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CDAR2_IG_IHE_CONSOL_R1_D1_2011MAY_AMALGAMATED_20110505163001

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					                                                            V3 Ballot Submission/Resolution Form

                             BALLOT TITLE:       HL7 Implementation Guides for CDA Release 2: IHE Health Story Consolidation, Release 1 - US Realm
                                                 (CDAR2_IG_IHE_CONSOL_R1_D1_2011MAY) - 1st DSTU Ballot


                          BALLOT CYCLE:          MAY 2011
                      SUBMITTED BY NAME:
                      SUBMITTED BY EMAIL:

                     SUBMITTED BY PHONE:
           SUBMITTED BY ORGANIZATION (if
                             applicable):
                      SUBMISSION DATE:
                SUBMITTED BY IDENTIFIER:
                  OVERALL BALLOT VOTE:




                                                 Enter Ballot Comments (Line Items)                            Instructions




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Submitter]                                  1                                                              March 2003
                                                            V3 Ballot Submission/Resolution Form

                             BALLOT TITLE:       HL7 Implementation Guides for CDA Release 2: IHE Health Story Consolidation, Release 1 - US Realm
                                                 (CDAR2_IG_IHE_CONSOL_R1_D1_2011MAY) - 1st DSTU Ballot


                          BALLOT CYCLE:          MAY 2011
                      SUBMITTED BY NAME:
                      SUBMITTED BY EMAIL:

                     SUBMITTED BY PHONE:
           SUBMITTED BY ORGANIZATION (if
                             applicable):
                      SUBMISSION DATE:
                SUBMITTED BY IDENTIFIER:
                  OVERALL BALLOT VOTE:




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Submitter]                                  2                                                              March 2003
                                                              V3 Ballot Submission/Resolution Form


                                                                                          Ballot Comment Submission

                                                                                   Vote
                                                                                   and
Number       Ballot WG    Artifact   Artifact ID    Chapter   Section       Pubs   Type    Existing Wording                   Proposed Wording

         1 StructDocs                                         5.27 Result          Neg-Mj 10. SHOULD contain zero or one      10. SHOULD contain zero or one
                                                              Observatio                  [0..1] interpretationCode           [0..*] interpretationCode
                                                              n                           (CONF:7147).                        (CONF:7147).




         2                                                    5.27 Result          Neg-Mj 6. SHOULD contain exactly one
                                                              Observatio                  [1..1] text (CONF:7138).
                                                              n                           a. element SHOULD include a
                                                                                          reference element which SHOULD
                                                                                          reference the narrative. The
                                                                                          reference/@value SHALL begin with
                                                                                          a hash '#' mark. (CONF:7139).




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                         3                                                                    March 2003
                                                        V3 Ballot Submission/Resolution Form

         3                                              5.27 Result         Neg-Mj 7. SHALL contain exactly one [1..1]
                                                        Observatio                 statusCode/@code="completed"
                                                        n                          Completed




         4 StructDocs     ??         CDAR2_IG_C Cover   Cover         Yes   Neg-Mi                                       Identify as DSTU
                                     ONSOL_R1_
                                     D1_2011APR
         5 StructDocs     ??         CDAR2_IG_C All     All           No    Neg-Mj Meaningful Use                        Global replace: Stage 1 Meaningful
                                     ONSOL_R1_                                                                           Use
                                     D1_2011APR
         6 StructDocs     ??         CDAR2_IG_C 1       1.7.4         No    Neg-Mj Figures 2 and 3 Conf 2777             It would be more clear as two
                                     ONSOL_R1_                                                                           conformance statements:
                                     D1_2011APR                                                                          1.    SHALL contain exactly one
                                                                                                                         participant with exactly one
                                                                                                                         typeCode where typeCode=”LOC”
                                                                                                                         2.    MAY contain one or more
                                                                                                                         participants with exactly one
                                                                                                                         typeCode where typeCode≠”LOC”


         7 StructDocs     ??         CDAR2_IG_C     1   1.9           No    Neg-Mj Table 1                               Add column for ballot applicability.
                                     ONSOL_R1_
                                     D1_2011APR
         8 StructDocs     ??         CDAR2_IG_C     2   2.1           No    Neg-Mi Table 3
                                     ONSOL_R1_
                                     D1_2011APR
         9 StructDocs     ??         CDAR2_IG_C     1   1.8.2         No     A-T     These documents to the Level 1,     These documents conform to the
                                     ONSOL_R1_                                                                           Level 1,
                                     D1_2011APR
       10 StructDocs      ??         CDAR2_IG_C     2   2.1.1         No     A-C
                                     ONSOL_R1_
                                     D1_2011APR




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                    4                                                                          March 2003
                                                    V3 Ballot Submission/Resolution Form

       11 StructDocs      ??         CDAR2_IG_C 2   2.1.1   No   Neg-Mj Such patientRoles SHALL contain at If the patient resides in the US, …
                                     ONSOL_R1_                          least one [1..*] US Realm Clinical
                                     D1_2011APR                         Document Header Address


       12 StructDocs      ??         CDAR2_IG_C 2   2.1.1   No   Neg-Mi 9. This patient SHOULD contain          9. This patient SHOULD contain
                                     ONSOL_R1_                          zero or one [0..1] guardian             zero or more [0..*] guardians
                                     D1_2011APR
       13 StructDocs      ??         CDAR2_IG_C 2   2.1.1   No   Neg-Mi This guardian, if present, SHALL        This guardian, if present, SHALL
                                     ONSOL_R1_                          contain exactly one [1..1] telecom      contain exactly one or more [1..*]
                                     D1_2011APR                         (CONF:5382).                            telecom (CONF:5382).
       14 StructDocs      ??         CDAR2_IG_C 2   2.1.1   No   Neg-Mi Table 11                                Remove
                                     ONSOL_R1_
                                     D1_2011APR




       15 StructDocs      ??         CDAR2_IG_C 2   2.1.2   No   Neg-Mj The author may be a device, a           The author may be a device, a
                                     ONSOL_R1_                          person, or an organization...iv. This   person, or an organization...iv. This
                                     D1_2011APR                         assignedAuthor SHALL contain            assignedAuthor SHALL contain
                                                                        exactly one [1..1] assignedPerson       exactly one [1..1] assignedPerson if
                                                                        (CONF:5430).                            and only if the author represents a
                                                                                                                person (CONF:5430) .



       16 StructDocs      ??         CDAR2_IG_C 2   2.1.5   No   Neg-Mj The custodian element represents the Add ress legal responsibility, i.e.,
                                     ONSOL_R1_                          entity responsible for maintaining   stewardship.
                                     D1_2011APR                         the availability of the clinical
                                                                        document
       17 StructDocs      ??         CDAR2_IG_C 2   2.1.6   No   Neg-Mi a. Such informationRecipients, if    Fix or clarify
                                     ONSOL_R1_                          present, SHALL contain exactly one
                                     D1_2011APR                         [1..1] intendedRecipient
                                                                        (CONF:5566).
                                                                        i. This intendedRecipient MAY
                                                                        contain zero or one [0..1]
                                                                        informationRecipient (CONF:5567).


       18 StructDocs      ??         CDAR2_IG_C 2   2.2     No   Neg-Mj The US Realm Clinical Document          The US Realm Clinical Document
                                     ONSOL_R1_                          Header Address template is used by      Header Address template is used by
                                     D1_2011APR                         US Realm Clinical Document              US Realm Clinical Document
                                                                        Header for the patient or any other     Header for the patient or any other
                                                                        person or organization mentioned        person or organization mentioned
                                                                        within it.                              within it when the represented
                                                                                                                location is in the US.



55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        5                                                                              March 2003
                                                    V3 Ballot Submission/Resolution Form

       19 StructDocs      ??         CDAR2_IG_C 2   2.2        No   Neg-Mi SHOULD contain @use, which       Address how to handle multiple uses
                                     ONSOL_R1_                             SHALL be selected from ValueSet… (address is home, and confidential,
                                     D1_2011APR                                                             and physical, and home office…)

       20 StructDocs      ??         CDAR2_IG_C 2   2.2        No   Neg-Mi Table 15                                Add "HP" for primary home.
                                     ONSOL_R1_
                                     D1_2011APR
       21 StructDocs      ??         CDAR2_IG_C 4   Various    No   Neg-Mj With the exceptions of Allergies and    Need to clarify how to express no
                                     ONSOL_R1_                             Meds, there are no instructions for     known items for every section. This
                                     D1_2011APR                            handling "no [procedures, results,      is explained for Allergies and Meds
                                                                           etc.] recorded."                        (an entry with a specific SNOMED
                                                                                                                   code), but not for other sections. I
                                                                                                                   suggest not requiring entries where
                                                                                                                   no correspoinding item exists. For
                                                                                                                   example, if there are no recorded
                                                                                                                   procedures, or if they have not been
                                                                                                                   coded yet, the narrative could
                                                                                                                   contain text to that effect ("No
                                                                                                                   procedures recorded for visit") and
                                                                                                                   no structured entries included.

                                                                                                                   This caused a lot of list server traffic
                                                                                                                   because the IHE profiles required
                                                                                                                   one or more entries but
                                                                                                                   implementers had no idea what to
                                                                                                                   put there.
       22 StructDocs      ??         CDAR2_IG_C 4   4.24       No   Neg-Mj The Immunizations section defines a     Change current immunization status
                                     ONSOL_R1_                             patient’s immunization status for the   to immunizations
                                     D1_2011APR                            context and use case of the             administered/refused during visit.
                                                                           document type. The section should       Also add context cross reference.
                                                                           include current immunization status,
                                                                           and may contain the entire
                                                                           immunization history.

       23 StructDocs      ??         CDAR2_IG_C 3   3.3.1.10   No   Neg-Mj 3.3.1.10 Physician Reading Study
                                     ONSOL_R1_                             Performer
                                     D1_2011APR                            [participant: templateId
                                                                           2.16.840.1.113883.10.20.6.2.2(open
                                                                           )]
                                                                           This participant is the attending
                                                                           physician and is usually different
                                                                           from the Physician Reading Study
                                                                           Performer defined in
                                                                           documentationOf/serviceEvent.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          6                                                                                  March 2003
                                                           V3 Ballot Submission/Resolution Form

       24 StructDocs      ??         CDAR2_IG_C 3          3.3.1.11   No    Neg-Mj 3.3.1.11 Physician of Record
                                     ONSOL_R1_                                     Participant
                                     D1_2011APR                                    [performer: templateId
                                                                                   2.16.840.1.113883.10.20.6.2.1(open
                                                                                   )]
                                                                                   This participant is the attending
                                                                                   physician and is usually different
                                                                                   from the Physician Reading Study
                                                                                   Performer defined in
                                                                                   documentationOf/serviceEvent.
                                                                                   1. SHALL contain exactly one [1..1]
                                                                                   performer/@typeCode="PRF"
                                                                                   (CodeSystem:
                                                                                   2.16.840.1.113883.5.6
                                                                                   HL7ActClass) (CONF:8424).
       25 StructDocs      ??         CDAR2_IG_C Appendix B Appendix   No    Neg-Mj Change log not precise enough
                                     ONSOL_R1_             B
                                     D1_2011APR




       26 StructDocs      ??         CDAR2_IG_C 4          4.19       Yes    A-T     Hopsital Course                     Hospital Course
                                     ONSOL_R1_
                                     D1_2011APR
       27 StructDocs      ??         CDAR2_IG_C 1          1.7.6      No     A-C     Null flavors
                                     ONSOL_R1_
                                     D1_2011APR


       28 StructDocs      ??         CDAR2_IG_C            General    No    Neg-Mi
                                     ONSOL_R1_
                                     D1_2011APR




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                    7                                                     March 2003
                                                    V3 Ballot Submission/Resolution Form

       29 StructDocs      ??         CDAR2_IG_C 3   3         No    Neg-Mi Lists five required sections for CCD Should not list any required
                                     ONSOL_R1_                                                                  sections, unless qualified as a "CCD
                                     D1_2011APR                                                                 conforming to Stage 1 Meaningful
                                                                                                                Use"




       30 StructDocs      ??         CDAR2_IG_C 4   4.00      No    Neg-Mi ** wherever referenced, intent is that Should say '…or both "Assessment"
                                     ONSOL_R1_                             either “Assessment and Plan” is        and "Plan of Care."'
                                     D1_2011APR                            present or both “Assessment” and
                                                                           “Plan”. Only these combinations
                                                                           should be used.


       31 StructDocs      ??         CDAR2_IG_C 4   4.10      No    Neg-Mj
                                     ONSOL_R1_
                                     D1_2011APR
       32 StructDocs      ??         CDAR2_IG_C 4   4.18      No    Neg-Mi the Procedure History section may
                                     ONSOL_R1_                             be included under the History of
                                     D1_2011APR                            Present Illness section or it may
                                                                           stand alone as its own section.


