HL 7 PUBLIC HEALTH WORKGROUP BIRTH DEFECTS IMPLEMENTATION
HL 7 PUBLIC HEALTH WORKGROUP BIRTH DEFECTS IMPLEMENTATION GUIDE BALLOT RECONCILIATION BLOCK #2 – SECTION 4 PULLED COMMENTS: 50, 51, 53, 59, 64 November 2, 2017
Null Values Optionality Comment #52 (NEG) Commenter indicated that "Should" seems too strong for null values, especially if the Value. code also has a “Should. ” Agree with the commenter. Disposition: Persuasive with Mod. We will change all @null. Flavor to “MAY” where Value. code is a “SHOULD”. 2
Antibiotic Administered Comment #54 (A-S) Rare to have a LOINC in a Substance Administration; this is generally stated in the material code. The Antibiotic substance administration includes information related to the standard names for clinical drugs as administered during labor and delivery. The Substance. Administration. code is an optional field, and HL 7 has made no use of this attribute (see next slide for verbiage from C-CDA guide) Disposition: Persuasive with Mod. We will delete the Substance. Administration. code as indicated in C-CDA guide. 3
Antibiotic Administered (continued) • The following is an excerpt from C-CDA R 2. 1 Medication Activity: From C-CDA R 2. 1 3. 48 Medication Activity (V 2) [substance. Administration: identifier urn: hl 7 ii: 2. 16. 840. 1. 113883. 10. 22. 4. 16: 2014 -06 -09 (open)] … 5. MAY contain zero or one [0. . 1] code (CONF: 1098 -7506). Note: Substance. Administration. code is an optional field. Per HL 7 Pharmacy Committee, "this is intended to further specify the nature of the substance administration act. To date the committee has made no use of this attribute". Because the type of substance administration is generally implicit in the route. Code, in the consumable participant, etc. , the field is generally not used, and there is no defined value set. … 4
Assisted Vent Comment #55 (NEG) The Assisted Vent observation is required, however, if there is no way to indicate that it wasn't done. It is recommended to include a negation indicator. We agree with the commenter. Disposition: Persuasive with Mod. We will add @negation. Ind to the Assisted Vent procedure. 5
Birth Defects Diagnosis Observation Comment #56 (A-S) Commenter indicated that the information more simply with observation. method. in the Qualifier looks like it could be handled The intent of the qualifier in the BD IG is to provide Diagnostic Confirmation information pertaining to the best way used to confirm the findings of the birth defect being reported. We are following the HL 7 Version 3 Implementation Guide: § Term. Info: Using SNOMED CT in CDA R 2 Models, Release Draft Standard for Trial Use December 2015: § “qualifier” elements (one or more) which encode attribute-value pairs that “qualify” (or modify) a primary concept (code) and are represented as an XML structure. Disposition: Considered – No Action Required. 6
Birth Defects Diagnosis Observation Example 11. SHOULD contain zero or more [0. . *] target. Site. Code (CONF: 1098 -14797). a. The target. Site. Code, if present, SHALL contain exactly one [1. . 1] @code, which SHOULD be selected from Value. Set Pressure Point urn: oid: 2. 16. 840. 1. 113883. 11. 20. 9. 36 STATIC (CONF: 1098 -14798). b. The target. Site. Code, if present, SHOULD contain zero or one [0. . 1] qualifier (CONF: 1098 -14799). i. The qualifier, if present, SHALL contain exactly one [1. . 1] name (CONF: 1098 -14800). 1. This name SHOULD contain zero or one [0. . 1] @code="272741003" laterality (Code. System: SNOMED CT urn: oid: 2. 16. 840. 1. 113883. 6. 96 STATIC) (CONF: 1098 -14801). ii. The qualifier, if present, SHALL contain exactly one [1. . 1] value (CONF: 1098 -14802). 1. This value SHOULD contain zero or one [0. . 1] @code, which SHOULD be selected from Value. Set Target. Site Qualifiers urn: oid: 2. 16. 840. 1. 113883. 11. 20. 9. 37 STATIC 2014 -09 -01 (CONF: 1098 -14803). 7
Electronic Fetal Monitoring During Delivery Comment #58 (A-Q) The IG narrative for this entry reads, “The Electronic Fetal Monitor During Delivery observation indicates if the newborn needed to be monitored with the Electronic Fetal Monitoring device during delivery. ” The commenter asked if the entry conveying whether monitoring was done or This entry conveys that “The Electronic Fetal Monitor During Delivery” was needed to be done? done. Disposition: Persuasive with Mod. We will revise narrative to indicate that the entry represents the finding was done. 8
History of Recreational Drug Use Comments #66 & #67 (A-S) - PULL Commenter mentioned this entry is more of an organizer than an observation, as it has no value other than those of its dependents. Commenter also mentioned: The "user" concept is a bit redundant with the drug, if the question is use. A single question "recreational drugs used" would provide the same information with less overhead. This is part of the social history section with the mother as the subject. The intent is to convey whether the mother is a recreational drug user or not. Disposition: Persuasive with Mod. § § § We will delete the “Recreational Drug User” observation. We will simplify the observation to “Type of recreational drugs used” which is contained in the mother’s social history section. Add narrative to address the effective time and the use of null. Flavor. 9
- Slides: 9