CDA Discrete Entry concepts text/reference – points to the entire human readable content for an act In laymen terms: the entire text of the Problem, Allergy, Medication, Immunization, Procedure, Encounter, … originalText/reference – always in reference to some (code, codeSystem) as a reference to the human readable text that led to the selection of the (code, codeSystem) The text the provider used/saw for a problem that led to use of a particular code, e.g., a particular ICD-10 code displayName – if present, the name as defined by the code system, or at least that does not change the meaning as defined by the code system

Industry Consistency is Important text/reference may be easiest tie from discrete entry to human readable text Needs to be carefully dereferenced in order to have usable content Importing systems benefit from reliable discrete content references to the narrative originalText/reference provides this for <code>, <value> and a few other coded elements @displayName is not for machine processing (somewhere there is a statement on “has no semantic meaning”) and should to be used only for debugging

HL7 Examples Task Force Review the examples, showing content for the 3 concepts What we see today from industry examples text/reference absent, or pointing to what really is the originalText content originalText/reference mostly absent @displayName often present, but also often containing originalText content

What follows? Review of selected Examples Task Force approved examples: Allergy Problem Medication Immunization Procedure Result For each there is: Link to example Table where 1st row shows content from text/reference, originalText/Reference, @displayName For some examples there is a second row saying something like: … below is … Then there is a third row presenting what would improve interoperability, or that might just be more complete

ALLERGIES, ADVERSE REACTIONS OR ALERTS Allergy to specific drug (penicillin) C-CDA 1.1 text/reference originalText @displayName Absent Penicillin penicillin …. Below is an example where the text reference is present Penicillin Anaphylaxis Severe Jan 4 2014 2006 Important to note: for the allergy observation, the originalText is on the code of the participant. Note 2: review the text/reference of the reaction – shouldn’t that include the Severity?

PROBLEMS Transition of Care Active Problem text/reference originalText @displayName Community Acquired Pneumonia Onset: February 27 2014 Active Absent Community Acquired Pneumonia ……below is the ideal state Community acquired pneumonia

MEDICATIONS Patient prescribed medication every 4 to 6 hours text/reference originalText @displayName Sudafed 30mg Oral Tablet take 2 tablets every 4-6 hours 30 MG Jan-18-2014 - Active Sudafed 30mg Oral Tablet Sudafed 30 MG Oral Tablet Note: originaltext is on code of the ManufacturedMaterial, i.e, inside the consumable; notice also the subtle difference between originalText and @displayName

IMMUNIZATIONS Influenza Vaccination Completed text/reference originalText @displayName Influenza Virus Vaccine 1 8/15/2010 Completed Absent Influenza virus vaccine …..better represented as Influenza Virus Vaccine Lot #1 8/15/2010 Completed Influenza Virus Vaccine influenza, unspecified formulation

PROCEDURES Procedure Activity Procedure Example in Procedures Section text/reference originalText @displayName Laparoscopic appendectomy >(03 Feb 2014 09:22am- 03 Feb 2014 11:15am) Completed Laparoscopic appendectomy

RESULTS Basic Metabolic Panel with Troponin Example text/reference originalText @displayName Na 140 mmol/L Normal 135-145 mmol/L Na Sodium [Moles/​volume] in Blood

HL7 Examples reviewed above Allergies https://github.com/jddamore/HL7-Task-Force- Examples/blob/master/ALLERGY_Drug_with_RxNorm.xml Medications https://github.com/jddamore/HL7-Task-Force-Examples/blob/master/MED_Med_Every_4- 6_hrs.xml Immunizations https://github.com/brettmarquard/HL7-C-CDA-Task-Force- Examples/blob/master/Influenza_Immunization_Complete.xml Procedures https://github.com/jddamore/HL7-Task-Force- Examples/blob/master/PROCEDURE_Procedure_Example.xml Results https://github.com/jddamore/HL7-Task-Force- Examples/blob/master/RESULT_BMP_with_Tropinin.xml