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Latest revision as of 14:58, 1 June 2008
HIMSS and RSNA
Integrating the Healthcare Enterprise
IHE Patient Care Coordination
Technical Framework
Volume II
Revision 3.0
2008-2009
Public Comment
- (PCC TF-2/Preface)Preface
- (PCC TF-2/Introduction)Introduction
IHE Transactions
This section defines each IHE transaction in detail, specifying the standards used, and the information transferred.
IHE Patient Care Coordination Bindings
This section describes how the payload used in a transaction of an IHE profile is related to and/or constrains the data elements sent or received in those transactions. This section is where any specific dependencies between the content and transaction are defined.
A content integration profile can define multiple bindings. Each binding should identify the transactions and content to which it applies.
The source for all required and optional attributes have been defined in the bindings below. Three tables describe the three main XDS object types: XDSDocumentEntry, XDSSubmissionSet, and XDSFolder. XDSSubmissionSet and XDSDocumentEntry are required. Use of XDSFolder is optional. These concepts are universal to XDS, XDR and XDM.
The columns of the following tables are:
- <XXX> attribute – name of an XDS attribute, followed by any discussion of the binding detail.
- Optional? - Indicates the required status of the XDS attribute, and is one of R, R2, or O (optional). This column is filled with the values specified in the XDS Profile as a convenience.
- Source Type – Will contain one of the following values:
| Source Type | Description |
| SA | Source document Attribute – value is copied directly from source document. The Source/Value column identifies where in the source document this attribute comes from. Specify the location in XPath when possible. |
| SAT | Source document Attribute with Transformation – value is copied from source document and transformed. The Source/Value column identifies where in the source document this attribute comes from. Specify the location in XPath when possible. Extended Discussion column must not be empty and the transform must be defined in the extended discussion |
| FM | Fixed (constant) by Mapping - for all source documents. Source/Value column contains the value to be used in all documents. |
| FAD | Fixed by Affinity Domain – value configured into Affinity Domain, all documents will use this value. |
| CAD | Coded in Affinity Domain – a list of acceptable codes are to be configured into Affinity Domain. The value for this attribute shall be taken from this list. |
| CADT | Coded in Affinity Domain with Transform - a list of acceptable codes are to be configured into Affinity Domain. The value for this attribute shall be taken from this list. |
| n/a | Not Applicable – may be used with an optionality R2 or O attribute to indicate it is not to be used. |
| DS | Document Source – value comes from the Document Source actor. Use Source/Value column or Extended Discussion to give details. |
| O | Other – Extended Discussion must be 'yes' and details given in an Extended Discussion. |
- Source/Value – This column indicates the source or the value used.
The following tables are intended to be summaries of the mapping and transforms. The accompanying sections labeled 'Extended Discussion' are to contain the details as necessary.
Medical Document Binding to XDS, XDM and XDR
This binding defines a transformation that generates metadata for the XDSDocumentEntry element of appropriate transactions from the XDS, XDM and XDR profiles given a medical document and information from other sources. The medical document refers to the document being stored in a repository that will be referenced in the registry. The other sources of information include the configuration of the Document Source actor, the Affinity Domain, the site or facility, local agreements, other documents in the registry/repository, and this Content Profile.
In many cases, the CDA document is created for the purposes of sharing within an affinity domain. In these cases the context of the CDA and the context of the affinity domain are the same, in which case the following mappings shall apply.
In other cases, the CDA document may have been created for internal use, and are subsequentyly being shared. In these cases the context of the CDA document would not neccessarily coincide with that of the affinity domain, and the mappings below would not necessarily apply.
Please note the specifics given in the table below.
