministration/effectiveTime/offset/(low|center|width|high)/translation/originalText/reference (MTP item, Dosage Instructions Dosage Change)
  • substanceAdministration/routeCode (mutliple refs, Dosage Instructions Start/Stop, Frequency, Dose)
  • substanceAdministration/approachSiteCode (mutliple refs, Dosage Instructions Start/Stop, Frequency, Dose)
  • substanceAdministration/doseQuantity (mutliple refs, Dosage Instructions Start/Stop, Frequency, Dose, Dosage Instructions Dosage Change)
  • substanceAdministration/rateQuantity (mutliple refs, Dosage Instructions Start/Stop, Frequency, Dose, Dosage Instructions Dosage Change)
  • substanceAdministration/code (multiple refs, MTP/PRE Reference Entry Content Module)
  • act/code (multiple refs, Patient Medication Instructions, Fulfillment Instructions, Substitution Permission Content Module, IHE Substitution Act Content Module, Pharmaceutical Advice Concern Entry Content Module)
  • functionCode (multiple refs, 2.16.756.5.30.1.1.10.9.54)
  • addr (multiple refs, 2.16.756.5.30.1.1.10.9.54, 2.16.756.5.30.1.1.10.9.27)
  • name (multiple refs, 2.16.756.5.30.1.1.10.9.27, 2.16.756.5.30.1.1.10.9.34)
  • manufacturerModelName/reference (2.16.756.5.30.1.1.10.9.21)
  • softwareName/reference (2.16.756.5.30.1.1.10.9.21)
  • manufacturedMaterial/code (multiple refs, Manufactured Material Entry Content Module)
  • manufacturedMaterial/name (multiple refs, Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:formCode (multiple refs, Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:asContent/pharm:containerPackagedMedicine/pharm:code (multiple refs, Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:asContent/pharm:containerPackagedMedicine/pharm:name (multiple refs, Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:asContent/pharm:containerPackagedMedicine/pharm:formCode (multiple refs, Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:asContent/pharm:containerPackagedMedicine/pharm:capacityQuantity/translation/reference (Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:ingredient/pharm:quantity/numerator/translation/reference (Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:ingredient/pharm:quantity/denominator/translation/reference (Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:ingredient/pharm:ingredient/pharm:code (multiple refs, Manufactured Material Entry Content Module)
  • manufacturedMaterial/pharm:ingredient/pharm:ingredient/pharm:name (multiple refs, Manufactured Material Entry Content Module)
  • supply/effectiveTime/width/translation/originalText/reference (Renewal Period Content Module)
  • supply/code (multiple refs, DIS item)
  • supply/quantity/translation/originalText/reference (DIS item)
  • observation/code (multiple refs, PADV item, PADV Reference Entry Content Module)
  • act/effectiveTime (multiple refs, Pharmaceutical Advice Concern Entry Content Module)
Tracking Open 2021-03-17 10:06:29 : Tracking by Annatina Foppa
Description
other possibility (discussion 17.3.):
> restriction on narrative text elements - workaround without change on PCC required. for conversion it would be easiest not to work with narrative text.
> easier to have it in structured part

Decision:
> go for proposal 2
> write a CP for PCC in parallel

Tracking Open 2021-03-16 11:22:35 : Tracking by Annatina Foppa
Description
Finding:

In emed documents, you have a required narrative text (component/section/text). It contains a human readable representation for some of the structured data. In some cases (such as annotation comments, fulfilment comments, etc.), the structured part only contains a reference to the narrative text. In order to get the comment, you have to parse the narrative text and extract the referenced element.

Since the pdf of the original representation as a pdf is also available we have a duplication of narrative. 

Suggestion:

-Following proposal came out of a discussion on rocketchat during the emed projectathon: 


1.) The narrative section is allowed to have a text "see pdf" and has a text ID (like pmlc)

2.) If the information is already structured on level3 and a reference is required it is allowed to add the reference to the ID

3) otherwise it should be in the text element
But this would bring us in contradiction with IHE PCC, for the comments. So maybe a Change Proposal that the restriction "For CDA, this SHALL be represented as a <reference> element that points at the narrative portion of the document. The comment itself is not the act being coded, so it appears in the <text> of the <observation>, not as part of the <code>. For HL7 Version 3 Messages, the full text SHALL be represented here." can be relaxed?

Further explanation:

See full discussion attached as a pdf or here: https://pat.chat.ihe-europe.net/group/hangout/thread/s98rbw9AEw36CMhKQ?msg=s98rbw9AEw36CMhKQ 


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