       33 StructDocs      ??         CDAR2_IG_C 4   4.40      No    Neg-Mi
                                     ONSOL_R1_
                                     D1_2011APR

       34 StructDocs      ??         CDAR2_IG_C 4   4.49      No    Neg-Mi This section records the patient's the This section records the reason for
                                     ONSOL_R1_                             reason for the patient's visit (the    the patient's visit (the provider’s
                                     D1_2011APR                            provider’s description of the reason description of the reason for visit).
                                                                           for visit). Local policy determines
                                                                           whether the information is divided
                                                                           into two sections or recorded in one
                                                                           section serving both purposes.

       35 StructDocs      ??         CDAR2_IG_C 4   4.50      No    Neg-Mi The scope includes hematology…         The scope includes observations
                                     ONSOL_R1_                                                                    such as hematology…
                                     D1_2011APR
       36 StructDocs      ??         CDAR2_IG_C     General   Yes    A-S
                                     ONSOL_R1_
                                     D1_2011APR




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                            8                                                                          March 2003
                                                    V3 Ballot Submission/Resolution Form

       37 StructDocs      ??         CDAR2_IG_C 4   4.50      No   Neg-Mj CONF:7113 SHALL contain exactly
                                     ONSOL_R1_                            one Result organizer
                                     D1_2011APR
       38 StructDocs      ??         CDAR2_IG_C 4   4.28      No   Neg-Mi
                                     ONSOL_R1_
                                     D1_2011APR




       39 StructDocs      ??         CDAR2_IG_C 4   4.35      No   Neg-Mi Plan Section                      Plan of Care Section
                                     ONSOL_R1_
                                     D1_2011APR
       40 StructDocs      ??         CDAR2_IG_C 4   4.56      No   Neg-Mi CONF:7277 SHALL contain exactly
                                     ONSOL_R1_                            one Vital Signs organizer
                                     D1_2011APR
       41 StructDocs      ??         CDAR2_IG_C     General   No    A-T     SNOMEDCT, SNOMED CT,
                                     ONSOL_R1_                              SNOMED-CT
                                     D1_2011APR

       42 StructDocs      ??         CDAR2_IG_C 1   1.7.4 and No   Neg-Mi
                                     ONSOL_R1_      constraints
                                     D1_2011APR     containing
                                                    "such that
                                                    it…"




       43 StructDocs      ??         CDAR2_IG_C 5   5.20      No   Neg-Mi
                                     ONSOL_R1_      Problem
                                     D1_2011APR     Status




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           9                                                      March 2003
                                                             V3 Ballot Submission/Resolution Form

       44 StructDocs      ??         CDAR2_IG_C 1.7.2                    No   Neg-Mi
                                     ONSOL_R1_ Conformance
                                     D1_2011APR Statements




       45 StructDocs      ??         CDAR2_IG_C              General     No   Neg-Mi
                                     ONSOL_R1_
                                     D1_2011APR




       46 StructDocs      ??         CDAR2_IG_C 5            5.2 Alert  No    Neg-Mj
                                     ONSOL_R1_               Status
                                     D1_2011APR              Observatio
                                                             n




       47 StructDocs      ??         CDAR2_IG_C 5            5.3 Allergy No   Neg-Mj
                                     ONSOL_R1_               Problem
                                     D1_2011APR              Act




       48 StructDocs      ??         CDAR2_IG_C 5            5.5         No   Neg-Mi
                                     ONSOL_R1_               Condition
                                     D1_2011APR




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                  10               March 2003
                                                    V3 Ballot Submission/Resolution Form

       49 StructDocs      ??         CDAR2_IG_C 5   5.18       No   Neg-Mi
                                     ONSOL_R1_      Medication
                                     D1_2011APR     Use - None
                                                    Known




       50 StructDocs      ??         CDAR2_IG_C 2   2.1.1     No    Neg-Mi Such patientRoles SHALL contain         Such patientRoles SHOULD contain
                                     ONSOL_R1_                             at least one [1..*] telecom             zero or more [0..*] telecom
                                     D1_2011APR                            (CONF:5280).                            (CONF:5280).
       51 StructDocs                                1.7              A-C none                                      an explanation of "optional entries"
                                                                                                                   vs. "required entries"




       52                                           1.7.4            A-Q     Figure 3- example of "only one like   an example that is representative
                                                                             this allowed".

       53                                           2.1             Neg-Mj conformance statements only             inclusion of business names and
                                                                                                                   textual descriptions for many of the
                                                                                                                   elements. There was a draft table
                                                                                                                   format recommended by the CDA
                                                                                                                   Consolidation Documentation WG
                                                                                                                   that would significantly help.
                                                                                                                   Additional textual descriptions

       54                                           2.1.2           Neg-Mj missing assignedAuthoringDevice         inclusion of these statements-
                                                                           and representedOrganization             directly or in reference




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          11                                                                             March 2003
                                                    V3 Ballot Submission/Resolution Form

       55                                           2.1.7        Neg-Mi This assignedEntity SHALL contain This assignedEntity SHOULD
                                                                        exactly one assignedPerson        contain exactly one assignedPerson.
                                                                        (CONF:5597)




       56                                           2.3          Neg-Mj despite the name template being for    inclusion of
                                                                        "the patient or any other person or    representedOrganization
                                                                        organization", there are not
                                                                        conformance statements for how an
                                                                        organization can be represented.

       57                                           2.1          Neg-Mj no "support" / "Patient Contacts"      inclusion of template for Patient
                                                                        module equivalents                     Contacts / "Support"


       58                                           2.1          Neg-Mj no "documentationOf" conformance inclusion of documentationOf
                                                                        statements                       statements



       59                                           2.4          Neg-Mj no "performer" statements within       inclusion of performer statements
                                                                        serviceEvent

       60                                           2.4           A-S    "use serviceEvent/effectiveTime/low
                                                                         with a width element"


       61                                           3.1.1.3       A-S


       62                                           3.1.2         A-T    "The Continuity of Care Document …requiring coded…
                                                                         supports both narrative sections and
                                                                         sections requiring code clinical
                                                                         statements"
       63                                           3.8           A-T    "A progress Note is not a revaluation …not a re-evaluation note
                                                                         note"




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       12                                                                         March 2003
                                                    V3 Ballot Submission/Resolution Form

       64                                           3.9           A-T    3rd paragraph: "…such as a word-        …"word-processing"
                                                                         proccesing document"

       65                                           3.9           A-C    5th paragraph: "…more restricted        "…more restricted use case,
                                                                         use case, specifically for scanned      specifically for scanned documents
                                                                         documents, and limits…"                 or 'virtually scanned' documents
                                                                                                                 (electronically created from existing
                                                                                                                 text sources), and limits…"

       66                                           4             A-S                                            inclusion of a description of the
                                                                                                                 narrative block.

       67                                           4.2           A-S    "Optional Entries"                      "Template for Entries Being
                                                                                                                 optional"


       68                                           4.2           A-S    "Required Entries"                      "Template for Entries Being
                                                                                                                 Required"


       69                                           4.5           A-S    2nd paragraph: "The assessment          delete from this paragraph or move
                                                                         formulates a specific plan or set of    to "Plan" paragraph that follows
                                                                         recommendations"
       70                                           4.9           A-S    2st paragraph: "The complications       The Complications section records
                                                                         section records problems that           problems that occurred during the
                                                                         occurred during the procedure."         serviceEvent (e.g. during the
                                                                                                                 procedure recorded in a Procedure
                                                                                                                 Note).
       71                                           4.18          A-S    "The History of Present Illness         …related to the service event (e.g.
                                                                         section describes the history related   related to the reason for the
                                                                         to the reason for the procedure."       procedure recorded in a Procedure
                                                                                                                 Note).
       72                                           4.19          A-T    "Hopsital Course Section"               "Hospital Course Section"


       73                                           4.29          A-S    "The Medications Administered           "The Medications Administered
                                                                         section defines medications and         section defines medications and
                                                                         fluids administered during the          fluids administered during the
                                                                         procedure…"                             service event (e.g. during the
                                                                                                                 procedure recorded in a Procedure
                                                                                                                 Note)."
       74                                           4.28          A-S    "Optional Entries"                      "Template for Entries Being
                                                                                                                 optional"




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       13                                                                               March 2003
                                                    V3 Ballot Submission/Resolution Form

       75                                           4.28          A-S    "Required Entries"                   "Template for Entries Being
                                                                                                              Required"


       76                                           4.2          Neg-Mj missing implementation of             inclusion of directions for
                                                                        documentation of NKDA/NKA.            documentation of NKDA/NKA

       77                                           4.4          Neg-Mj missing implementation of             inclusion of directions for
                                                                        documentation of No known             documentation of No Known
                                                                        Problems                              Problems
       78                                           4.48         Neg-Mj missing implementation of             inclusion of directions for
                                                                        documentation of No Procedures        documentation of No Procedures

       79                                           4.50         Neg-Mj missing implementation of             inclusion of directions for
                                                                        documentation of No Results           documentation of No Results

       80                                           4.40          A-C    UML Diagram



       81                                           4.48          A-S    "Optional Entries"                   "Template for Entries Being
                                                                                                              optional"


       82                                           4.48          A-S    "Required Entries"                   "Template for Entries Being
                                                                                                              Required"


       83                                           4.50          A-S    "Optional Entries"                   "Template for Entries Being
                                                                                                              optional"


       84                                           4.50          A-S    "Required Entries"                   "Template for Entries Being
                                                                                                              Required"


       85                                           4.56          A-S    "Optional Entries"                   "Template for Entries Being
                                                                                                              optional"


       86                                           4.56          A-S    "Required Entries"                   "Template for Entries Being
                                                                                                              Required"


       87                                           5.4          Neg-Mi conformance statement #8, value set inclusion of a description of what
                                                                        for "value" not defined.            the value is to represent and the
                                                                                                            expected value set.



55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       14                                                                       March 2003
                                                    V3 Ballot Submission/Resolution Form

       88                                           5.25         Neg-Mj conformance statement #4, "SHALL value set not defined
                                                                        contain exactly one…code"

       89                                           5            Neg-Mj no Comments template                     inclusion of a Comments
                                                                                                                 Annotation template (like the HITSP
                                                                                                                 C83 Comments module). I also
                                                                                                                 strongly recommend a "MAY
                                                                                                                 contain…Comment Annotation"
                                                                                                                 conformance statement in EVERY
                                                                                                                 section and entry template




       90                                           5.6          Neg-Mi a. The <text> element points to the      element SHOULD include a
                                                                        text describing the problem being        reference element which SHOULD
                                                                        recorded; including any dates,           reference the narrative. The
                                                                        comments, et cetera. The                 reference/@value SHALL begin
                                                                        <reference> contains a URI in value      with a hash '#' mark.
                                                                        attribute. This URI points to the free
                                                                        text description of the problem in the
                                                                        document that is being described.
                                                                        b. The problem name SHOULD be
                                                                        recorded in the entry by recording a
                                                                        <reference> where the value
                                                                        attribute points to the narrative text
                                                                        containing the name of the problem.


