We ran into problems:
1. Conformance numbers for effectiveTime and effectiveTime/low are not changing correctly. (seem to be added, but change is not taking effect when reviewing the template after saving.)
2. We changed the effectiveTime/low to NP, but this is not causing a SHALL NOT to appear in the conformance language.

We were not able to add the effectiveTime elements for width, high, and center. Issues with ordering as we tried to add them, and we touched the data element to try and drag and drop it, we caused the elements to move to a higher level of the xml structure....very much NOT what we wanted to have happen and we could not figure out how we caused that, or how to undo it (rather than just a full cancel).

We modified the template purpose description to include the errata language change.

Modification to Social History Observation templates were tricky. See extra tab for 596 to review details of changes need and changes not needed to apply this errata to 2013-01-31. 

Summary: we did not need to add the Tobacco Use template - it was already added to the R1.1 Social History section. We did modify the Smoking Status Observation description for the R1.1. template. We needed to add the additional conformance onto the effectiveTime of that Smoking Status Template. [CONF: 1098-32894, 

effectiveTime CONF:14814 was replaces with CONF:1098-31928 even though the conformance statement was identical. We did this to keep the whole effectiveTime data element updating to the same set of Conformance Statements.

Constraint on effectiveTime/low CONF:14818 became CONF:1098-32894. All were NP.
Other constraints added were  (width) CONF:1098-32895, (high) CONF:1098-32896, (center) CONF:1098-32897. All were NP

Want to confirm about the template name change.

Questioning if this change would require me to update the Template Name also???

Otherwise it is a straight forward edit to the Template Purpose statement.

Finding:

-C-CDA R1.1

-Smoking Status Observation

--effectiveTime = being used as two things. Used as 'when the observation was made' and 'When the person was a smoker' (clinical relevant time)

Align with C-CDA R2.0 which splits this into two templates

Suggestion:

-Conformance statements Prior to the Change

…

If the patient is a smoker (77176002), the effectiveTime/low element must be present. If the patient is an ex-smoker (8517006), both the effectiveTime/low and effectiveTime/high element must be present.

..Conformance Statements After the Update:

…

This template represents a “snapshot in time” observation, simply reflecting what the patient’s current smoking status is at the time of the observation. As a result, the effectiveTime is constrained to a time stamp, and will approximately correspond with the author/time. Details regarding the time period when the patient is/was smoking would be recorded in the Tobacco Use template.

...

Further explanation:

-[Modify Purpose Statement for the Template]