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epSOS aims to design, build and evaluate a service infrastructure that demonstrates cross-border interoperability between electronic health record systems in Europe.
epSOS attempts to offer seamless healthcare to European citizens. Key goals are to improve the quality and safety of healthcare for citizens when travelling to another European country. Moreover, it concentrates on developing a practical eHealth framework and ICT infrastructure that enables secure access to patient health information among different European healthcare systems. epSOS can make a significant contribution to patient safety by reducing the frequency of medical errors and by providing quick access to documentation. In emergency situations, this documentation provides the medical personnel with life-saving information and reduces the (sometimes needless) repetition of diagnostic procedures. The technical, legal and organizational concepts developed within the framework of the project are subject to an extensive practical testing phase over a period of one year. epSOS will test cross-border eHealth services in the following areas: In a first phase:
- The prescription ID must be the same as the prescription ID defined in the document header (document ID).
- Rename the template http://art-decor.org/art-decor/decor-templates--epsos-?id=2.16.840.1.113883.3.1937.777.11.10.144 “epSOS Related Prescription Item” to “eHealth DSI Related Prescription”
- In the asContent element we see the following description:This structure describes the packaging of the medication. The element provides the code for the particular package.But if we go into the formCode, we have the freedom to choose from the epSOSDoseForm value set OR the epSOSPackage value set. In my opinion, the Pharmaceutical dose form has to come into the formCode element under the manufacturedMaterial level and the formCode element under the /asContent/containerPackageMedicine can only contain values from the epSOSPackage value set
- Remove the possibility to have a value from the 2 value sets.
-
- We received a question from Heiko Zimmermann:The "value" element, shouldn't it be with a cardinality 1..1 instead of 0..* ? as it is mentioned that it shall be given. Is a max "*" cardinality really useful in practice?I had a look in the IHE PCC templates: https://art-decor.ihe-europe.net/art-decor/decor-templates--IHE-PCC-?id=1.3.6.1.4.1.19376.1.5.3.1.4.6
In this template the cardinality of the value element is 1 … *:
I don't know if these this template is something official we can rely on (I guess it's based on this pdf document: http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_TF_Vol2.pdf since the ART-DÉCOR references the paragraph in this document)?
From the pdf document:
6.3.4.15.5 <value xsi:type='CD' code=' ' codeSystem=' ' codeSystemName=' ' displayName=' '>
The <value> is a description of the allergy or adverse reaction. While the value may be a coded or an uncoded string, the type is always a coded value (xsi:type='CD'). If coded, the code and codeSystem attributes must be present. The codingSystem should reference a controlled vocabulary describing allergies and adverse reactions, see Table 5.4 12 above. If uncoded, all attributes other than xsi:type='CD' must be absent. The allergy or intolerance may not be known, 5570 in which case that fact shall be recorded appropriately. This might occur in the case where a patient experiences an allergic reaction to an unknown substance.
In the pdf we don't have any indication about the cardinality.
BUT, if the IHE PCC has a minimum cardinality of 1 and our template has a minimum cardinality of 0, it means we are not compatible with the IHE PCC templates, since omitting the value will provide a valid document according to the ehDSI specifications, but will be an invalid document according to the IHE PCC templates.
- Change the cardinality from 0 ... * to 1 ... 1 or at least 0 ... 1
- This template is a subtype of the Problem Entry, and so must also confirm to the rules of the problem entry, which has the template identifier of 1.3.6.1.4.1.19376.1.5.3.1.4.5. This is an OID from the IHE PCC that is duplicated by an eHDSI template. But from the description, I understand that the templateId is referring to the IHE PCC Problem Entry. There the hl7:id and hl7:text are 1 … 1 M. Then I don't see why the hl7:id and hl7:text are 0 … * R and 1 … 1 R .
- Lets make this template compatible with the IHE PCC Problem template and change the cardinality and conformance
- added the templateId element
- Can't edit template. Error message says: Template locked User Oliver Egger 2017-11-27
There is an inconsistency between the specification with OID 1.3.6.1.4.1.19376.1.5.3.1.4.3.1 in the older EXPAND documentation (where the implementation guides were written in paper) where the old validator was based upon and the current ART-DÉCOR definitions.
