2017 Ask me a Question Archive

  1. what CCD type is this 'small' thing that some want... as I understand it they just want allergies/problems/medications (just the basics) and no episode stuff?
  2. Hi,

    As we are building a RESTful API based on FHIR standards for sending query about a patient and receiving back the requested information, do we have standard/format/schema defined in FHIR for sending a query with patient's ID or other demographics?
    1. It's a restful thing. For Patient it would be:
      Where possible query parameters can be found here:
  3. Fairly (I think) simple question: where would I place a medicare provider identifier for an inpaitent hospital (for use in an X12 transmission, eventually) in a v3 CDA?

    I'm looking at Grahame's book, which suggests that all information to 'contact, bill to and collect from' the payer should be in the payer section, but it seems to make sense that if the PNI sits in the recordTarget/providerOrganization then the medicare id would as well.
    1. When I Google Medicare provider identifier, all I get are pages referencing NPI. It would appear to be the same thing. But if not the same thing, it would certqinly go into the same place. NPI is not about how to reach the payer, so much as it is how to identify the provider to the payer, any payer, or, to identify them to anyone else for that matter
  4. After reading Grahame's book, where he describes that in a CCD all information to authorize, bill, contact and collect from a payer should be in the payer section: would the medicare identifier for a hospital go in there, or be in the provider organization under clinicaldocument?
  5. Hi Keith,

    I have always been a fan and learn so much from the discussions over the years on your blog. I am a first timer asking a question. I have been reviewing the CCDA r2 document and looking for an answer which I am having problems with. I read through the implementation guide but I am trying to find out if clinical indicators should be included in the machine readable section of the CCDA. I am not a developer but am trying to learn more about the CCDA and this is one of my first questions. I understand HL7 but if you could point me in the right direction for an answer, I would appreciate it. My assumption upon my research is they are not required to be included. Thank you for your itme.
    1. If, by "Clinical Indicators", you mean indications for a procedure, diagnostic test, medication or other therapy, you are correct in noting that these are NOT required in most implementation guides (including CCDA). However, they are supported by many of them, including CCDA, and by the base CDA standard. They are often shown as the "Reason" or indication. See the relationships tab on Indication here in Trifolia.

    2. Dude you Rock. That is exactly what I meant. I appreciate the quick response. I am reviewing our recommendation. Thanks again.
  6. We are running into aggregated CCDAs with XML/HTML reports inside the lab result values. Our current stylesheets cannot handle that. Any suggestions on how to go about rendering these lab results using the stylesheet.

  7. We are running into aggregated Cda documents with XML/HTML (full body html documents) inside the lab result nodes. Our stylesheet does not handle displaying such embedded test results. Are there any stylesheets out to display these test results properly?
    1. The real question here is whether this embedded test result proper?
  8. Hi Keith,

    We're looking for looking for sample clinical docs CCDA, C32, but from the vendor community, e.g.Epic CCDA's Cerner CCDAs, NextGen, GE, etc. We've found Josh Mandel's work on Git (https://github.com/chb/sample_ccdas), which is great stuff and some of the work from the CDA example task force work,
    which is vendor agnostic. Are there additional resources similar to Josh's work that provide vendor/product/version specific examples (but contain no PHI/PID) that you know of?


  9. Mike, if your company participated in IHE Connectathon, you'd have access to a large number of sample CCDAs as well for additional testing. Otherwise, I'm not aware of other test sets available.

  10. Hi,
    I am looking for a CCDA template for Mu3 requirement. I found few CCDA 2.1 version files but not finding a full CCDA template file with its XSD file.
    I need to know that there in CCDA file, lot of templateid's so need some description (which template ID should come where) of it.
    Can anyone help me into this.

    Also i need to create XDM package file for MU3 and for that i need CCDA file its MetaData.XML file template also.

    1. You need to read the standards themselves to understand this better. You can find the CCDA Standard on the HL7 Web Site and the XDM Profile on the IHE Web Site (look in Volume 3 of the ITI Technical Framework).
  11. What are the most important differences between C-CDA R2.1 and R1.1?
    1. Criticality in Allergy instead of severity and the new Care Plan templates
  12. I am validating my CCDA file with file "170.315_b1_toc_amb_sample1_v13.pdf" and validation objective "170.315_b1_ToC_Amb". I have added component section for Medical Equipment. Now i am getting below error:

    cvc-complex-type.2.4.a: Invalid content was found starting with element 'templateId'. One of '{"urn:hl7-org:v3":id, "urn:hl7-org:v3":code, "urn:hl7-org:v3":addr, "urn:hl7-org:v3":telecom, "urn:hl7-org:v3":playingDevice, "urn:hl7-org:v3":playingEntity, "urn:hl7-org:v3":scopingEntity}' is expected.

