1. 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

2. 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

3. 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

4. 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

5. 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
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?

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

7. 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 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

8. 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

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

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

11. HL7 Examples reviewed above
Allergies
Examples/blob/master/ALLERGY_Drug_with_RxNorm.xml
Medications
6_hrs.xml
Immunizations
Examples/blob/master/Influenza_Immunization_Complete.xml
Procedures
Examples/blob/master/PROCEDURE_Procedure_Example.xml
Results
Examples/blob/master/RESULT_BMP_with_Tropinin.xml