XDSDocumentEntry Metadata
| XDSDocumentEntry Attribute | Optional? | Source Type | Source/ Value |
|---|---|---|---|
| availabilityStatus | R | DS | |
| authorInstitution | R2 | SAT |
$inst <=
/ClinicalDocument/author |
| authorPerson | R2 | SAT |
$person <= /ClinicalDocument/author
|
| authorRole | R2 | SAT | This metadata element should be based on a mapping of the participation function defined in the CDA document to the set of author roles configured for the affinity domain. If the context of the CDA coincides with that of the affinity domain, then the following x-path may be appropriate: /ClincicalDocument/author/ participationFunction |
| authorSpecialty | R2 | SAT | This metadata element should be based on a mapping of the code associated with the assignedAuthor to detailed defined classification system for healthcare providers such configured in the affinitity domain. Possible classifications include those found in SNOMED-CT, or the HIPAA Healthcare Provider Taxonomy. If the context of the CDA coincides with that of the affinity domain, then the following x-path may be appropriate: /ClinicalDocument/author/ assignedAuthor/code |
| classCode | R | CADT | Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code |
| classCodeDisplayName | R | CADT | DisplayName of the classCode derived. Derived from a mapping of /ClinicalDocument/code/@code to the appropriate Display Name based on the Type of Service. Must be Consitent with /ClinicalDocument/code/@code |
| confidentialityCode | R | CADT | Derived from a mapping of /ClinicalDocument/confidentialityCode/@code to an Affinity Domain specified coded value and coding system. When using the BPPC profile, the confidentialyCode may also be obtained from the <authorization> element.
|
| comments | O | DS | |
| creationTime | R | SAT | /ClinicalDocument/effectiveTime
|
| entryUUID | R | DS | |
| eventCodeList | O | CADT | These values express a collection of keywords that may be relevant to the consumer of the documents in the registry. They may come from anywhere in the CDA document, according to its purpose. |
| eventCodeDisplayNameList | R (if event Code is valued) |
CADT | These are the display names for the collection of keywords described above. |
| formatCode | R | FM | The format code for each PCC Document content profile is provided within the document specifications. |
| healthcareFacilityTypeCode | R | CAD | A fixed value assigned to the Document Source and configured form a set of Affinity Domain defined values. Must be concistent with /clinicalDocument/code |
| healthcareFacility TypeCodeDisplay Name |
R | CAD | Must be concistent with /clinicalDocument/code |
| intendedRecipient (for XDR, XDM) | O | SAT |
$person <=
/ClinicalDocument/intendedRecipient
"^^^^^&", |
| languageCode | R | SA | /ClinicalDocument/languageCode |
| legalAuthenticator | O | SAT | $person <= /ClinicalDocument/ legalAuthenticator
|
| mimeType | R | FM | text/xml |
| parentDocumentRelationship | R (when applicable) |
DS | Local document versions need not always be published, and so no exact mapping can be determined from the content of the CDA document. The parentDocumentRelationship may be determined in some configurations from the relatedDocument element present in the CDA dsocument. If the context of the CDA coincides with that of the affinity domain, then the following x-path may be appropriate: /ClinicalDocument/relatedDocument/@typeCode |
| parentDocumentId | R (when parent Document Relationship is present) |
DS | Local document versions need not always be published, and so no exact mapping can be determined from the content of the CDA document. The parentDocumentId may be determined in some configurations from the relatedDocument element present in the CDA dsocument. If the context of the CDA coincides with that of the affinity domain, then the following x-path may be appropriate: $docID <= /ClinicalDocument/ relatedDocument/parentDocument/id
|
| patientId | R | DS | The XDS Affinity Domain patient ID can be mapped from the patientRole/id element using transactions from the ITI PIX or PDQ profiles. See sourcePatientId below. If the context of the CDA coincides with that of the affinity domain, then the following x-path may be appropriate:
|
| practiceSettingCode | R | CAD | This elements should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC. |
| practiceSettingCodeDisplayName | R | CAD | This element shall contain the display names associated with the codes described above. |
| serviceStartTime | R2 | SAT | /ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/low/ @value
|
| serviceStopTime | R2 | SAT | /ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/high/ @value
|
| sourcePatientId | R | SAT | $patID <= /ClinicalDocument/recordTarget/ patientRole/id
|
| sourcePatientInfo | R | SAT | /ClinicalDocument/recordTarget/ patientRole
|
| title | O | SA | /ClinicalDocument/title |
| typeCode | R | CADT | /ClinicalDocument/code/@code
|
| typeCodeDisplay Name |
R | CADT | /ClinicalDocument/code/@displayName |
| uniqueId | R | SAT | $docID <= /ClinicalDocument/id
|
XDSSubmissionSet Metadata
The submission set metadata is as defined for XDS, and is not necessarily affected by the content of the clinical document. Metadata values in an XDSSubmissionSet with names identical to those in the XDSDocumentEntry may be inherited from XDSDocumentEntry metadata, but this is left to affinity domain policy and/or application configuration.
