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Allergies And Intolerances
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History (6)
Date Author Status Type
2018-03-28 10:47:24 Mathias Ghys Draft version
2018-03-05 10:10:25 Mathias Ghys Draft version
2018-03-05 10:08:23 Mathias Ghys Draft version
2018-02-14 10:29:37 Mathias Ghys Draft version
2018-02-12 15:07:56 Mathias Ghys Draft version
2017-08-01 19:23:31 Christof Gessner Draft version
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Issues (7)
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Change Request Status = Open ( epsos-issue-150 ): Fix participant role for agents
Type Change Request Status Change Request Status = Open Priority Highest
Current Labels
 
 (M1) Milestone 1 
Events
Tracking / Status = Open 2017-05-17 14:49:33 : Tracking by Giorgio Cangioli
 
 M1 
Description
TO BE FIXED creating a template fragment for agents
Tracking / Status = Open 2016-11-15 12:49:27 : Tracking by Giorgio Cangioli
Description
Finding:

the participant includes a reference to a "wrong" template CDA participant, update adding the element that have to be valorized for this template

Suggestion:

-

Further explanation:

-

Change Request Status = Open ( epsos-issue-206 ): Define a specialized template for the agent
Type Change Request Status Change Request Status = Open Priority Normal
Current Labels
 
 (TID) Template ID 
Events
Tracking / Status = Open 2017-09-05 12:04:37 : Tracking by Giorgio Cangioli
 
 TID 
Description
Finding:
hl7:participant
0 … *C

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.


Contains 2.16.840.1.113883.3.1937.777.11.10.134 CDA Participant (Body) (DYNAMIC)
Suggestion:

A specialized template should be defined for the <participant> structure describing the substance that causes the allergy or intolerance

Further explanation:

-

Change Request Status = Open ( epsos-issue-232 ): participant duplication - see epsos-issue-231
Type Change Request Status Change Request Status = Open Priority Normal
Events
Assignment 2017-10-29 12:07:07 : Assigned To Dr. Kai U. Heitmann by Christof Gessner
Tracking / Status = Open 2017-10-29 12:07:06 : Tracking by Christof Gessner
Description
Finding:

-

Suggestion:

-

Further explanation:

-

Change Request Status = Closed ( epsos-issue-260 ): Change participant constraint text: replace inactive concept
Type Change Request Status Change Request Status = Closed Priority Normal
Events
Tracking / Status = Closed 2018-02-12 15:13:03 : Tracking by Mathias Ghys
Description
Text adapted
Assignment 2018-02-12 15:12:23 : Assigned To Mathias Ghys by Mathias Ghys
Tracking / Status = Open 2018-02-12 15:12:22 : Tracking by Mathias Ghys
Description
Finding:

- In the participant element, there is a constraint that indicates an inactive SNOMED-CT concept: 160244002 - No known allergies

Suggestion:

- Change it to SNOMED-CT 716186003-  No known allergy

Further explanation:

-

Change Request Status = Rejected ( epsos-issue-265 ): Add templateID 2.16.840.1.113883.10.20.1.54 to manifestation observation.
Type Change Request Status Change Request Status = Rejected Priority Normal
Events
Tracking / Status = Rejected 2018-03-28 11:02:57 : Tracking by Mathias Ghys
Description
It was agreed upon to remove the dependency to the CCD template (2.16.840.1.113883.10.20.1.54) from the allergies observation. No formal reason could be found to keep it. Since the constraint was just in textual form, it won't be tested in the validation.

It's a spurious remaining from the IHE PCC, where conformance to CCD was requested. No formal rules could be seen that could not be covered by other templates present in the Allergy Reaction Observation.


Tracking / Status = Feedback needed 2018-03-02 12:06:43 : Tracking by Mathias Ghys
 
 TBA 
Tracking / Status = Open 2018-03-02 12:06:13 : Tracking by Mathias Ghys
 
 TBA 
Assignment 2018-03-02 12:05:29 : Assigned To Mathias Ghys by Mathias Ghys
Tracking / Status = Open 2018-03-02 12:05:28 : Tracking by Mathias Ghys
Description
Finding:

- 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>
At this moment, the templateID is defined in ART-DECOR as  2.16.840.1.113883.10.20.1.28 instead of 2.16.840.1.113883.10.20.1. 54

Suggestion:

- 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?