    Can you please help?
    1. This is a schema related error. It appears as if you have a element after the element within the , and it should be before it. That's the only explanation I can think of that would have caused this error without actually seeing the XML.
  13. Hi Keith,

    My Client is using Mirth result as a CDR. I'm new to CDR. Wanted to understand what are pros and cons of Mirth Result CDR over other CDR available in the market (I dont know others CDRs)?

    Thank you!
    1. This is not a product I have used. You would be better off looking at Klas reports on CDRs or reviews by others.
  14. Hi Keith,

    I'm working on Reconciliation of Allergies from CCDA R2.1.

    I have no known allergies, unknown allergies, not allergic to a specific substance.

    All those three sections looks identical and they all have the negation indicator.

    I only want to reconcile the No Known Allergies.

    Is there any way to differentiate between No Known Allergy, Unknown Allergy and Not Allergic to specific substance?

    I appreciate any help you can provide.

    1. No known allergy negates allergy coded using SNOMED CT general code for type of allergy, and uses negationInd=true. Not allergic top specific substance uses a more specific code identifying the substance.

      Unknown allergy is a postive assertion that there is an allergy where the code for the substance is represented using nullFlavor='UNK'.

      On the other hand, if it is unknown whether there is an allergy, that applies nullFlavor to the allergy concern observation itself, rather than a component of it.
  15. Hi Satish,

    Keith might have other references, but one reference that might be helpful is the HL7 Example Task Force site. Here is the link for the Allergies samples: http://hl7-c-cda-examples.herokuapp.com/sections/595166e8e6ca6a48c70dac56

    Hope this helps.

    1. Excellent reference content!
  16. I have written a moderately successful EHR system for small behavioral health agencies and I decided that I need to get ONC 2015 Edition certified. I have been researching for about a week and it seems all the documentation assumes you already understand all the other documentation plus the standards have changed over time, so it is slow going. Is there any one place that can tell me what the what the current standard is, english translations of the terms, and whether or not something is optional (for behavioral health I know I must include a vital statistics section, but that information is always going to be blank)? For example, what does "Clinical Information Reconciliation and Incorporation" mean?
    1. If you want ONE site, try Google.
      Certification is NOT simple. The NIST Test Methods are a good starting place. You can find them here.
  17. Dear Keith - In the near future, I will be interfacing our product to a hospital's EPIC system, via EPIC native protocols (not Rhapsody). In the open EPIC standard, I see FHIR endpoints for Patient and Procedure, but with limited search parameters. What I need is to be able to find all patients that have been scheduled for a particular type of surgery, on a daily basis. I also need to find all patients whose clinic (not surgery) appointment dates have been changed, on a per-clinic basis. This does not seem like a straightforward task under EPIC (normally, in SQL, I would use a "modified" timestamp to find all records that were changed). Their IT staff seems to not prefer (or have used) EPIC's FHIR protocol, so that may not be what I end up with. Can you give me an idea of the most straightforward way to accomplish the aforementioned tasks?
  18. Hello I would like to understand how easy (or difficult) it would be for a large hospital to locate and sever archived HL7 messages in response to an access-to-information request from an individual patient. Any help or links you can provide would be much appreciated!
    1. As HL7 Messaging goes, easy enough. It's not a technology problem, its a policy issue. As hospital policy goes, well, good luck with that one.
  19. In the C-CDA R2.1, what is the difference between the Medication Supply Order (V2) and the Medication Dispense (V2) entries?
    1. The former is the request to a pharmacy, the latter is a report from the pharmacy that the request has been performed.
  20. Dear Kieth, in you blog post from March (http://motorcycleguy.blogspot.com/2017/03/diagnostic-imaging-reports-in-ccd.html) you mentioned the issue of e1 containing a diagnostic image report in the body of the document. I've encountered this issue and was wondering if you'd found a resolution, or could point me to someone who may help resolve this? Thanks!


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