Use of XDS Submission Set
This content format uses the XDS Submission Set to create a package of information to send from one provider to another. All documents referenced by the Medical Summary in this Package must be in the submission set.
Use of XDS Folders
No specific requirements identified.
Configuration
IHE Content Profiles using this binding require that Content Creators and Content Consumers be configurable with institution and other specific attributes or parameters. Implementers should be aware of these requirements to make such attributes easily configurable. There shall be a mechanism for the publishing and distribution of style sheets used to view clinical documents.
Extensions from other Domains
Scanned Documents (XDS-SD)
XDS-SD is a CDA R2 document and thus conforms to the XDS Metadata requirements in the PCC-TF, volume 2, Section 5 unless otherwise specified below.
XDSDocumentEntry
XDS-SD leverages the XDS DocumentEntry Metadata requirements in the PCC-TF, volume 2, Section 5.1.1.1.1 and in PCC_TF-2/Bindings unless otherwise specified below
XDSDocumentEntry.formatCode
The XDSDocumentEntry.formatCode shall be urn:ihe:iti:xds-sd:pdf:2008 when the document is scanned pdf and urn:ihe:iti:xds-sd:text:2008 when the document is scanned text. The formatCode codeSystem shall be 1.3.6.1.4.1.19376.1.2.3.
XDSDocumentEntry.uniqueId
This value shall be the ClinicalDocument/id in the HL7 CDA R2 header. The root attribute is required, and the extension attribute is optional. In accordance with the XDS.a profile, total length is limited to 128 characters; for XDS.b the limit is 256 characters. Additionally see PCC-TF, volume 2, Section 5.1.1.1.1 or PCC_TF-2/Bindings for further content specification.
Relating instances of XDS-SD documents
In general, most instances of XDS-SD will not have parent documents. It is possible, however, in some specific use cases that instances of XDS-SD documents are related. For example, for a particular document it may be the case that both the PDF scanned content and somewhat equivalent plaintext need to be wrapped and submitted. Each document would correspond to separate XDSDocumentEntries linked via an XFRM Association that indicates one document is a transform of the other. These can be submitted in a single submission set, or in separate ones. Other specific examples may exist and this profile does not preclude the notion of a parent document for these cases.
XDSSubmissionSet
No additional constraints. Particular to this profile, a legitimate use of submission sets would be to maintain a logical grouping of multiple XDS-SD documents. We encourage such usage. For more information, see PCC-TF-2 Section 5.1.1.1.2 or PCC_TF-2/Bindings.
XDSFolder
No additional requirements. For more information, see PCC-TF-2 Section 5.1.1.1.3 or PCC_TF-2/Bindings.
Basic Patient Privacy Consents (BPPC)
Laboratory Reports (XD-LAB)
XD-Lab is a CDA R2 document and thus conforms to the XDS Metadata requirements in the PCC-TF, volume 2, Section 5 unless otherwise specified below.
