Ask me a Question

This page was inspired by Grahame Grieve.  Simply post a comment with your question or topic suggestion below.  I'll either answer it in a followup comment, or write a post on it.

[Note: Due to increases in spamming on other pages, your comment may not be published immediately.  Don't worry, I'll accept all comments so long as they aren't spam, and if I cannot answer it, I'll let you know.  One benefit of this new approach is that it should encourage me to answer your questions sooner!]

The rules are simple:
  1. Topics I'll cover include anything in the Tag cloud to the right...
    (Please do not ask me questions about my employer's products.  While I may sometimes be the right person to answer these, this blog is not related to my employment, and isn't the proper channel to ask or respond to those questions.  If uncertain, you can always contact me directly).
    (Also don't ask me questions about Meaningful Use certification (e.g., how to pass a test).  I'm not an authority there, and while I can tell you what is correct in the standard, I don't want to give bad advice about certification).
  2. All questions and suggestions posted are subject to this Blog's Policies.  
  3. If I don't know or cannot otherwise answer your question, I'll let you know.  
  4. Questions are not necessarily answered or addressed in the order received.  Note, the SLA here is when I can get to it, which is probably not what you are looking for.  However, I do encourage other readers to answer when possible.
Answers and Questions from 2011 have been Archived.
Answers and Questions from 2012 have been Archived.
Answers and Questions from 2013 have been Archived.
Answers and Questions from 2014 have been Archived.
Answers and Questions from 2015-2016 have been Archived.
Answers and Questions from 2017 have been Archived.


38 comments:

  1. 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?

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  2. 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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  3. Hello Kieth,

    I am struggling in understanding the differences between XDR/XDM and XDS(.b). All I know is below:

    XDR: SOAP based post over HTTPS. This will be under HISP Direct protocol.
    XDM: SOAP based post over SMTP. This will be under HISP Direct protocol.
    XDS: SOAP based post over HTTPS using SAML as and Mutual TLS for encryption.

    In healthcare industry, What approach is more acceptable? XDS.b or XDR?

    ReplyDelete
    Replies
    1. XDR and XDM are used for messaging, and supported by the Direct protocol. Most every EHR in the US supports the Direct protocol in some way, most often through XDM and SMTP (though XDR is also used to some extent). NOTE: XDM is NOT SOAP based.

      XDS.b is widely used with HIE systems, and is likely the preferred approach for HIE connections.

      All are widely acceptable, the question is, what is your specific use case, and then you can get a better answer.

      Delete
  4. Hello,
    On the Fhir coverage resource, what type indicates "Medicare" and what type indicates "Medicaid"? Also is there an easy way of identifying if the payor is a private party like "Aetna"?

    ReplyDelete
    Replies
    1. Codes used to identify coverage vary according to jurisdiction, but most are commonly based on Federal claims standards to identify type of payer.

      May payers (like Aetna) act in both public and private interactions (e.g., they handle some kinds of Medicare processing), so there isn't an easy way to distinguish between them.

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  5. Please explain how SNOMED can provide hierarchy and ontology coding

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  6. Using a Google search, I came across your blog post for 04/27/2010 concerning Advance Directives in a CCD. You mentioned the advance directive content should not be included in a CCD, and indeed, the Advance Directive Observation Template (2.16.840.1.113883.10.20.22.4.48) did not allow for a value element. However, there has since been a 2015-08-01 update to this template requires a value element. I've seen many sample CCD's, including in HL7 documentation, that have a value element here describing the advance directive content. Is your old blog post now obsolete, and advance directive content can and should be summarized in the value element?

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    Replies
    1. Summarized as to type, perhaps, but not in more detail. The challenge is that an advance directive can be VERY specific, but the summary not. For example, a no intubation order may be for a specific time period, but that would not be captured in a summary, and thus anything more than the type of content contains can result in a misapplication of the patient's intent.

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  7. Having zero knowledge at all, how long will it take for a person to learn HL7 Messaging?....

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  8. With zero knowledge at all, how long will it take for a person to learn HL7 Messaging?...Thanks in advance

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    Replies
    1. A junior developer given the first four or five chapters of HL7 V2 could learn the basics on their own well enough to craft a functional ADT message in a couple of weeks. Lab inbound would take about a month. Orders outbound could take a couple of months. V3 message requires training, and at least a quarter to het something working... 6 months to conformance for anything usefull. FHIR? Give them a week with it.

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  9. Hi Keith - I'm trying to track down the differences between the HL7 QRDA CAT III and CMS QRDA CAT III standard for 2018 reporting. I believe that payer is expressed differently, but I'm not really finding a good comparison of the two on line.
    Questions -
    Is payer the only difference that you know of?
    If not, do you know of a good resource for me to learn more?

    thanks very much,
    Laura

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  10. regarding dates and timestamps -
    unless time is clearly irrelevant, keep as datetime datattype, and convert on the fly, e.g., convert(date,DateCreated)='2018-04-09'

    ReplyDelete
    Replies
    1. I would be keeping as both for efficiency, which is about as good as converting on the fly, because the additional storage is small and cheap.