- Change to moodCode=INT
- I checked the PDF documentation, the parent template from IHE PCC 1.3.6.1.4.1.19376.1.5.3.1.4.3.1, and the C-CDA template 2.16.840.1.113883.10.20.1.43
(see https://art-decor.ihe-europe.net/art-decor/decor-templates--IHE-PCC-?id=1.3.6.1.4.1.19376.1.5.3.1.4.3.1 )
Also see IHE PCC TF2 6.3.4.8.4: <act classCode='ACT' moodCode='INT'>The related statement is the intent (moodCode='INT') on how the related entry is to be performed.
- no fixed value for inversion Ind
- fixed inversionInd value true, according to IHE PCC 1.3.6.1.4.1.19376.1.5.3.1.4.7, and epsos PDF specification
We noticed that the same OIDs are used in ART-DECOR for defining different templates. This originates from the older implementation guide definitions in the EXPAND period and is a known issue for some time.The majority of conflicts arises from re-using templates from IHE PCC in epSOS, but with additional constraints.I compared the list of templates in epsos: http://art-decor.org/art-decor/decor-template-ids--epsos-with the IHE PCC templates: https://art-decor.ihe-europe.net/art-decor/decor-template-ids--IHE-PCC-I tried to list the templates where the OID is reused in epSOS:
Change the OIDs. To what OIDs has to be discussed and maybe the change has to occur by a change request.
- Some previously available constructs are missing:
- outcome of gap analysis of Abderrazek: consumable/manufacturedProduct/manufacturedMaterial/name required. In Expand the Cardinality is for the element is: (eP/eD/PS: R/NA/NA).
- Change the cardinality from 0 ... 1 to 1 ... 1
- telecom @use is required, but should be optional, according to text.
- change cardinality to 0...1 (as in other occurences of telecom)
- to be changed from UNK to NI
The current specs requires that all the IHE PCC (simple obs ad socila Obs) and the CCD template IDs are provided .
IHE PCC template just says that "These <templateId> elements identify this as a Social History observation." without indicating any optionality.
Evaluate if is really needed that all of them would be required.
This applies to several other templates
the conceptual model consider only three types of social observation:
Alcohol
Evaluate if we need to specialize the IHE PCC template considering three different specialized template for each of them
in the case of diet a coded element is excpected in the obs.value , but the epSSO MVC doesn't define such a type of value set
This is a known issue. No Value set have been identified for describing autonomy/invalidity
- The LOINC code used here signifies a document, not a section. Furthermore, it asks for specification of {setting} and {Author Type}. Not sure if this is appropriate code here.
- Check for alternative, possibly request new code from LOINC
Only a few concepts in associated value set Obs.code
In the future a value set should contain much more concepts, see e.g. ELGA_Vitalparameterarten 1.2.40.0.34.10.34
According to CP#8 the optionality R/R/RFNA shall be read as RNFA / RNFA / RNFA
Update the work document consequently
Update Specialty cardinality to 0..1 (table in § 10.1)
-realmCode is Mandatory
-change to 0..1 R
-is Mandatory
--change to 0..1 R
-is mandatory
-validation fails for multiple effectiveTime instances. But epSOS requires two instances, at least in some cases. Note: this will probably be fixed by epsos-issue-101.
- add more specific information on occurrence, like effectiveTime[1], effectiveTime[2] etc.
- EffectiveTime of ServiceEvent required Low and high
- Modify template to allow for high only (without low) and also allow for TS, alternatively ("silent demotion")
The OID for the Comment Entry here is the same as for the IHE Comment Entry from PCC. You cannot use the same OID as it defines additional constraints here.
Use the IHE Comment Entry as-is (ref) or clone it with a new template ID.
To be evaluate if the value set indicated "The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.16040EntityCode (DYNAMIC)" is here appropriate.
To describe the Preferred Health Professional for emergency contact is currently used participant/functionCode = PCP and particiapnt/associatedEntity@classCode="PRS"The usage of the classCode ECON seems to be more appropriate.