XDSDocumentEntry
XD-Lab leverages the XDS DocumentEntry Metadata requirements in the PCC-TF, volume 2, Section 5.1.1.1.1 and in PCC_TF-2/Bindings unless otherwise specified below
XDSDocumentEntry.eventCodeList
XD-Lab documents further constrain the the XDSDocumentEntry.eventCodeList to the following.
| Attribute | Optional? | Source Type | Source/ Value |
|---|---|---|---|
| eventCodeList | R2 | SAT | ClinicalDocument / component / structuredBody / component / section / entry / act / entryRelationship / organizer (templateId="1.3.6.1.4.1.19376.1.3.1.1")/ component / observation(templateId="1.3.6.1.4.1.19376.1.3.1.1.1")/code
AND ClinicalDocument / component / structuredBody / component / section / entry / act / subject / code If the document has Reportable Condition, then this code shall be among those listed in the eventCodeList. Additionally, if the document contains information about a Non-Human Subject, then the code that indicates what this subject is shall be among those listed in the eventCodeList. Thus, this attribute has been enhanced from the XDS profile from O to R2. |
XDSDocumentEntry.formatCode
The XDSDocumentEntry.formatCode shall be urn:ihe:lab:xd-lab:2008 The formatCode codeSystem shall be 1.3.6.1.4.1.19376.1.2.3.
XDSSubmissionSet
No additional constraints. For more information, see PCC-TF-2 Section 5.1.1.1.2 or PCC_TF-2/Bindings.
XDSFolder
No additional requirements. For more information, see PCC-TF-2 Section 5.1.1.1.3 or PCC_TF-2/Bindings.
Namespaces and Vocabularies
This section lists the namespaces and identifiers defined or referenced by the IHE PCC Technical Framework, and the vocabularies defined or referenced herein.
The following vocabularies are referenced in this document. An extensive list of registered vocabularies can be found at http://www.hl7.org/oid/.
| codeSystem | codeSystemName | Description |
| 1.3.6.1.4.1.19376.1.5.3.1 | IHE PCC Template Identifiers | This is the root OID for all IHE PCC Templates. A list of PCC templates can be found below in CDA Release 2.0 Content Modules. |
| 1.3.6.1.4.1.19376.1.5.3.2 | IHEActCode | See IHEActCode Vocabulary below |
| 1.3.6.1.4.1.19376.1.5.3.3 | IHE PCC RoleCode | See IHERoleCode Vocabulary below |
| 1.3.6.1.4.1.19376.1.5.3.4 | Namespace OID used for IHE Extensions to CDA Release 2.0 | |
| 2.16.840.1.113883.10.20.1 | CCD Root OID | Root OID used for by ASTM/HL7 Continuity of Care Document |
| 2.16.840.1.113883.5.112 | RouteOfAdministration | See the HL7 RouteOfAdministration Vocabulary |
| 2.16.840.1.113883.5.1063 | SeverityObservation | See the HL7 SeverityObservation Vocabulary |
| 2.16.840.1.113883.5.7 | ActPriority | See the HL7 ActPriority Vocabulary |
| 2.16.840.1.113883.6.1 | LOINC | Logical Observation Identifier Names and Codes |
| 2.16.840.1.113883.6.96 | SNOMED-CT | SNOMED Controlled Terminology |
| 2.16.840.1.113883.6.103 | ICD-9CM (diagnosis codes) | International Classification of Diseases, Clinical Modifiers, Version 9 |
| 2.16.840.1.113883.6.104 | ICD-9CM (procedure codes) | International Classification of Diseases, Clinical Modifiers, Version 9 |
| 2.16.840.1.113883.6.26 | MEDCIN | A classification system from MEDICOMP Systems. |
| 2.16.840.1.113883.6.88 | RxNorm | RxNorm |
| 2.16.840.1.113883.6.63 | FDDC | First DataBank Drug Codes |
| 2.16.840.1.113883.6.12 | C4 | Current Procedure Terminology 4 (CPT-4) codes. |
| 2.16.840.1.113883.6.257 | Minimum Data Set for Long Term Care | The root OID for Minimum Data Set Answer Lists |
| 1.2.840.10008.2.16.4 | DCM | DICOM Controlled Terminology; PS 3.16 Content Mapping Resource, Annex D |
| 2.16.840.1.113883.6.24 | MDC | ISO/IEEE 11073 Medical Device Nomenclature |
| 2.16.840.1.113883.3.26.1.5 | NDF-RT | National Drug File Reference Terminology (NCI version) |
| 2.16.840.1.113883.11.19465 | nuccProviderCodes | National Uniform Codes Council Healthcare Provider Terminology |
| 2.16.840.1.113883.6.255.1336 | X12DE1336 | Insurance Type Code (ASC X12 Data Element 1336) |
| 2.16.840.1.113883.6.256 | RadLex | RadLex (Radiological Society of North America) |
The IHE FormatCode vocabulary is now managed in an Implementation Guide published using FHIR.
