CDA Changes approved by Structured Documents TC

1 CDA Changes approved by Structured Documents TC1
(Bob, Feb 2001) Retire Document_service.origination_dttm. (because it is redundant with
(Bob, Feb 2001) Retire originator, confidentiality, language from <level_one> and from (what will
become) entities.
(Fred, Jan 2001) New value for <document_relationship.type_cd> includes "XFRM" (transform).
(Kai, Jan 2001) An <intended_recipient> can be a person OR organization.
(Bob, Jan 2001) (Technical Correction) :: The error is that we said that there is (optionally) just one
<fulfills_order>, which can contain one to many <order>. What we should have said is that there is
zero to many <fulfills_order>, each of which contains exactly one <order>. (The reason is because in
RIM 0.98, a service can have many service_relationships, and a service_relationship has exactly one
source and one target.)
Here's how the DTD would need to change:
----------------------------------------------------------CURRENT DTD
----------------------------------------------------------<!ELEMENT clinical_document_header (
... )>
<!ELEMENT fulfills_order (
... )>
----------------------------------------------------------REVISED DTD
----------------------------------------------------------<!ELEMENT clinical_document_header (
... )>
<!ELEMENT fulfills_order (
... )>
(Changes to the Hierarchical Description in section 3.2.3 include:
o Cardinality in Row 16 changes from 0..1 to 0..*;
These changes will be folded into the next draft of the standard and will be subject to
approval/disapproval by formal vote at the Committee and Membership levels.
o Cardinality in Row 18 changes from 1..* to 1..1 )
2 Summary of deprecated functionality
(This is a copy of the email we posted to the listserver)
Subject: Planned deprecated CDA functionality
I wanted to summarize the complete set of CDA Level One, Release 1.0 functionality that we propose to
deprecate in the next release of the standard. Some of this was agreed to during the January 2001 meeting,
and some was agreed to last week in Minneapolis. If anyone objects to these please speak up. We'll also
include this list of items in an executive summary that is included in our future ballot package (anticipated
for the end of this year or first part of next year).
(1) Deprecate the CDA Header <service_tmr> component. Rationale: The CDA Header has an
<origination_dttm> component that represents the date/time the document is originated, and an
<encounter_tmr> component that represents the date/time a patient encounter occurred. According to the
"The <service_tmr> represents the time the service being documented took place. It is required unless there
is an encounter associated with the service in which case <encounter_tmr>, which represents the time of the
encounter, is required, and <service_tmr> need not be recorded."
There was never an intent in the CDA Header to model the date/time of a procedure that occurred during an
encounter. Rather, the <service_tmr> was intended to represent the date/time of a service that occurred
outside the context of a patient encounter - but we're not sure that such a use case actually exists.
(2) Deprecate the use of the "originator", "confidentiality" and "xml:lang" attributes in the CDA Level One
Body <levelone> component. Rationale: The use of these attributes in the <levelone> component is
ambiguous - The CDA standard does not say what to do if the values in <levelone> differ from those in the
CDA Header. The CDA Header is the context of the entire document.
(3) Deprecate the use of the "originator", "confidentiality" and "xml:lang" attributes in the following CDA
Level One Body components: <link>, <coded_entry>, <observation_media>, <local_markup>. Rationale:
The CDA differentiates between Structures and Entries. We've agreed to differentiate the context of a
structure from the context of an entry. In order to guarantee safe context (meaning that contextual attributes
are inherited by nested content unless explicitly overridden), we've limited the "originator",
"confidentiality" and "xml:lang" attributes to CDA structures.
(4) Deprecate the data type of <participation_tmr> for <authenticator>, <legal_authenticator>, and
<originator> from a time interval (IVL_TS) to a time point (TS). Rationale: This may have been an
oversight in CDA. It's not clear that there are any use cases for these to be an interval.