       91                                           5.11         Neg-Mi a. The 'text' elements SHOULD            element SHOULD include a
                                                                        contain a 'reference' element            reference element which SHOULD
                                                                        pointing to the narrative where the      reference the narrative. The
                                                                        severity is recorded, rather than        reference/@value SHALL begin
                                                                        duplicate text to avoid ambiguity.       with a hash '#' mark.
       92                                           5.13         Neg-Mi i. A reference/@value can point to       element SHOULD include a
                                                                        its corresponding narrative (using       reference element which SHOULD
                                                                        the approach defined in CDA              reference the narrative. The
                                                                        Release 2, section 4.3.5.1 ).            reference/@value SHALL begin
                                                                                                                 with a hash '#' mark.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       15                                                                             March 2003
                                                        V3 Ballot Submission/Resolution Form

       93                                               5.2           Neg-Mi i. A reference/@value SHOULD         element SHOULD include a
                                                                             point to its corresponding narrative reference element which SHOULD
                                                                             (using the approach defined in CDA   reference the narrative. The
                                                                             Release 2, section 4.3.5.1 ).        reference/@value SHALL begin
                                                                                                                  with a hash '#' mark.
       94                                               5.25          Neg-Mi i. A reference/@value SHOULD         element SHOULD include a
                                                                             point to its corresponding narrative reference element which SHOULD
                                                                             (using the approach defined in CDA reference the narrative. The
                                                                             Release 2, section 4.3.5.1 ).        reference/@value SHALL begin
                                                                                                                  with a hash '#' mark.
       95                                               5.27           A-C a. element SHOULD include a
                                                                             reference element which SHOULD
                                                                             reference the narrative. The
                                                                             reference/@value SHALL begin with
                                                                             a hash '#' mark.
       96                                               5.29          Neg-Mi i. A reference/@value SHOULD         element SHOULD include a
                                                                             point to its corresponding narrative reference element which SHOULD
                                                                             (using the approach defined in CDA reference the narrative. The
                                                                             Release 2, section 4.3.5.1 ).        reference/@value SHALL begin
                                                                                                                  with a hash '#' mark.
       97                                               5.31           A-C a. element SHOULD include a
                                                                             reference element which SHOULD
                                                                             reference the narrative. The
                                                                             reference/@value SHALL begin with
                                                                             a hash '#' mark.
       98 StructDocs      ??                        2   2.1            A-Q The value of @value, if present,
                                                                             SHALL be precise to the day and
                                                                             SHOULD be precise to the minute.
                                                                             If precise to minute, SHOULD
                                                                             include time-zone offset
                                                                             (CONF:5257).
       99 StructDocs      ??         Document       2   General        A-Q CONF-HP-23: Shall contain
                                     Templates          Header               [1..1]effectiveTime
                                                        Constraints
                                                        -
      100 StructDocs                                3   3.0            A-S    Table 18 - Optional Sections
                                                        Document
                                                        Level
                                                        Template -
                                                        Table 18 -
                                                        CCD




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      101 StructDocs                                3   3.2           A-S    An NPP is defined as any licensed medical           An NPP is defined as any licensed medical
                                                                             professional as recognized by the state in          professional as recognized by the state in
                                                        Consultatio
                                                                             which the professional practices, including,        which the professional practices, including,
                                                        n Note               but not limited to, physician assistants, nurse     but not limited to, physician assistants, nurse
                                                                             practitioners, clinical nurse specialists, social   practitioners, clinical nurse specialists, social
                                                                             workers, physical therapists, and speech            workers, registered dietitians, physical
                                                                             therapists.                                         therapists, and speech therapists.



      102 StructDocs                                3   3.8.1.2       A-S
                                                        ClinicalDo
                                                        cument/Co
                                                        de: Table
                                                        29
      103 StructDocs                                4   Table 31      A-S    Allergies and Other Adverse
                                                                             Reactions

      104 StructDocs                                4   4.11          A-S    This section records a narrative                    This section records a narrative
                                                        Discharge            description of the expectations for                 description of the expectations for
                                                        Diet                 diet, including proposals, goals, and               diet and nutrition, including
                                                        Section              order requests for monitoring,                      nutrition prescription,
                                                                             tracking, or improving the dietary                  proposals, goals, and order
                                                                             control of the patient, used in a                   requests for monitoring,
                                                                             discharge from a facility such as an                tracking, or improving the
                                                                             emergency department, hospital, or                  nutritional status dietary
                                                                             nursing home.                                       control of the patient, used in
                                                                                                                                 a discharge from a facility
                                                                                                                                 such as an emergency
                                                                                                                                 department, hospital, or
                                                                                                                                 nursing home.



      105 StructDocs                                4   4.2           A-Q    2. SHALL contain exactly one
                                                        Hospital             [1..1] code/@code="48765-2"
                                                        Discharge            Allergies, adverse reactions,
                                                        Diagnosis            alerts (CodeSystem:
                                                        Section              2.16.840.1.113883.6.1
                                                                             LOINC) (CONF:7980).




      106 StructDocs                                4   4.49          A-T    This section records the patient's the              This section records the patient's the
                                                        Reason for           reason for the patient's visit (the                 reason for the patient's visit (as
                                                        Visit                provider’s description of the reason                documented by the provider’s
                                                        Section              for visit).                                         description of the reason for visit).
                                                        29299-5




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      107 StructDocs                                4   4.53           A-Q    Changes as reported by the patient or as documented by a member of the
                                                        Subjective            patient's caregiver                   healthcare team
                                                        Section


      108 StructDocs                                5   5.4            A-S    The agent that is the cause of the
                                                        Allergy/Ale           allergy or adverse reaction is
                                                        rt                    represented as a manufactured
                                                        Observatio            material participant playing entity in
                                                        n                     the allergy observation. . . . . In an
                                                                              allergy to a food or other substance
                                                                              the code@code SHALL be selected
                                                                              from the ValueSet
                                                                              2.16.840.1.113883.3.88.12.80.20
                                                                              Ingredient Name. (CONF:7421).

      109 StructDocs                                5   5.4           Neg-Mi Table 39: Ingredient Name Value Set Unique ingredient identifiers
                                                        Allergy/Ale          Description: Unique identifiers for (UNIIs) for substances in drugs,
                                                        rt                   active drug ingredients.            biologics, foods, and devices.
                                                        Observatio
                                                        n
      110 StructDocs                                5   5.4           Neg-Mi Table 39: Ingredient Name Value Set
                                                        Allergy/Ale
                                                        rt
                                                        Observatio
                                                        n




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                            18                                                                        March 2003
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      111 StructDocs                                General   General      Neg-Mj




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                                                              V3 Ballot Submission/Resolution Form

      112 StructDocs                                General                Neg-Mj




      113 StructDocs                                General                Neg-Mj



      114 StructDocs                                General   Immunizati   Neg-Mj Believe the xml in the table showing Should be changed to this:
                                                              on                  a problem template id value is           cda:entryRelationship[@typeCode=’
                                                                                  incorrect. Believe that this in table 2- RSON’]/ cda:act
                                                                                  18
                                                                                  cda:entryRelationship[@typeCode=’ See also 2.2.2.13.2 Refusal Reason
                                                                                  RSON’]/ cda:act                          Constraints
                                                                                  cda:templateId/@root=2.16.840.1.11 C154-[DE-13.10-1] The reason for
                                                                                  383.10.20.1.27                           refusal SHALL be coded as
                                                                                                                           specified in HITSP/C80 Section
                                                                                                                           2.2.3.5.3 No Immunization Reason
                                                                                                                           And reviewing HITSP/C80 the No
                                                                                                                           Immunization Reason Value Set
                                                                                                                           does not look like a problem list.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                 20                                                                            March 2003
                                                              V3 Ballot Submission/Resolution Form

      115 StructDocs                                General   General      Neg-Mj




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                               21                   March 2003
                                                              V3 Ballot Submission/Resolution Form

      116 StructDocs                                General                Neg-Mj




      117 StructDocs                                General                Neg-Mj



      118 StructDocs                                General   Immunizati   Neg-Mj Believe the xml in the table showing Should be changed to this:
                                                              on                  a problem template id value is           cda:entryRelationship[@typeCode=’
                                                                                  incorrect. Believe that this in table 2- RSON’]/ cda:act
                                                                                  18
                                                                                  cda:entryRelationship[@typeCode=’ See also 2.2.2.13.2 Refusal Reason
                                                                                  RSON’]/ cda:act                          Constraints
                                                                                  cda:templateId/@root=2.16.840.1.11 C154-[DE-13.10-1] The reason for
                                                                                  383.10.20.1.27                           refusal SHALL be coded as
                                                                                                                           specified in HITSP/C80 Section
                                                                                                                           2.2.3.5.3 No Immunization Reason
                                                                                                                           And reviewing HITSP/C80 the No
                                                                                                                           Immunization Reason Value Set
                                                                                                                           does not look like a problem list.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                 22                                                                            March 2003
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      119 StructDocs                                Table 11:     Neg-Mj
                                                    State Value
                                                    Set




      120 StructDocs                                5.26.5.a      Neg-Mj a. SHOULD be from LOINC            a. SHOULD be from LOINC
                                                                         (CodeSystem:                       (CodeSystem:
                                                                         2.16.840.1.113883.6.1) or          2.16.840.1.113883.6.1) or
                                                                         SNOMED CT (CodeSystem:             SNOMED CT (CodeSystem:
                                                                         2.16.840.1.113883.6.96), and MAY   2.16.840.1.113883.6.96), and MAY
                                                                         be selected from CPT-4             be selected from CPT-4
                                                                         (CodeSystem:                       (CodeSystem:
                                                                         2.16.840.1.113883.6.12)            2.16.840.1.113883.6.12)
                                                                         (CONF:7164).                       (CONF:7164).

                                                                                                            Laboratry results SHOULD be from
                                                                                                            LOINC (CodeSystem:
                                                                                                            2.16.840.1.113883.6.1) or other
                                                                                                            constrained terminology named by
                                                                                                            the US Department of Health and
                                                                                                            Human Services Office of National
                                                                                                            Coordinator or other federal agency.
                                                                                                            Local codes for laboratory results
                                                                                                            SHOULD also be allowed.
      121 StructDocs                                5.26.5.a       A-S                                      Suggest add:

                                                                                                            Regional codes for laboratory results
                                                                                                            SHOULD also be allowed.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        23                                                                         March 2003
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      122 StructDocs                                5.27.5.a     Neg-Mj a. SHOULD be from LOINC                a. SHOULD be from LOINC
                                                                        (CodeSystem:                           (CodeSystem:
                                                                        2.16.840.1.113883.6.1) or              2.16.840.1.113883.6.1) or
                                                                        SNOMED CT (CodeSystem:                 SNOMED CT (CodeSystem:
                                                                        2.16.840.1.113883.6.96), and MAY       2.16.840.1.113883.6.96), and MAY
                                                                        be selected from CPT-4                 be selected from CPT-4
                                                                        (CodeSystem:                           (CodeSystem:
                                                                        2.16.840.1.113883.6.12)                2.16.840.1.113883.6.12)
                                                                        (CONF:7164).                           (CONF:7164).

                                                                                                               Laboratry results SHOULD be from
                                                                                                               LOINC (CodeSystem:
                                                                                                               2.16.840.1.113883.6.1) or other
                                                                                                               constrained terminology named by
                                                                                                               the US Department of Health and
                                                                                                               Human Services Office of National
                                                                                                               Coordinator or other federal agency.
                                                                                                               Local codes for laboratory results
                                                                                                               SHOULD also be allowed.
      123 StructDocs                                5.27.5.a      A-S                                          Suggest add:

                                                                                                               Regional codes for laboratory results
                                                                                                               SHOULD also be allowed.
      124 StructDocs                                5.27.4 and    A-Q
                                                    5.27.5

      125 StructDocs                                4.23 and      A-Q
                                                    4.50



      126 StructDocs      ??                        1.7.4        Neg-Mi In the next figure, the constraint says ??
                                                                        only one Participant "like this" is to
                                                                        be present. Other participant
                                                                        elements are not precluded by this
                                                                        constraint.
      127 StructDocs      ??                        2.2          Neg-Mi SHALL not have mixed content            ??

      128 StructDocs      ??                        2.3          Neg-Mi SHALL not have mixed content           ??

      129 StructDocs      ??                        4.2          Neg-Mi Optional Entries/Required Entries      suggest definition and consistancy
                                                                                                               on how section templateId
                                                                                                               constrains whether the <entry> is
                                                                                                               optional or required




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      130 StructDocs      ??                        5.3          Neg-Mi 6. SHALL contain exactly one [1..1
                                                                        statusCode, which SHALL be
                                                                        selected from Value Set
                                                                        2.16.840.1.113883.11.20.919
                                                                        ProblemAct statusCode



      131 StructDocs      ??                        5.5          Neg-Mi same as 5.3

      132 StructDocs      ??                        5.25         Neg-Mj 10. SHOULD contain exactly one
                                                                        [1..1] entrRelationship (CONF:7580)
                                                                        such that it
      133 StructDocs      ??                        5.29         Neg-Mj This clinical statement represents the
                                                                        severity of the reaction to an agent.