      Delete
  11. Any good places to find a complete list of typeCodes, classCodes, and moodCodes?

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  12. Hi,

    I want to understand the main difference between CDA/CCDA/CCD/C32. I understand that CDA is a schema, CCD is a document, CCDA can have sections from CCD and other documents also and I don't know C32. And there are multiple releases for each one. Can you give me a little deeper insight into them? And what are the identifying elements for each one. I heard all of them serve same purpose, do they?

    Please educate me on this?

    Thank You.

    ReplyDelete
  13. Good afternoon Keith,
    We are struggling to get clarification on the CCD. In 2014 Edition certification we have creted one consolidated CCD (xml) which included discharge summary and SOC. Based on the certification company we are being told with 2015 Edition we need to generate at least 3 different xml document with different templates.
    I cannot get a good answer from any resources I have. What is your take on this.

    I appreciate your feedback.

    ReplyDelete
    Replies
    1. Paul, your certifier is most certainly right, and is a good resource to trust. In 2014, you had to show compliance with CCDA. In 2015 you have to go further. You can find the test procedures here: 2015 Edition Test Methods

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  14. Hi Keith,
    I met you at a conference in Phoenix 2017. You provided a presentation on FHIR.
    I’m teaching a master’s level class in Data Management and FHIR is currently being discussed. Is it still relevant and a cutting-edge technology?
    Thanks, Jill Snider

    ReplyDelete
    Replies
    1. Absolutely! Just have a look at the increasing frequency of posts which mention FHIR on this blog.

      Delete
  15. Hi Keith,
    How do you represent a phone number with an extension in a R2.1 CCDA
    Thanks

    ReplyDelete
    Replies
    1. See extension at https://tools.ietf.org/html/rfc3966#page-5

      Delete
  16. This is more than a bar bet, but do non-CCD documents contain the LOINC code 34133-9? I thought the LOINC code 34133-9 and template ID 2.16.840.1.113883.10.10.20.22.1.2 of 2.16.840.1.113883.10.10.20.22.1.1 togethr defined a Continuity of Care Document. There is a disagreement on our team about this. We need a referee and an expert, hence I contacted you!

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    Replies
    1. There is absolutely no requirement that this LOINC be only used on CCD documents. The HL7 Care Record Summary predates (and is the direct antecedant) the CCD and could use this code. The likelyhood is small, but does exist and there are some non-CCD Summary of Episode Notes out there using this. If you said NOT just CCD, you win the bet, otherwise you are buying the next round.

      Delete
  17. Well, I'm out a couple bucks! I hope there's a cheap beer night somewhere in Atlanta!

    thanks!

    ReplyDelete
  18. As a follow-up, is a CCD only identified with templateIDs then? (still some lingering discussion) Would these two template IDs (2.16.840.1.113883.10.10.20.22.1.2 or 2.16.840.1.113883.10.10.20.22.1.1) then be used as only identifying CCDs? I did read your blog where you state (i edited a bit):


    Identifies document as a CCDA Release 2.1 or later
     
    Indicates document is backwards compatible with CCDA Release 1.1
    If only one templateId where root="2.16.840.1.113883.10.20.22.1.1" and no extension (like extension="2015-08-01")
    The document (CCDA 1.1) hasn't been uplifted to CCDA 2.1 yet
    templateId where root="2.16.840.1.113883.10.20.22.1.1" but extension="2014-06-09" 
    The document (CCDA 2. won't be backwards compatible with CCDA 1.1

    (I have your CDA book too, but I couldn't find the answer to this question. If it's in there, can you please let me know?)

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    Replies
    1. It's not in there, the book was written in 2010 and published in early 2011. Given my focus on FHIR these days, a second edition (even though needed) probably isn't going to happen any time soon.

      Delete
    2. CCD has a document type as well as a template ID. Generally you can use a combination of templateId and ClinicalDocument/code to identify which of the CCDA document types is present.

      Delete
  19. Hi Keith - After reading chapter 6, I decided to try wrapping a base64 encoded pdf in a CDA document. Are there any tools out there that will let me test my work? Thanks!

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    Replies
    1. You might look into IHE Mesa testing tools, but I haven't had to do any IHE validation of CDA wrapped PDFs in some time, so I don't know what is available.

      Delete
  20. What should a FHIR response look like when no information is available? For instance, if the query is for a patient's medications and the patient does not have any medications, what should the response be? I was told to use a Bundle but we do not use List Resources. Thank you!

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    Replies
    1. A query that has no matching data will always return an empty Bundle. (A query that has matching data will return a Bundle with the first set of matching entries.) The use of List doesn't really come into it.

      Delete
  21. Hi Keith,
    I'm struggling with standards to submit vital signs tagged as recorded via telemonitored device. As we move towards this type of healthcare, is there any standard way to code this? jprusik@hixny.org Thank you!

    ReplyDelete