- classCode is mandatory, according to schema
- change cardinality from 0..1 to 1..1
- observation classCode is mandatory
- change cardinality to 1..1
- cardinality of entry is 0..1
- change to 0..*
- good practice is to have one entry to contain one ProblemConcernAct, containing one Problem observation.
-section allows only 0..1 entry
- It is good practice that one entry contains one Act containing one Problem. So for multiple past illnesses we need multiple entries.
- The current value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.5 does not reflect the most recent version of MVC
- should be updated to contain 4 -digit ICD codes
- Value set does not follow the updates in MVC
- Suggest to update the value set.Please clarify with Solution Provider Terminology Expert how to proceed...
- act.id is mandatory
- change to 0..1 R
- no reason to have it mandatory in base templates.
- Description doesn't make it clear that codeSystem IHEActCode (1.3.5.1.4.1.19376.1.5.3.2) must be used, and not generic HL7 ActCode (2.16.840.1.113883.5.4)
- add text to clarify
- id cardinality is 1..1 R
- id cardinality should be 0..1 R
- is 1..1 R
- should be 0..1 R
The substance that causes the allergy or intolerance shall be specified in the <participant> structure.
The <code> element shall be present. It may contain a code and codeSystem attribute to indicate the code for the substance causing the allergy or intolerance. It shall contain a <reference> to the <originalText> in the narrative where the substance is named.
A specialized template should be defined for the <participant> structure describing the substance that causes the allergy or intolerance
The CDA standard claims"A conformant CDA document can have a single relatedDocument with typeCode "APND"; a single relatedDocument with typeCode "RPLC"; a single relatedDocument with typeCode "XFRM"; a combination of two relatedDocuments with typeCodes "XFRM" and "RPLC"; or a combination of two relatedDocuments with typeCodes "XFRM" and "APND". No other combinations are allowed."
This constraint is not captured by the current specifications. Add an explicit assertion to check this.
- cardinality of id is 0..*
- must be maximum 1. Changed it to 0..1
- cardinality of manufacturedProduct must be less or equal 1
- Changed to 0...1
-Test : CDATEMP005(Validation Level : FLATTEN_4 , Type : ERROR) Location : //rules/template[14]/element[1]/element[16]/element[1] CDALocation : /hl7:substanceAdministration[hl7:templateId/@root='1.3.6.1.4.1.12559.11.10.1.3.1.3.2']/hl7:consumable/hl7:manufacturedProduct Description : The maximum multiplicity SHALL be lower or equals to the maximum multiplicity from the CDA model [CDATEMP-005]
- When <let> used, it shall not contains circular references to other <let> elements [HL7TEMP-045]
- more information needed.
- effectiveTime has cardinality 1..*
-The maximum multiplicity SHALL be lower or equals to the maximum multiplicity from the CDA model [CDATEMP-005]
- text cardinality is 1...*
- The maximum multiplicity SHALL be lower or equals to the maximum multiplicity from the CDA model [CDATEMP-005]
- effectiveTime is 1..*
- substanceAdministration maximum multiplicity is *
- The cardinality of custodian telecom is 0..* here, while it is constrained to 0..1 in the CDA Spec for custodiaon Org. Moreover, ID is mandatory for Custodian organisation.
- cannot use the generic Organization template here. Adapt to additional constraints, specific for custodian organization.
- cardinality is 0..*
-Test : CDATEMP005(Validation Level : FLATTEN_4 , Type : ERROR)
- The contains statement produces a duplication of the participant element (nesting).
- replace "contains" by "include"?
- In the Template EntryAllergyAndIntolerance [1.3.6.1.4.1.19376.1.5.3.1.4.6] in ART-DECOR, the hl7:id element is not consistent with the inheritance from the template Problem[1.3.6.1.4.1.19376.1.5.3.1.4.5]
- The template EntryAllergyAndIntolerance inherit from the template Problem, the template EntryAllergyAndIntolerance says that hl7:id is 0..* , however the template Problem says that hl7:id is 1..1. This is not permitted to relax constraints.
- Change the EntryAllergyAndIntolerance template and make the id a 1 ... 1 (with a conformance M?)