      134 StructDocs


      135 StructDocs                                             Neg-Mi




      136 StructDocs                                5.2, 5.11,   Neg-Mj
                                                    5.20




      137 StructDocs                                5.30.        Neg-Mj



      138 StructDocs                                5.31         Neg-Mj




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      139 StructDocs                                    4.2, 4.28,         Neg-Mj
                                                        4.48, 4.50,
                                                        4.56




      140 StructDocs                                    5.14               Neg-Mj




      141 StructDocs                                    All                Neg-Mj




      142 StructDocs                                3   Document No         A-Q
                                                        type -
                                                        Discharge
                                                        Summary




      143 StructDocs                                4   4.13          No    A-C


      144 StructDocs                                4   4.18          No    A-C


      145 StructDocs                                4   4.45          No    A-Q




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      146 StructDocs                                1.7.2                 A-S




      147 StructDocs                                1.7.6                 A-S



      148 StructDocs                                1.8.1                 A-S


      149 StructDocs                                1.8.3                 A-S




      150 StructDocs                                1.9                   A-S


      151 StructDocs                                2.1                  Neg-Mi




      152 StructDocs                                2.1                   A-Q


      153 StructDocs                                2.1.1                Neg-Mi


      154 StructDocs                                3.1                   A-S




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                               27                 March 2003
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      155 StructDocs                                passim                 A-S




      156 StructDocs                                5.4                   Neg-Mi




      157 StructDocs                                5.3                    A-T


      158 StructDocs                                4.13                   A-Q


      159 StructDocs                                4.19                   A-T


      160 StructDocs                                passim                 A-Q


      161 StructDocs                                4.24                   A-S




      162 StructDocs                                4.40                   A-S


      163 StructDocs                                passim                 A-S




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                28                 March 2003
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      164 StructDocs                                1.5                      A-S




      165 StructDocs                                passim                   A-S




      166 StructDocs                                5.31                     A-Q


      167 StructDocs                                1            1.4        Neg-Mj The Consolidation Project team
                                                    Introduction Approach          members completed the analysis by
                                                                                   creating a fully compliant CCD
                                                                                   document, then layering in the
                                                                                   additional HITSP, IHE and
                                                                                   Meaningful Use constraints. When a
                                                                                   new constraint introduced an issue,
                                                                                   conflict or ambiguity, the item was
                                                                                   flagged for review with the full
                                                                                   consolidation team. The full analysis
                                                                                   covered the CDA Header, section-
                                                                                   level and entry-level requirements
                                                                                   sufficient for Meaningful Use.

                                                                                    The consolidation of templates
                                                                                    developed across these organizations
                                                                                    and their publication in catalog form
                                                                                    driven from model-based tools is a
                                                                                    strong step toward satisfying the full
                                                                                    range of requirements for clinical
                                                                                    information use and reuse through
                                                                                    templated CDA.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                  29                                        March 2003
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      168 StructDocs                 Progress_Note 1            1.4         Neg-Mi All involved in the Consolidation
                                     .xml          Introduction Approach           Project recognize the critical need
                                                                                   for an intrinsic tie between the
                                     MU_CCD.sam                                    human-readable conformance
                                     ple.xml                                       requirements, the computable
                                                                                   expression of those requirements, the
                                                                                   production of validation test suites
                                                                                   and application interfaces to
                                                                                   facilitate adoption. To that end, the
                                                                                   analysis performed by the volunteers
                                                                                   and staff of the Consolidation
                                                                                   Project was the prelude to data entry
                                                                                   into a set of model-based tools.




      169 StructDocs                 Progress_Note             4.5          Neg-Mi Progress_note.xml indicates
                                     .xml                      Assessmen           Assessment and Plan section
                                                               t and Plan          <templateId
                                                               Section -           root="2.16.840.1.113883.10.20.22.2
                                                               51487-2             .9" />


                                                                                    IG p. 108 states: [section: templateId
                                                                                    2.16.840.1.113883.10.20.21.2.9(ope
                                                                                    n)] while other references to the
                                                                                    section template ID in the IG have
                                                                                    the template ID found in the sample
                                                                                    documents where Assessment and
                                                                                    Plan are required
      170 StructDocs                                           1.7.6         A-Q    MSK attribute: There is information
                                                               Figure 4             on this item available but it has not
                                                               nullFlavor           been provided by the sender due to
                                                               example              security, privacy, or other reasons.
                                                                                    There may be an alternate
                                                               p.18                 mechanism for gaining access to this
                                                                                    information.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                  30                                        March 2003
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      171 StructDocs                                      1.4           A-T     The full analysis covered the CDA       The full analysis covered the CDA
                                                          Approach              Header, section-level and entry-level   Header, section-level and entry-level
                                                                                requirements sufficient for             requirements sufficient for
                                                                                Meaningful Use The Project also         Meaningful Use. The Project also
                                                                                reviewed document and section-level     reviewed document and section-
                                                                                requirements for the full set of        level requirements for the full set of
                                                                                document types.                         document types.
      172 StructDocs                                All                Neg-Mi




      173 StructDocs                                All                Neg-Mi




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                             31                                                                                 March 2003
                                                    V3 Ballot Submission/Resolution Form

      174 StructDocs                                3.2.1.2       A-S     Use of these codes is not
                                                                          recommended, as this duplicates
                                                                          information potentially present in the
                                                                          header




      175 StructDocs                                All           A-S



      176 StructDocs                                Table 31:    Neg-Mi
                                                    Sections
                                                    and
                                                    Required/O
                                                    ptional
                                                    Document
                                                    Types

                                                    P.100

                                                    Allergies
                                                    and Other
                                                    Adverse
                                                    Reactions

                                                    Table 18:
                                                    Document
                                                    Types and
                                                    Required/O
                                                    ptional
                                                    Sections
                                                    p.40




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       32                                         March 2003
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      177 StructDocs                 Progress_Note    All          Neg-Mi
                                     .xml




      178 StructDocs                                  4.1           A-S     6. MAY contain exactly one [1..1]
                                                      Advance               entry (CONF:7957)
                                                      Directives
                                                      Section
                                                      42348-3




      179 StructDocs                 CDAR2_IG_C 2.1                Neg-Mi
                                     ONSOL_R1_
                                     D1_2011APR




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         33                                    March 2003
                                                        V3 Ballot Submission/Resolution Form

      180 StructDocs                 CDAR2_IG_C 2.1                   A-S
                                     ONSOL_R1_
                                     D1_2011APR


      181 StructDocs                 CDAR2_IG_C 2.1                   A-S
                                     ONSOL_R1_
                                     D1_2011APR


      182 StructDocs                 CDAR2_IG_C 2.1     6.a.          A-S     can either be a locally defined name MAY either be a locally defined
                                     ONSOL_R1_                                or …                                 name or …
                                     D1_2011APR
      183 StructDocs                 CDAR2_IG_C 2.1.2   13.b.i.      Neg-Mj This assignedAuthor SHALL contain This assignedAuthor SHALL
                                     ONSOL_R1_                              exactly one [1..1] id             contain one or more [1..*] id
                                     D1_2011APR




      184 StructDocs                 CDAR2_IG_C 2.1.2   13.b.        Neg-Mi -                                     SHALL include in id the physician’s
                                     ONSOL_R1_                                                                    National Provider Identifier (root
                                     D1_2011APR                                                                   OID = 2.16.840.1.113883.4.6)

      185 StructDocs                 CDAR2_IG_C 2.1.2   13.b.        Neg-Mi -                                     SHOULD include in code a value
                                     ONSOL_R1_                                                                    from coding system NUCC Health
                                     D1_2011APR                                                                   Care Provider Taxonomy (OID =
                                                                                                                  2.16.840.1.113883.6.101)
      186 StructDocs                 CDAR2_IG_C 2.4                   A-S     When you know only the date ...
                                     ONSOL_R1_                                However, if you know the date ...
                                     D1_2011APR
      187 StructDocs                 CDAR2_IG_C 2.4     1            Neg-Mj SHOULD contain exactly one [1..1]
                                     ONSOL_R1_                              serviceEvent/@classCode="PCPR"
                                     D1_2011APR


      188 StructDocs                 CDAR2_IG_C 3       Table 18     Neg-Mi Required Sections | Optional
                                     ONSOL_R1_                              Sections
                                     D1_2011APR
      189 StructDocs                 CDAR2_IG_C 3       Table 18     Neg-Mi
                                     ONSOL_R1_
                                     D1_2011APR




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           34                                                                          March 2003
                                                          V3 Ballot Submission/Resolution Form

      190 StructDocs                 CDAR2_IG_C 3         Table 18     Neg-Mi Procedures (6)
                                     ONSOL_R1_                                (6) Required only for inpatient
                                     D1_2011APR                               settings

      191 StructDocs                 CDAR2_IG_C     3     Table 18     Neg-Mi Diagnostic Imaging Report /
                                     ONSOL_R1_                                Findings (Radiology Comparison
                                     D1_2011APR                               Study - Observation)
      192 StructDocs                 CDAR2_IG_C     3     Table 18     Neg-Mi Diagnostic Imaging Report /
                                     ONSOL_R1_                                Radiology - impression
                                     D1_2011APR
      193 StructDocs                 CDAR2_IG_C     3     Table 18     Neg-Mi Procedure Note /
                                     ONSOL_R1_                                Plan of Care
                                     D1_2011APR
      194 StructDocs                 CDAR2_IG_C     3     Table 18     Neg-Mi Procedure Note /
                                     ONSOL_R1_                                Procedure Disposition
                                     D1_2011APR
      195 StructDocs                 CDAR2_IG_C     3                  Neg-Mj <templateID>
                                     ONSOL_R1_
                                     D1_2011APR

      196 StructDocs                 CDAR2_IG_C 3.1                     A-S    C32                               HITSP C32
                                     ONSOL_R1_
                                     D1_2011APR
      197 StructDocs                 CDAR2_IG_C 3.2.1.2   Table 19      A-S
                                     ONSOL_R1_
                                     D1_2011APR
      198 StructDocs                 CDAR2_IG_C 3.2.2     7.a.         Neg-Mj A Consult Note can have either a
                                     ONSOL_R1_                                structuredBody or a nonXMLBody.
                                     D1_2011APR




      199 StructDocs                 CDAR2_IG_C 3.3.1     1            Neg-Mj Conforms to US Realm Clinical
                                     ONSOL_R1_                                Document Header Template
                                     D1_2011APR
      200 StructDocs                 CDAR2_IG_C 3.3.1.5                 A-T    inFullfillmentOf                  inFulfillmentOf
                                     ONSOL_R1_
                                     D1_2011APR




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                             35                                                   March 2003
                                                          V3 Ballot Submission/Resolution Form

      201 StructDocs                 CDAR2_IG_C 3.3.1.6   8.a.iv       Neg-Mi This serviceEvent SHALL contain
                                     ONSOL_R1_                                exactly one [1..1]
                                     D1_2011APR                               effectiveTime/@value




      202 StructDocs                 CDAR2_IG_C 3.7       1            Neg-Mj Conforms to Consolidated US Realm
                                     ONSOL_R1_                                Header Template
                                     D1_2011APR
      203 StructDocs                 CDAR2_IG_C 3.7.1.6   7.c.ii.1     Neg-Mi SHALL be selected from ValueSet
                                     ONSOL_R1_                                2.16.840.1.114222.4.11.1066
                                     D1_2011APR                               Healthcare Provider Taxonomy
                                                                              (NUCC - HIPAA)

      204 StructDocs                 CDAR2_IG_C 3.7                    Neg-Mi
                                     ONSOL_R1_
                                     D1_2011APR




      205 StructDocs                 CDAR2_IG_C 4                       A-S
                                     ONSOL_R1_
                                     D1_2011APR




      206 StructDocs                 CDAR2_IG_C 4.10      4            Neg-Mi SHALL NOT contain [0..0] title
                                     ONSOL_R1_
                                     D1_2011APR


      207 StructDocs                 CDAR2_IG_C 4.10      5            Neg-Mi SHALL NOT contain [0..0] text
                                     ONSOL_R1_
                                     D1_2011APR
      208 StructDocs                 CDAR2_IG_C 4.40                   Neg-Mi The following constraints apply to a The following constraints apply to a
                                     ONSOL_R1_                                Problem List section in which entries Problem List section in which
                                     D1_2011APR                               are required                          entries are not required
      209 StructDocs                 CDAR2_IG_C 4.40                   Neg-Mi SHOULD contain a case-insensitive
                                     ONSOL_R1_                                language-insensitive string
                                     D1_2011APR                               containing 'problems'.