- formal canonical URI https://profiles.ihe.net/fhir/ihe.formatcode.fhir/ValueSet-formatcode.html
- formal publication URL https://profiles.ihe.net/fhir/ihe.formatcode.fhir/
- FormatCode gitHub repository for source of the Implementation Guide can be used to register issues, or create pull requests for modifications. Formal governance is managed by ITI Technical Committee.
This FormatCode vocabulary represents:
- Code System 1.3.6.1.4.1.19376.1.2.3
- Value Set 1.3.6.1.4.1.19376.1.2.7.1
IHEActCode Vocabulary
| CCD | ASTM/HL7 Continuity of Care Document | |
| CCR | ASTM CCR Implementation Guide |
The IHEActCode vocabulary is a small vocabulary of clinical acts that are not presently supported by the HL7 ActCode vocabulary. The root namespace (OID) for this vocabulary is 1.3.6.1.4.1.19376.1.5.3.2. These vocabulary terms are based on the vocabulary and concepts used in the CCR and CCD standards listed above.
| Code | Description |
| COMMENT | This is the act of commenting on another act. |
| PINSTRUCT | This is the act of providing instructions to a patient regarding the use of medication. |
| FINSTRUCT | This is the act of providing instructions to the supplier regarding the fulfillment of the medication order. |
| IMMUNIZ | The act of immunization of a patient using a particular substance or class of substances identified using a specified vocabulary. Use of this vocabulary term requires the use of either the SUBSTANCE or SUBSTCLASS qualifier described below, along with an identified substance or class of substances. |
| DRUG | The act of treating a patient with a particular substance or class of substances identified using a specified vocabulary. Use of this vocabulary term requires the use of either the SUBSTANCE or SUBSTCLASS qualifier described below, along with an identified substance or class of substances. |
| INTOL | An observation that a patient is somehow intollerant of (e.g., allergic to) a particular substance or class of substances using a specified vocabulary. Use of this vocabulary term requires the use of either the SUBSTANCE or SUBSTCLASS qualifier described below, along with an identified substance or class of substances. |
| SUBSTANCE | A qualifier that identifies the substance used to treat a patient in an immunization or drug treatment act. The substance is expected to be identified using a vocabulary such as RxNORM, SNOMED CT or other similar vocabulary and should be specific enough to identify the ingredients of the substance used. |
| SUBSTCLASS | A qualifier that identifies the class of substance used to treat a patient in an immunization or drug treatment act. The class of substances is expected to be identified using a vocabulary such as NDF-RT, SNOMED CT or other similar vocabulary, and should be broad enough to classify substances by mechanism of action (e.g., Beta Blocker), intended effect (Dieuretic, antibiotic) or ... |
| For Public Comment | What else needs to appear above for SUBSTCLASS? |
IHERoleCode Vocabulary
The IHERoleCode vocabulary is a small vocabulary of role codes that are not presently supported by the HL7 Role Code vocabulary. The root namespace (OID) for this vocabulary is 1.3.6.1.4.1.19376.1.5.3.3.
| Code | Description |
| EMPLOYER | The employer of a person. |
| SCHOOL | The school in which a person is enrolled. |
| AFFILIATED | An organization with which a person is affiliated (e.g., a volunteer organization). |
| PHARMACY | The pharmacy a person uses. |