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the participant includes a reference to a "wrong" template CDA participant, update adding the element that have to be valorized for this template
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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
- In the participant element, there is a constraint that indicates an inactive SNOMED-CT concept: 160244002 - No known allergies
- Change it to SNOMED-CT 716186003- No known allergyFurther explanation:
- We noticed that when member states construct the manifestation of the allergies as defined in ART-DECOR, the manifestation is not correctly displayed in the CDA Display tool. From the EXPAND documentation and the CDA wiki, we learn that an adverse reaction has to be of the following form:
<entryRelationship typeCode='MFST'> <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.6.1'/> <!-- a problem entry --> <observation classCode='OBS' moodCode='EVN'> <templateId root='2.16.840.1.113883.10.20.1.54'/> <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.5'/> ∶ </observation> </entryRelationship>
- Adapt the ART-DECOR implementation guides. Unfortunately the Problem template is used in different places, so adapting it might not be an issue. maybe we have to create a separate one?
- 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