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      210 StructDocs                 CDAR2_IG_C General                       A-S     code/@code, which SHALL be         code, which SHALL be selected
                                     ONSOL_R1_                                        selected from ValueSet             from ValueSet
                                     D1_2011APR

      211 StructDocs                 CDAR2_IG_C General                       A-S     example:                           example:
                                     ONSOL_R1_                                        SHALL contain exactly one [1..1]   SHALL contain exactly one [1..1]
                                     D1_2011APR                                       code/@code="34133-9"               code = {"34133-9", LOINC,
                                                                                      Summarization of Episode Note      "Summarization of Episode Note"}
                                                                                      (CodeSystem:
                                                                                      2.16.840.1.113883.6.1 LOINC)

      212 StructDocs
      213 StructDocs                                General   Change   Yes   Neg-Mj
                                                              Log




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      214 StructDocs                                General       Substantiv
                                                                  e Changes




      215 StructDocs                                1.7.2                      Neg-Mi
                                                    Conformance
                                                    Statements

      216 StructDocs                                1.7.2                      Neg-Mj
                                                    Conformance
                                                    Statements

      217 StructDocs                                1.7.2                       A-S
                                                    Conformance
                                                    Statements




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      218 StructDocs                                1.7.2                       A-S
                                                    Conformance
                                                    Statements

      219 StructDocs                                1.7.5                      Neg-Mj
                                                    Vocabulary
                                                    Conformance




      220 StructDocs                                1.7.5                      Neg-Mi
                                                    Vocabulary
                                                    Conformance




      221 StructDocs                                1.7.2                      Neg-Mi
                                                    Conformance
                                                    Statements




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      222 StructDocs                                1.7.2                      Neg-Mi
                                                    Conformance
                                                    Statements

      223 StructDocs                                1.7.2                       A-S
                                                    Conformance
                                                    Statements




      224 StructDocs                                1.7.2                      Neg-Mi
                                                    Conformance
                                                    Statements

      225 StructDocs                                                           Neg-Mj




      226 StructDocs                                                           Neg-Mi




      227 StructDocs                                                           Neg-Mj




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      228 StructDocs                                             Neg-Mj




      229 StructDocs                                             Neg-Mj




      230 StructDocs                                             Neg-Mj




      231 StructDocs                                             Neg-Mj




      232 StructDocs                                             Neg-Mj




      233 StructDocs                                             Neg-Mj




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      234 StructDocs                                             Neg-Mi




      235 StructDocs                                             Neg-Mj




      236 StructDocs                                             Neg-Mj




      237 StructDocs                                             Neg-Mi




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     42                   March 2003
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      238 StructDocs                                Section 2.2                  Neg-Mj
                                                    US Realm
                                                    Clinical
                                                    Document
                                                    Header
                                                    Address




      239 StructDocs                                Section 2.2                  Neg-Mi
                                                    US Realm
                                                    Clinical
                                                    Document
                                                    Header
                                                    Address
      240 StructDocs                                Section 2.3                  Neg-Mj
                                                    US Realm
                                                    Clinical
                                                    Document
                                                    Name




      241 StructDocs                                Section 2.3                  Neg-Mi
                                                    US Realm
                                                    Clinical
                                                    Document
                                                    Name

      242 StructDocs                                Advance                      Neg-Mj
                                                    Directives
                                                    Section




      243 StructDocs                                Allergies and                 A-T
                                                    Adverse
                                                    Reaction
                                                    Section




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      244 StructDocs                                Allergies and                Neg-Mj
                                                    Adverse
                                                    Reaction
                                                    Section



      245 StructDocs                                Allergies and                 A-S
                                                    Adverse
                                                    Reaction
                                                    Section




      246 StructDocs                                Allergies and                Neg-Mi
                                                    Adverse
                                                    Reaction
                                                    Section


      247 StructDocs                                Allergy                      Neg-Mj
                                                    Observation




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      248 StructDocs                                Allergy                    Neg-Mj
                                                    Observation




      249 StructDocs                                Problem                    Neg-Mj
                                                    Status




      250 StructDocs                                Allergy                    Neg-Mj
                                                    Problem Act


      251 StructDocs                                Allergy                    Neg-Mj
                                                    Problem Act




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      252 StructDocs                                Condition                 Neg-Mj




      253 StructDocs                                Condition                  A-T




      254 StructDocs                                Condition                 Neg-Mi
                                                    Entry




      255 StructDocs                                Condition                 Neg-Mi
                                                    Entry

      256 StructDocs                                Medication                Neg-Mj




      257 StructDocs                                Text                      Neg-Mj
                                                    References



      258 StructDocs                                Text                      Neg-Mj
                                                    References




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      259 StructDocs                                Medication                     Neg-Mj



      260 StructDocs                                Medication                     Neg-Mj
                                                    Supply Order



      261 StructDocs                                Medication                     Neg-Mi
                                                    Supply Order



      262 StructDocs                                Medication                     Neg-Mi
                                                    Dispense



      263 StructDocs                                Medication                     Neg-Mj
                                                    Use None
                                                    Known




      264 StructDocs      ??                                       2.1.1     Yes    A-C     reference to "US Realm Clinical
                                                                                            Document Header Address"




      265 StructDocs      ??                                       2.1.1;           A-Q     administrativeGenderCode/@cod
                                                                   Table 5                  e, which SHALL be selected from
                                                                                            ValueSet … Administrative
                                                                                            Gender (HL7 V3)




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      266 StructDocs      ??                        2.1.1;        A-C     birthTime
                                                    12.a.iv.3
      267 StructDocs      ??                        2.4; 3.a      A-C     The serviceEvent/effectiveTime          The serviceEvent/effectiveTime
                                                                          element SHALL be accurate to the        element SHALL be accurate to the
                                                                          day, and MAY be accurate to the         day, and MAY be accurate to the
                                                                          second. (CONF:7602)                     second and MAY include GMT
                                                                                                                  offset. If no offset indicated, then
                                                                                                                  an offset of 0 is assumed.
                                                                                                                  (CONF:7602)
      268                                           3.1.1.4       A-T     Item numbering uses a "1"               Should be a "5" because it flows
                                                                                                                  from previous sections?
      269                                           3.1.2        Neg-Mi                                           This should read similar to section
                                                                                                                  3.2.2--"SHALL contain exactly one
                                                                                                                  [1…1] component" and "can have
                                                                                                                  either a structuredBody or a
                                                                                                                  nonXMLBody.

      270                                           3.2.2         A-T   A History and Physical document      A Consultation Note document can
                                                                        can conform to CDA Level 1           conform to CDA Level 1
                                                                        (nonXMLBody)…                        (nonXMLBody)…
      271                                           3.2.2        Neg-Mi A History and Physical document
                                                                        can conform to CDA Level 1
                                                                        (nonXMLBody), CDA Level 2
                                                                        (structuredBody with sections that
                                                                        contain a narrative block), or CDA
                                                                        Level 3 (structuredBody containing
                                                                        sections that contain a narrative
                                                                        block and coded entries). This Guide
                                                                        provides separate templateIds for
                                                                        documents in which coded entries
                                                                        are required and for documents in
                                                                        which coded entries are optional. In
                                                                        this template (templateId
                                                                        2.16.840.1.113883.10.20.22.1.4),
                                                                        coded entries are optional.
                                                                        (CONF:8399).
      272                                           3.2.1.3;      A-T     A special class of participant is the   A special class of participant is the
                                                    4.b.                  supporting person or organization:      supporting person or organization:
                                                                          an individual or an organization that   an individual or an organization that
                                                                          has a relationship to the patient,      has a relationship to the patient,
                                                                          including including parents,            including parents, relatives,
                                                                          relatives, caregivers, insurance        caregivers, insurance policyholders,
                                                                          policyholders, and guarantors.          and guarantors.




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      273                                           3.3.1.3;      A-T     <code code="18748-4"                <code code="18748-4"
                                                    Figure 19             codeSystem="2.16.840.1.113883.6.1   codeSystem="2.16.840.1.113883.6.
                                                                          "                                   1"
                                                                              codeSystemName="LOINC"              codeSystemName="LOINC"
                                                                              displayName="Diagnostic             displayName="Diagnostic
                                                                          Imaging Report”                     Imaging Report” >
                                                                          <translation code='XRPEDS'          <translation code='XRPEDS'
                                                                              displayName='Pediatric              displayName='Pediatric
                                                                          Radiography Report'                 Radiography Report'

                                                                          codeSystem='2.16.840.1.123456.78. codeSystem='2.16.840.1.123456.78.
                                                                          9'/>                              9'/>
                                                                          </code>                           </code>

      274                                           3.3.2        Neg-Mi                                       This should read similar to section
                                                                                                              3.2.2--"SHALL contain exactly one
                                                                                                              [1…1] component" and "can have
                                                                                                              either a structuredBody or a
                                                                                                              nonXMLBody, etc.

      275                                           3.4.1.4;      A-Q     1. The dischargeDispositionCode
                                                    1.a.iii.1             SHALL be displayed when the
                                                                          document is rendered.
                                                                          (CONF:8477).
      276                                           3.4.2        Neg-Mi                                       This should read similar to section
                                                                                                              3.2.2--"SHALL contain exactly one
                                                                                                              [1…1] component" and "can have
                                                                                                              either a structuredBody or a
                                                                                                              nonXMLBody, etc.

      277                                           3.6.2        Neg-Mi                                       This should read similar to section
                                                                                                              3.2.2--"SHALL contain exactly one
                                                                                                              [1…1] component" and "can have
                                                                                                              either a structuredBody or a
                                                                                                              nonXMLBody, etc.

      278                                           3.7.2        Neg-Mi                                       This should read similar to section
                                                                                                              3.2.2--"SHALL contain exactly one
                                                                                                              [1…1] component" and "can have
                                                                                                              either a structuredBody or a
                                                                                                              nonXMLBody, etc.




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      279                                           3.8.2        Neg-Mi                                         This should read similar to section
                                                                                                                3.2.2--"SHALL contain exactly one
                                                                                                                [1…1] component" and "can have
                                                                                                                either a structuredBody or a
                                                                                                                nonXMLBody, etc.

      280                                           3.9.2         A-C




      281                                           4.0          Neg-Mi




      282                                           4.20; 2       A-T     2. SHALL contain exactly one [1..1]
                                                                          code/@code="48765-2" Allergies,
                                                                          adverse reactions, alerts
                                                                          (CodeSystem:
                                                                          2.16.840.1.113883.6.1 LOINC)
                                                                          (CONF:7980).
      283                                           4.40;        Neg-Mi
                                                    Required
                                                    Entries
      284                                           4.40;        Neg-Mi 2. SHOULD contain zero or more  2. SHALL contain one or more
                                                    Required            [0..*] entry (CONF-CONSOL-549), [1..*] entry (CONF-CONSOL-549),
                                                    Entries; 2
      285                                           5.4          Neg-Mi 5. SHALL contain exactly one [1..1]
                                                                        code, which SHALL be selected
                                                                        from ValueSet
                                                                        2.16.840.1.113883.3.88.12.3221.6.2
                                                                        Allergy/Adverse Event Type
                                                                        DYNAMIC (CONF:7383).




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      286                                           5.4; 8.a.i.1   Neg-Mi 1. A reference/@value SHOULD
                                                                          point to its corresponding narrative
                                                                          (using the approach defined in CDA
                                                                          Release 2, section 4.3.5.1 ).
                                                                          (CONF:7401).




      287                                           5.4;           Neg-Mi 1. A reference/@value SHOULD
                                                    9.b.ii.2.b            point to its corresponding narrative
                                                                          (using the approach defined in CDA
                                                                          Release 2, section 4.3.5.1 ).
                                                                          (CONF:7426).
      288                                           5.11; 6        Neg-Mj 6. SHOULD contain exactly one
                                                                          [1..1] text (CONF-CONSOL-546)
                                                                          a. The 'text' elements SHOULD
                                                                          contain a 'reference' element
                                                                          pointing to the narrative where the
                                                                          severity is recorded, rather than
                                                                          duplicate text to avoid ambiguity.
                                                                          (CONF-CONSOL-544)




      289                                           5.x            Neg-Mj no Comments template                   inclusion of a Comments
                                                                                                                 Annotation template (like the HITSP
                                                                                                                 C83 Comments module). I also
                                                                                                                 strongly recommend a "MAY
                                                                                                                 contain…Comment Annotation"
                                                                                                                 conformance statement in EVERY
                                                                                                                 section and entry template




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      290                                           4.x and 5.x   Neg-Mi Details about data types from the
                                                                         RIM and even the CDA are not
                                                                         included and clarified in this
                                                                         document




      291 StructDocs                                1.5           Neg-Mi Chapter 4. Section-level Templates.   Chapter 4. Section-level Templates.
                                                                         This chapter describes the section-   This chapter specifies the section
                                                                         level constraints for sections        templates referenced within the
                                                                         referenced within the document        document types described here.
                                                                         types described here and which can    Sections are atomic units and they
                                                                         be reused by future specifications.   can be reused by future
                                                                                                               specifications.
      292 StructDocs                                1.5           Neg-Mi Chapter 5. Entry-level Templates.     Chapter 5. Entry-level Templates.
                                                                         This chapter specifies the atomic     This chapter specifies the entry
                                                                         units of the report, the entry        templates, called clinical statements.
                                                                         templates, or clinical statements.    The entries are the machine-
                                                                         Machine-processable data is sent in   processable data which represent
                                                                         the entry templates. The entry        concepts from the human readable
                                                                         templates are referenced by section   narrative expressed in the associted
                                                                         templates.                            section. Entry templates are
                                                                                                               referenced by section templates.
                                                                                                               Entries are a sub-atomic unit that
                                                                                                               can be reused by future
                                                                                                               specifications within the context of
                                                                                                               other sections.

      293                                           5             Neg-Mj Each section-level template           add to the bullet list an item to
                                                                         description contains the following    require that every section contain an
                                                                         major information:                    instance id.