Further explanation:

-

Change Request Status = Open ( epsos-issue-274 ): Change cardinality of value element
Type Change Request Status Change Request Status = Open Priority Normal
Events
Assignment 2018-06-08 10:54:16 : Assigned To Mathias Ghys by Mathias Ghys
Tracking / Status = Open 2018-06-08 10:54:15 : Tracking by Mathias Ghys
Description
Finding:

- 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.

Suggestion:

- Change the cardinality from 0 ... * to 1 ... 1 or at least 0 ... 1

Further explanation:

-

Change Request Status = Feedback needed ( epsos-issue-275 ): Change the Cardinality of the id and text elements according to the IHE PCC
Type Change Request Status Change Request Status = Feedback needed Priority Normal
Current Labels
 
 (TBA) To be approved 
Events
Tracking / Status = Feedback needed 2018-06-11 10:24:17 : Tracking by Mathias Ghys
 
 TBA 
Description
Dear Giorgio, thank you for your feedback. This is highly appreciated.

I always create tickets for the things I want to change where I don't feel 100% confident, and ask for feedback from the semantic experts. 
This is one of these cases. I changed the issue status to "Feedback needed" and Label "(TBA) To be approved".

If I understand it correctly, we make the following distinction:

  • specialization: we modify an existing template (in this case the IHE PCC template) and add some self-defined elements or we add some additional restrictions to existing elements (as been decided in previous project phases)
  • adaptation: we use an existing template as a base but add/modify elements so that the template is not following the rules of the original template anymore.
From the definition of the templateId: "Use of the templateId indicates that the CDA instance conforms to the constraints specified by each templateId referenced as well as to the standard CDA schema" (Principles of Health Interoperability)

As you mentioned, I also noticed the fact that in a lot of cases the templateId is specified, even when the template is not conform to the constraints specified by the referenced template.

I think there are 2 problems that have to be fixed:
  1. Some eHDSI reuse the exisiting OID from the IHE PCC templates. This is just wrong. The templates should receive eHDSI specific template IDs.
  2. In my opinion, no template IDs can be specified if the template is not a specialization of the template. The fact if a template is an adaptation/specialization is described in the description.
I don't see a problem in just removing the template IDs in the case of an adaptation, since validation won't fail the CDA document if the template ID is still mentioned, but in that case, at least the templates are correctly described. Another option is to just make them conform to the referenced templates, but I don't think this is the way to go, since in this case we are reverting changes that have been made in previous project phases (like the choice you mentioned where the choice of epSOS was not to impose that entries would be linked to the section text)

What do you think?
Tracking / Status = Open 2018-06-08 13:12:42 : Tracking by Giorgio Cangioli
Description
Giorgio's friendly suggestions: (a) evaluate carefully the reasons of the choices and do not just say align to xyz. (b) consider that there is still an unresolved problem with the template IDs in the current eHDSI specifications. There are several cases in which IHE PCC template IDs are used, even if the templates are not the IHE PCC templates and even not specialization of them. This is one of these cases.

One of the choice of epSOS was not to impose that entries would be linked to the section text. Because this linkage is not available in the 95% of the cases (at least at that time). This is instead required by the IHE PCC templates and this is the reason why you have entry.text 1..1 M for observations.  (I wonder if the fix should be text 0..1 R )
Similar considerations of the IDs.

In the 99% of the cases eHDSI templates are adaption and not specialization of  the IHE PCC. But this is wrongly reflected in the template ID used.

This is an old known problem that I have the impression that has not been yet resolved. This has implication in the validation of the templates (because you refer to templates you are not conformant to...)

I suggest to fix the real problem instead of attempting to by-pass it changing cardinalities.

Assignment 2018-06-08 11:03:45 : Assigned To Mathias Ghys by Mathias Ghys
Tracking / Status = Open 2018-06-08 11:03:44 : Tracking by Mathias Ghys
Description
Finding:

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 .

Suggestion:

- Lets make this template compatible with the IHE PCC Problem template and change the cardinality and conformance

Further explanation:

-

 
 
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