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      294                                                       3.1          Neg-Mi 3.1.1 - 3.1.8 cover all the            add 3.1.9 to cover participant.
                                                                                    participations (RecordTaget,
                                                                                    authenticator, legalAuthenticator,
                                                                                    etc.) except participant.
      295                                                       4 table 2.   Neg-Mi Document Type in first row shows       Document type should be
                                                                                    CCD as the Document Type for           Summarization of Episode Note
                                                                                    documents with LOINC code of
                                                                                    34133-9
      296                                                       4.4.1.2      Neg-Mi When a patient is discharged from
                                                                table 6             the hospital, how many Discharge
                                                                                    Summary CDAs would be expected
                                                                                    to be generated?




      297                                                       5 Table 12           Vital Signs templateIds are the same 2.16.840.1.113883.10.20.21.2.4.1
                                                                                     for the Entries Required as the      2.16.840.1.113883.10.20.21.2.4
                                                                                     Entries Optional.
                                                                                     2.16.840.1.113883.10.20.21.2.4
                                                                                     2.16.840.1.113883.10.20.21.2.4
      298 StructDocs                                General     2.3           A-C    pg 32
                                                    Header                           Table 17, HL7
                                                    Template                         EntityNamePartQualifier, Code-
                                                                                     DEV Device name.
                                                                                     OID 2.16.840.1.113883.5.43


      299 StructDocs                                Document    3             A-C    pg 40                                 Change medical equipment to a
                                                    level                            Table 18, CCD, OID                    required section and include the
                                                    templates                        2.16.840.1.113883.10.20.22.1.2        FDA unique device identification
                                                                                     Optional sections include medical
                                                                                     equipment

      300 StructDocs                                Document    3             A-C    pg 40
                                                    level                            Table 18, Consultation Note,
                                                    templates                        Optional sections- lists includes 3
                                                                                     reports (Chief Complaint, Chief
                                                                                     Complaint/Reason for Visit, and
                                                                                     Reason for Visit).




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      301 StructDocs                                Document    3             A-C    pg 41
                                                    level                            Table 18, Diagnostic Imaging
                                                    templates                        Report



      302 StructDocs                                Document    3             A-C    pg 42                                 Change implants to a required
                                                    level                            Table 18, Operative note, OID         section and include the FDA unique
                                                    templates                        2.16.840.1.113883.10.20.22.1.7        device identification
                                                                                     Optional sections includes implants


      303 StructDocs                                Document    3             A-C    pg 102                                Change implants to be required in
                                                    level                            Table 31, Section name- Implants,     an operative note and include the
                                                    templates                        LOINC 55122-6, OID                    FDA unique device identification
                                                                                     2.16.840.1.113883.10.20.22.1.7
                                                                                     Marked as (O) Optional in the
                                                                                     operative note column
      304 StructDocs                                Document    3             A-C    pg 103                                Change medical equipment to a
                                                    level                            Table 31, Section name- Medical       required section in the CCD and
                                                    templates                        equipment, LOINC 46264-8, OID         include the FDA unique device
                                                                                     2.16.840.1.113883.10.20.22.2.23       identification
                                                                                     Marked as (O) Optional in the CCD
                                                                                     column




      305 StructDocs                                Document    3             A-C    pg 104                                Change procedure implants to a
                                                    level                            Table 31, Section name- Medical       required section for the procedure
                                                    templates                        equipment, LOINC 59771-6, OID         note and include the unique device
                                                                                     2.16.840.1.113883.10.20.22.2.40       identification
                                                                                     Marked as (O) Optional in the
                                                                                     Procedure note column
      306                                                       3.3           A-C
                                                                Diagnostic
                                                                Imaging
                                                                Report




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                   54                                                                          March 2003
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      307                                           4.2           A-C
                                                    Allergies,
                                                    Adverse
                                                    Reactions,
                                                    Alerts
                                                    section
                                                    48765-2


      308 StructDocs                                4.25          A-C    pg 118
                                                    Implant              Note: This conformance statement is
                                                    section              for reference only. It has not yet been
                                                    55122-6              reviewed and consolidated according
                                                                         to the scope and intent of this guide.
                                                                         a. If the Implants section is present,
                                                                         there SHALL be a statement
                                                                         providing details of the implants
                                                                         placed or SHALL explicitly state
                                                                         there were no implants placed.


      309 StructDocs                                4.25          A-C    pg 118
                                                    Implant              b. The Implants section may contain
                                                    section              clinical statements. If present, the
                                                    55122-6              clinical statements shall include one
                                                                         or more supply activities (CCD
                                                                         templateId
                                                                         2.16.840.1.113883.10.20.1.34), may
                                                                         include product instance (CCD
                                                                         templateId
                                                                         2.16.840.1.113883.10.20.1.52) and
                                                                         may include one or more medication
                                                                         activities (CCD templateId
                                                                         2.16.840.1.113883.10.20.1.24).




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       55                                         March 2003
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      310 StructDocs                                4.26          A-C     pg 119
                                                    Medical               a. NOTE: This conformance
                                                    Equipment             statement is for reference only. It has
                                                    section               not yet been reviewed and
                                                    46264-8               consolidated according to the scope
                                                                          and intent of this guide.

                                                                          CONF-XXXX: The Medical
                                                                          Equipment section SHOULD
                                                                          contain clinical statements. Clinical
                                                                          statements SHOULD include one or
                                                                          more supply activities (templateId
                                                                          2.16.840.1.113883.10.20.22.4.17)
                                                                          and MAY include one or more
                                                                          medication activities (templateId
                                                                          2.16.840.1.113883.10.20.22.4.16).
                                                                          NOTE: This conformance statement
                                                                          is for reference only. It has not yet
                                                                          been reviewed and consolidated
                                                                          according to the scope and intent of
                                                                          this guide. (CONF:7950).

      311 StructDocs                                4.45          A-C     pg 132                               a. The Implants section may contain
                                                    Procedure             NOTE: This conformance statement     clinical statements. If present, the
                                                    implants              is for reference only. It has not yetclinical statements shall include one
                                                    Section               been reviewed and consolidated       or more CCD Supply activities
                                                    59771-6               according to the scope and intent of (templateId
                                                                          this guide.                          2.16.840.1.113883.10.20.1.34),
                                                                                                               shall include CCD Product instance
                                                                          a. The Implants section may contain (templateId
                                                                          clinical statements. If present, the 2.16.840.1.113883.10.20.1.52), and
                                                                          clinical statements may include one may include one or more CCD
                                                                          or more CCD Supply activities        Medication activities (templateId
                                                                          (templateId                          2.16.840.1.113883.10.20.1.24).
                                                                          2.16.840.1.113883.10.20.1.34), may
                                                                          include CCD Product instance
                                                                          (templateId
                                                                          2.16.840.1.113883.10.20.1.52), and
                                                                          may include one or more CCD
                                                                          Medication activities (templateId
                                                                          2.16.840.1.113883.10.20.1.24).
      312 StructDocs                                1.2          Neg-Mi
                                                    Purpose




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       56                                                                             March 2003
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      313 StructDocs                                immunizati     A-C
                                                    on




      314 StructDocs                                1.3            A-Q    When complete, this guide will fully
                                                                          specify a compliant CDA R2
                                                                          document for each of document
                                                                          types. At present, the entry-level
                                                                          templates cover only those required
                                                                          for Meaningful Use. The next release
                                                                          of this guide will include the full set
                                                                          of entry-level templates used by
                                                                          CCD, Health Story, and the
                                                                          corresponding IHE profiles.

      315 StructDocs                                1.8.2          A-T    xmis                                 xmls
      316 StructDocs                                2.1.1.12.a.i   A-S    5. This patient MAY contain zero or MAY contain zero or more
                                                    v                     one [0..1] religiousAffiliationCode,
                                                                          which SHALL be selected from
                                                                          ValueSet
                                                                          2.16.840.1.113883.1.11.19185 HL7
                                                                          Religious Affiliation DYNAMIC
                                                                          (CONF:5317).
      317                                           2.1.1.12.a.i   A-S    6. This patient MAY contain zero or MAY contain zero or more
                                                    v                     one [0..1] raceCode, which SHALL
                                                                          be selected from ValueSet
                                                                          2.16.840.1.113883.1.11.14914 Race
                                                                          DYNAMIC (CONF:5322).
      318                                           2.1.1.12.a.i   A-S    7. This patient MAY contain zero or
                                                    v                     more [0..*] sdwg:raceCode, which
                                                                          SHALL be selected from ValueSet
                                                                          2.16.840.1.113883.1.11.14914 Race
                                                                          DYNAMIC (CONF:7263).

      319                                           2.1.1.12.a.i   A-S    9.c. This guardian, if present,           SHALL contain one or more
                                                    v                     SHALL contain exactly one [1..1]
                                                                          telecom (CONF:5382).
      320                                           2.1.1.12.a.i   A-S    9. This patient SHOULD contain            SHOULD contain zero or more
                                                    v                     zero or one [0..1] guardian
                                                                          (CONF:5325).




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      321                                                       2.1.1            Neg-Mi Current value set uses FIPS 5-2 for    Change this Value Set to the
                                                                Table 11                the state codes. This has Alabama as   standard 2 letter code that everyone
                                                                                        "01", Florida as "12", FEDERATED       commonly uses. The official USPS
                                                                                        STATES OF MICRONESIA as "64".          list is located at the following site:
                                                                                                                               http://www.usps.com/ncsc/lookups/
                                                                                                                               abbr_state.txt




      322                                                       3.2.1.3.4.b       A-T    patient, including including parents, patient, including parents,

      323                                                       3.2.2.7.a.i       A-T    A History and Physical document      A Consultation Note document can
                                                                                         can conform                          conform
      324                                                       3.3.1.2.3         A-S    a. OIDs SHALL be represented in
                                                                                         dotted decimal notation, where each
                                                                                         decimal number is either 0 or starts
                                                                                         with a nonzero digit. More formally,
                                                                                         an OID SHALL be in the form ([0-
                                                                                         2])(.([1-9][0-9]*|0))+ (CONF:8406).
                                                                                         b. OIDs SHALL be no more than 64
                                                                                         characters in length. (CONF:8407).


      325                                                       5                Neg-Mi SHALL contain at least one [1..*] id
                                                                                        ... or ...
                                                                                        MAY contain zero or more [0..*] id




      326 StructDocs                                Introduction Figure 1: Yes    A-Q    [observation: templateId
                                                                 Constraits              2.16.840.1.113883.10.20.21.4.8(ope
                                                                 format                  n)]
                                                                 exchange
      327 StructDocs                                Introduction 1.7.6 Null       A-S
                                                                 Flavor



      328 StructDocs                                1.7.2       Figure 6:         A-S
                                                    Conformance nullFlavor
                                                    Statements explictly
                                                                disallowed




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      329 StructDocs                                General     Table 2:      A-T
                                                    Header      Basic
                                                    Template    Confidenti
                                                                ality Kind
                                                                Value Set
      330 StructDocs                                General     Table 10:     A-T
                                                    Header      Personal
                                                    Template    Relationshi
                                                                p Role
                                                                Type Value
                                                                Set
      331 StructDocs                                General     Table 12:     A-T
                                                    Header      Postal
                                                    Template    Code
                                                                Value Set
      332 StructDocs                                General     Table 15:     A-T
                                                    Header      PostalAddr
                                                    Template    essUse
                                                                Value Set
      333 StructDocs                                General     Table 16:     A-T
                                                    Header      EntityNam
                                                    Template    eUse Value
                                                                Set
      334 StructDocs                                General     Table 16:     A-T
                                                    Header      EntityNam
                                                    Template    eUse Value
                                                                Set
      335 StructDocs                                General     Table 16:     A-T
                                                    Header      EntityNam
                                                    Template    eUse Value
                                                                Set
      336 StructDocs                                Document-                 A-T
                                                    Level
                                                    Templates
      337 StructDocs                                Document-   Table 18:     A-T
                                                    Level       Document
                                                    Templates   Types and
                                                                Required/O
                                                                ptional
                                                                Sections
      338 StructDocs                                Document-   3.1.1.3       A-T
                                                    Level       documenta
                                                    Templates   tionOf/serv
                                                                iceEvent




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      339 StructDocs                                Document-     3.1.1.3        A-Q
                                                    Level         documenta
                                                    Templates     tionOf/serv
                                                                  iceEvent
      340 StructDocs                                3.2           Table 19:      A-Q
                                                    Consultation Consultatio
                                                    Note          n Note
                                                                  LOINC
                                                                  Document
                                                                  Codes
      341 StructDocs                                3.3           3.3.1.6.       A-T
                                                    Diagnostic documenta
                                                    Imaging       tionOf
                                                    Report
      342 StructDocs                                3.3           3.3.1.7       Neg-Mi
                                                    Diagnostic authorizati
                                                    Imaging       on
                                                    Report
      343 StructDocs                                3.6 Operative 3.6.1.4        A-T
                                                    Note          documenta
                                                                  tionOf
      344 StructDocs                                3.7           3.7.1.6        A-T
                                                    Procedure     ServiceEve
                                                    Note          nt
      345 StructDocs                                4 Section-                   A-T
                                                    Level
                                                    Templates
      346 StructDocs                                4 Section-    Table 31:      A-T
                                                    Level         Sections
                                                    Templates     and
                                                                  Required/O
                                                                  ptional
                                                                  Document
                                                                  Types
      347 StructDocs                                4 Section-    4.4           Neg-Mi
                                                    Level         Assessmen
                                                    Templates     t Section
                                                                  51848-0
      348 StructDocs                                4 Section-    4.5           Neg-Mi
                                                    Level         Assessmen
                                                    Templates     t and Plan
                                                                  Section
                                                                  51487-2




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      349 StructDocs                                4 Section-   4.11            A-T
                                                    Level        Discharge
                                                    Templates    Diet
                                                                 Section
                                                                 10154-3
      350 StructDocs                                4 Section-   4.11           Neg-Mi
                                                    Level        Discharge
                                                    Templates    Diet
                                                                 Section
                                                                 10154-3
      351 StructDocs                                4 Section-   4.11           Neg-Mi
                                                    Level        Discharge
                                                    Templates    Diet
                                                                 Section
                                                                 10154-3
      352 StructDocs                                4 Section-   4.11           Neg-Mi
                                                    Level        Discharge
                                                    Templates    Diet
                                                                 Section
                                                                 10154-3


      353 StructDocs                                4 Section-   4.17           Neg-Mi
                                                    Level        History of
                                                    Templates    Past Illness
                                                                 Section
                                                                 11348-0

      354 StructDocs                                4 Section-   4.18           Neg-Mi
                                                    Level        History of
                                                    Templates    Present
                                                                 Illness
                                                                 Section
                                                                 11348-0
      355 StructDocs                                4 Section-   4.18           Neg-Mi
                                                    Level        History of
                                                    Templates    Present
                                                                 Illness
                                                                 Section
                                                                 11348-0
      356 StructDocs                                4 Section-   4.18           Neg-Mi
                                                    Level        History of
                                                    Templates    Present
                                                                 Illness
                                                                 Section
                                                                 11348-0




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      357 StructDocs                                4 Section-   4.20          Neg-Mi
                                                    Level        Hospital
                                                    Templates    Discharge
                                                                 Diagnosis
                                                                 Section
                                                                 48765-2
      358 StructDocs                                4 Section-   4.20          Neg-Mi
                                                    Level        Hospital
                                                    Templates    Discharge
                                                                 Diagnosis
                                                                 Section
                                                                 48765-2
      359 StructDocs                                4 Section-   4.20          Neg-Mi
                                                    Level        Hospital
                                                    Templates    Discharge
                                                                 Diagnosis
                                                                 Section
                                                                 48765-2
      360 StructDocs                                4 Section-   4.21           A-T
                                                    Level        Hospital
                                                    Templates    Discharge
                                                                 Medication
                                                                 s Section
                                                                 10183-2
      361 StructDocs                                4 Section-   4.24           A-Q
                                                    Level        Immunizati
                                                    Templates    ons Section
                                                                 11369-

      362 StructDocs                                4 Section-   4.28           A-Q
                                                    Level        Medication
                                                    Templates    s Section
                                                                 10160-0
      363 StructDocs                                4 Section-   4.34          Neg-Mi
                                                    Level        Physical
                                                    Templates    Exam
                                                                 Section
                                                                 29545-1
      364 StructDocs                                4 Section-   4.34          Neg-Mi
                                                    Level        Physical
                                                    Templates    Exam
                                                                 Section
                                                                 29545-1
      365 StructDocs                                4 Section-   4.35 Pan       A-Q
                                                    Level        Section
                                                    Templates    18776-5




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      366 StructDocs                                4 Section-   4.40          A-T
                                                    Level        Problem
                                                    Templates    List
                                                                 Section
                                                                 11450-4
      367 StructDocs                                4 Section-   4.40          A-Q
                                                    Level        Problem
                                                    Templates    List
                                                                 Section
                                                                 11450-4
      368 StructDocs                                4 Section-   4.47          A-Q
                                                    Level        Procedure
                                                    Templates    Specimens
                                                                 Taken
                                                                 Section
      369 StructDocs                                4 Section-   4.48          A-Q
                                                    Level        Procedures
                                                    Templates    Section
                                                                 47519-4
      370 StructDocs                                4 Section-   4.50          A-Q
                                                    Level        Results
                                                    Templates    Section
                                                                 30954-2
      371 StructDocs                                4 Section-   4.56 Vital    A-Q
                                                    Level        Signs
                                                    Templates    Section
                                                                 8716-3
      372 StructDocs                                5 Entry-     5.10         Neg-Mi
                                                    Level        Episode
                                                    Templates    Observatio
                                                                 n
      373 StructDocs                                5 Entry-     5.21          A-T
                                                    Level        Procedure
                                                    Templates    Activity
                                                                 Act
      374 StructDocs                                5 Entry-     5.21          A-T
                                                    Level        Procedure
                                                    Templates    Activity
                                                                 Act
      375 StructDocs                                5 Entry-     5.22          A-T
                                                    Level        Procedure
                                                    Templates    Activity
                                                                 Observatio
                                                                 n




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      376 StructDocs                                5 Entry-       5.23          A-T
                                                    Level          Procedure
                                                    Templates      Activity
                                                                   Procedure


      377 StructDocs                                Appendix B -   Table 60:     A-Q
                                                    Changes        Section
                                                    from           Template
                                                    Previous       Change
                                                    Guides         Tracking
      378 StructDocs                                3.9                         Neg-Mi
                                                    Unstructured
                                                    Documents



      379 StructDocs                                3.9                          A-Q
                                                    Unstructured
                                                    Documents

      380 StructDocs                                               3.6.1.3       A-S

                                                                   3.7.1.5




      381 StructDocs                                               overall       A-C


      382 StructDocs                                               overall       A-C




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      383 StructDocs                                overall       A-S




      384 StructDocs                                overall       A-Q




      385 StructDocs      ??         CDAR2_IG_C     1.1 /         A-S
                                     ONSOL_R1_      general
                                     D1_2011APR     comment




      386 StructDocs                 CDAR2_IG_C     1.3           A-S    All CDA templates required for Final
                                     ONSOL_R1_                           Rules for Meaningful Use are
                                     D1_2011APR                          included in this guide.



      387 StructDocs                 CDAR2_IG_C     1.4           A-S
                                     ONSOL_R1_
                                     D1_2011APR


      388 StructDocs                 CDAR2_IG_C     1.4           A-T    When complete, this guide will fully When complete, this guide will fully
                                     ONSOL_R1_                           specify a compliant CDA R2           specify a compliant CDA R2
                                     D1_2011APR                          document for each of document        document for each document type.
                                                                         types.




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      389 StructDocs                 CDAR2_IG_C     1.4           A-S    These unconsolidated entries are
                                     ONSOL_R1_                           included here for reference, flagged
                                     D1_2011APR                          as pre-review.



      390 StructDocs                 CDAR2_IG_C     1.4           A-T    A full mapping of change is              A full mapping of change is
                                     ONSOL_R1_                           anticipated for after ballot.            anticipated to occur after ballot.
                                     D1_2011APR
      391 StructDocs                 CDAR2_IG_C     1.6           A-S    The value of this attribute provides a
                                     ONSOL_R1_                           unique identifier for the template in
                                     D1_2011APR                          question.


      392 StructDocs                 CDAR2_IG_C     1.7           A-S    CDA implementers think about
                                     ONSOL_R1_                           conformance requirements in terms
                                     D1_2011APR                          of three general levels corresponding
                                                                         to three different, incremental types
                                                                         of conformance statements

      393 StructDocs                 CDAR2_IG_C     1.7.2         A-S    Most conformance statements within Remove these statements, they're
                                     ONSOL_R1_                           this implementation guide are       production notes and offer no
                                     D1_2011APR                          presented as constraints from a     guidance for implementation.
                                                                         Template Database (Tdb). An
                                                                         algorithm converts constraints
                                                                         recorded in a Templates Database to
                                                                         a printable presentation.

                                                                         AND

                                                                         Constraints from the Model-Driven
                                                                         Health Tools (MDHT) look similar,
                                                                         but do not contain the same unique
                                                                         identifiers; many reference
                                                                         conformance statements from the
                                                                         source document.
      394 StructDocs                 CDAR2_IG_C     1.7.2         A-S    In open templates, all of the features
                                     ONSOL_R1_                           of the CDA R2 base specification
                                     D1_2011APR                          are allowed except as constrained by
                                                                         the templates.
      395 StructDocs                 CDAR2_IG_C     1.7.5         A-S    These controlled vocabularies are
                                     ONSOL_R1_                           defined in ...
                                     D1_2011APR
      396 StructDocs                 CDAR2_IG_C     1.7.5         A-S    ….value-set identifiers …
                                     ONSOL_R1_
                                     D1_2011APR




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      397 StructDocs                 CDAR2_IG_C             1.8.1         A-S
                                     ONSOL_R1_
                                     D1_2011APR




      398 StructDocs                 CDAR2_IG_C             Table 1       A-S    DIR.xml…                                 DIR.sample.XML
                                     ONSOL_R1_
                                     D1_2011APR
      399 StructDocs                 CDAR2_IG_C             2             A-S
                                     ONSOL_R1_
                                     D1_2011APR

      400 StructDocs      ??                        1.7.3                Neg-Mi The keyword "SHALL" implies a             The keyword "SHALL" allows
                                                                                lower cardinality of 1, but allows        NULL values.
                                                                                NULL values.




      401                 ??                        1.7.6                 A-S    Any SHALL conformance statement
                                                                                 may use nullFlavor, unless the
                                                                                 attribute is explicity required or the
                                                                                 nullFlavor is explicitly disallowed.

      402                 ??                        2.1                   A-S    7. SHALL contain exactly one [1..1]
                                                                                 effectiveTime (CONF:5256).
                                                                                   a. The value of @value, if present,
                                                                                 SHALL be precise to the day and
                                                                                 SHOULD be precise to the minute.
                                                                                 If precise to minute, SHOULD
                                                                                 include time-zone offset
                                                                                 (CONF:5257).

                                                                                 3. This patient SHALL contain
                                                                                 exactly one [1..1] birthTime
                                                                                 (CONF:5298).
                                                                                 a. SHALL be precise to year
                                                                                 (CONF:5299).
                                                                                 b. SHOULD be precise to day
                                                                                 (CONF:5300).




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      403                 ??                        2.1                Neg-Mj 7. This patient MAY contain zero or Remove the extended-namespace-
                                                                              more [0..*] sdwg:raceCode, which    based constraint.
                                                                              SHALL be selected from ValueSet
                                                                              2.16.840.1.113883.1.11.14914 Race
                                                                              DYNAMIC (CONF:7263).




      404                                                               A-T


      405                                                               A-T


      406                                                              Neg-Mj




      407                                                              Neg-Mj




      408                                                              Neg-Mj




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      409                                                        Neg-Mi




      410                                                         A-S




      411                                                         A-T     In section templates, the subheadings “With coded entries optional”,
                                                                          “Optional Entries”, “Required         “With coded entries required”
                                                                          Entries”


      412                                                        Neg-Mj




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      413                                           4.28         Neg-Mj




      414                                                        Neg-Mi




      415                                           4.4           A-T


      416                                           4.4           A-T



      417                                                        Neg-Mi



      418                                           5.6           A-T


      419                                                         A-S




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      420                                                         A-S




      421                                                         A-T


      422                                                         A-S




      423                                           5.29         Neg-Mi




      424                                                        Neg-Mi




      425                                           CONF:175      A-T


      426                                           CONF-         A-S
                                                    7556

      427                                           2.1.6         A-S     The intended recipient MAY also be    “If the intended recipient of the
                                                                          the health chart of the patient, in   document is the patient's health
                                                                          which case the receivedOrganization   chart, set the receivedOrganization
                                                                          is the scoping organization of that   to be the scoping organization for
                                                                          chart.                                that chart.”

      428                                           2.1.6,        A-Q
                                                    3.3.1.4




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      429                                           CONF:843     Neg-Mi If present,                           1. If present, responsibleParty
                                                    9                   responsibleParty/assignedEntity       SHALL 1..1 contain assignedEntity,
                                                                        SHALL have at least one               which /// a. SHALL [1..2] contain
                                                                        assignedPerson or                     assignedPerson and/or
                                                                        representedOrganization element       representedOrganization.
                                                                        present.
      430                                                         A-S




      431                                                         A-S



      432                                           3.7.1.2 /     A-T    This code/@code MAY contain
                                                    CONF:849             exactly one [1..1] code/@code, ...
                                                    8
      433                                           3.7.1.2 /     A-T   3. SHOULD contain exactly one
                                                    CONF:849            [1..1] code/@code="28570-0"
                                                    7-8498              Procedure Note (CodeSystem:
                                                                        2.16.840.1.113883.6.1 LOINC)
                                                                        (CONF:8497). a. This code/@code
                                                                        MAY contain exactly one [1..1]
                                                                        code/@code, which MAY be
                                                                        selected from ValueSet
                                                                        2.16.840.1.113883.11.20.6.1
                                                                        ProcedureNoteDocumentTypeCodes
                                                                        DYNAMIC (CONF:8498).
      434                                           5.23         Neg-Mj template name: Procedure Activity
                                                                        Procedure




      435                                                         A-S




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      436                                                 5.23           A-Q


      437                                                 CONF:765       A-T     5. SHALL contain exactly one [1..1]
                                                          7                      code (CONF:7656). a. This code
                                                                                 @code in a procedure activity
                                                                                 SHOULD be selected from... (CONF-
                                                                                 7657)
      438 StructDocs                                                    Neg-Mj




      439 StructDocs                                      Table 18       A-T     Consultation Note row:                Use asterisk and reference to how
                                                                                 Assessment/Assessment and Plan        the Assessment and Plan sections
                                                                                 Plan/Assessment and Plan              should be implmented. See table 31
                                                                                                                       for example.
      440 StructDocs                                      Table 2        A-T     Confidentiality Code                  Confidentiality Code
      441 StructDocs                                      4.35           A-T     2.16.840.1.113883.10.20.21.2.10       2.16.840.1.113883.10.20.22.2.10
      442 StructDocs                                2.3   1 (conf        A-S     1. SHALL NOT have mixed               Please add child comment statement
                                                          7278)                  content (CONF:7278).                  regarding what is meant by mixed
                                                                                                                       content such as "A mixed complex
                                                                                                                       type element contains any
                                                                                                                       combination of attributes, elements,
                                                                                                                       and text.3"
      443 StructDocs                                2.3   Table 17:     Neg-Mi … which SHALL be selected from          create new valueSet and adjust
                                                          EntityNam            ValueSet                                applicable conformance statements
                                                          ePartQualif          2.16.840.1.113883.1.11.15888
                                                          ier Value            EntityNamePartQualifier STATIC
                                                          Set                  2005-05-01 (CONF:7156).
                                                                               Everywhere this valueSet is used on
                                                                               person name




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      444 StructDocs                                2.1            Table 11:      A-T     extra row in table(before Alabama      remove
                                                                   State Value            row)
                                                                   Set
      445 StructDocs                                General                       A-T     General comment: Need to develop
                                                    comment:                              discrete computable conformance
                                                    (Examples:                            statements for "or" requirements
                                                    3.1.1.4 and
                                                    3.2.1.3
      446 StructDocs                                3.2.1.3        Participant    A-S     c. When participant/@typeCode is
                                                                                          IND, associatedEntity/@classCode
                                                                                          SHALL be PRS,
                                                                                          NOK,CAREGIVER, AGNT,GUAR,
                                                                                          or ECON. (CONF:8380).

      447 StructDocs                                2.1.1        #9               A-S     9. This patient SHOULD contain         9. This patient MAY contain zero or
                                                    RecordTarge                           zero or one [0..1] guardian            one [0..1] guardian (CONF:5325).
                                                    t                                     (CONF:5325).
      448 StructDocs                                3.2.1.3                       A-S
                                                    (USheader)
                                                    3.4.1.3
                                                    3.5.1.3
                                                    Participant)
      449 StructDocs                                General                       A-S
                                                    comment
                                                    about header
                                                    template

      450 StructDocs                                5.3 Allergy                   A-T
                                                    Problem Act

      451 StructDocs                                5.6                          Neg-Mi The value of negationInd should not
                                                    Condition                           normally be set to true. Instead, to
                                                    Entry                               record that there is "no prior history
                                                    [Observation                        of chicken pox" one would use a
                                                    : templateId                        coded value indicated exactly that.
                                                    2.16.840.1.1
                                                    13883.10.20.
                                                    22.4.4(open)
                                                    ]




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      452 StructDocs                                5.6                           A-T    This section uses the …..
                                                    Condition
                                                    Entry
                                                    [Observation
                                                    : templateId
                                                    2.16.840.1.1
                                                    13883.10.20.
                                                    22.4.4(open)
                                                    ]

      453 StructDocs                                4.40 Problem                  A-T    link to condition entry doesn’t work
                                                    List Section
                                                    11450-4
      454 StructDocs                                5.5                          Neg-Mi 1. SHALL contain exactly one [1..1]
                                                    Condition                           @classCode="ACT" Act
                                                    [Act:                               (CodeSystem:
                                                    templateId                          2.16.840.1.113883.5.6
                                                    2.16.840.1.1                        HL7ActClass) (CONF-146)
                                                    13883.10.20.
                                                    22.4.3(open)
                                                    ]
      455 StructDocs                                4.48                          A-T    Therefore this section contains
                                                    Procedures                           procedure templates represented with
                                                    Section                              three RIM classes Act: Observation
                                                    47519-4                              and Procedure
                                                    (Template
                                                    Description)
      456 StructDocs                                General                       A-S
                                                    Comment

      457 StructDocs                                4.20 Hospital                 A-S    The Discharge Diagnosis section
                                                    Discharge                            (entry) describes the relevant
                                                    Diagnosis                            problems or diagnoses that occurred
                                                    Section                              during the hospitalization or that
                                                    48765-2                              need to be followed after
                                                    and                                  hospitalization. This section includes
                                                    5.7                                  an optional entry to record patient
                                                    Discharge                            conditions
                                                    Diagnosis
                                                    Act




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                       75                                        March 2003
                                                                    V3 Ballot Submission/Resolution Form

      458 StructDocs                                Table 58:                     A-S    Hospital Admission Section no
                                                    Discharge                            longer defined (deemed unessesary
                                                    Summary                              during consol anlaysis) suggest
                                                    Cardinality                          adding entry similar to 5.7 Discharge
                                                    Updates                              Diagnosis Act defining Admission
                                                                                         Diagnosis

      459 StructDocs                                4.21 Hospital                 A-T    link to Discharge Medication
                                                    Discharge                            template doesn’t work
                                                    Medications
                                                    Section
                                                    (optional
                                                    entries)
                                                    10183-2

      460 StructDocs                                General                       A-T    all the conformance statements        1. A reference/@value SHOULD
                                                                                         requirring a text reference should be point to its corresponding narrative
                                                                                         written in the same style             (using the approach defined in CDA
                                                                                                                               Release 2, section 4.3.5.1 ).

      461 StructDocs                                4.50 Results                 Neg-Mi 5. SHALL contain at least one [1..*]     4. SHOULD contain at least one
                                                    Section                             entry (CONF:7112) such that it           [1..*] entry (CONF:7119) such that
                                                    30954-2                             a. SHALL contain exactly one [1..1]      it
                                                    Required                            Result Organizer                         a. SHALL contain exactly one [1..1]
                                                    Entries                             (templateId:2.16.840.1.113883.10.2       Result Organizer
                                                    [component:                         0.22.4.1) (CONF:7113                     (templateId:2.16.840.1.113883.10.2
                                                    templateId                                                                   0.22.4.1)
                                                    2.16.840.1.1                                                                 5. SHALL contain exactly one [1..1]
                                                    13883.10.20.                                                                 Result Observation
                                                    21.2.3.1                                                                     (templateId:2.16.840.1.113883.10.2
                                                                                                                                 0.22.4.2)
      462 StructDocs                                5.26 Result                   A-T
                                                    Organizer
                                                    .
      463 StructDocs                                5.26 Result                   A-T    a. SHOULD be "BATTERY" or               1.This organizer SHOULD contain
                                                    Organizer                            "CLUSTER"                               exactly one [1..1]
                                                    conf 1a                                                                      @classCode="CLUSTER"
                                                    CONF:7165                                                                    CLUSTER (CodeSystem:
                                                                                                                                 2.16.840.1.113883.5.6
                                                                                                                                 HL7ActClass)
                                                                                                                                 OR
                                                                                                                                 1. SHOULD contain exactly one
                                                                                                                                 [1..1] @classCode="BATTERY"
                                                                                                                                 BATTERY (CodeSystem:
                                                                                                                                 2.16.840.1.113883.5.6
                                                                                                                                 HL7ActClass)




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                                                                   V3 Ballot Submission/Resolution Form

      464 StructDocs                                5.26 Result                  A-T    a. SHOULD be from LOINC              a. This code @code in a result
                                                    Organizer                           (CodeSystem:                         organizer SHOULD be selected
                                                    conf 5a                             2.16.840.1.113883.6.1) or            from LOINC (codeSystem
                                                    (CONF:7164                          SNOMED CT (CodeSystem:               2.16.840.1.113883.6.1) or
                                                    ).                                  2.16.840.1.113883.6.96), and MAY     SNOMED-CT CT (codeSystem
                                                                                        be selected from CPT-4               2.16.840.1.113883.6.96), and MAY
                                                                                        (CodeSystem:                         be selected from CPT-4
                                                                                        2.16.840.1.113883.6.12)              (codeSystem
                                                                                        (CONF:7164).                         2.16.840.1.113883.6.12)
      465 StructDocs                                5.3 Allergy 8b               A-T    link to allergy/alert Observation
                                                    Problem Act                         doesn't work

      466 StructDocs                                general                     Neg-Mi " SHOULD ... one [1..1] "



      467 StructDocs                                Table 52       multiple      A-S    SHALL use: Value Set: HL7            SHALL use VALUE SET:
                                                                   conf                 ServiceDeliveryLocationRoleType      HealthcareServiceLocation
                                                                   statenment           2.16.840.1.113883.1.11.17660         (2.16.840.1.113883.1.11.20275)
                                                                   s                    Code System(s): HL7 RoleCode
                                                                                        (2.16.840.1.113883.5.111


      468 StructDocs                                2.1.1       11b              A-S    b. Such languageCommunications, if   add: Such
                                                    RecordTarge                         present, MAY contain zero or one     languageCommunications, if
                                                    t                                   [0..1] modeCode, which SHALL be      present, SHOULD contain zero or
                                                                                        selected from ValueSet               one [0..1] proficiencyLevelCode
                                                                                        2.16.840.1.113883.1.11.12249         which SHALL be selected from
                                                                                        (member examples: EWR Language       valueSet
                                                                                        Ability Mode Expressed written,      LanguageAbilityProficiency
                                                                                        RSP Language Ability Mode            (2.16.840.1.113883.1.11.12199)
                                                                                        Received spoken )




      469 StructDocs                                4.40 Problem                 A-T    links
                                                    List Section
                                                    5.5
                                                    Condition




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      470 StructDocs                                5.6                         Neg-Mi
                                                    Condition                            a. The <effectiveTime> of this
                                                    Entry                                <observation> is the time interval
                                                    7. SHOULD                            over which the <observation> is
                                                    contain                              known to be true. The <low> and
                                                    exactly one                          <high> values should be no more
                                                    [1..1]                               precise than known, but as precise as
                                                    effectiveTim                         possible. While CDA allows for
                                                    e (CONF-                             multiple mechanisms to record this
                                                    CONSOL-                              time interval (e.g., by low and high
                                                    532)                                 values, low and width, high and
                                                                                         width, or center point and width), we
                                                                                         are constraining Medical summaries
                                                                                         to use only the low/high form. The
                                                                                         <low> value is the earliest point for
                                                                                         which the condition is known to
                                                                                         have existed. The <high> value,
                                                                                         when present, indicates the time at
                                                                                         which the observation was no longer
                                                                                         known to be true. Thus, the
                                                                                         implication is made that if the
                                                                                         <high> value is specified, that the
                                                                                         observation was no longer seen after
                                                                                         this time, and it thus represents the
                                                                                         date of resolution of the problem.
                                                                                         Similarly, the <low> value may seem
                                                                                         to represent onset of the problem.
                                                                                         Neither of these statements is
                                                                                         necessarily precise, as the <low> and
                                                                                         <high> values may represent only an
                                                                                         approximation of the true onset and
      471 StructDocs                                5.6                                  resolution (respectively) times. For
                                                                                         C83 references
                                                    Condition
                                                    Entry
      472 StructDocs                                5.6                                  8. SHALL contain exactly one [1..1]     SHALL contain exactly one [1..1]
                                                    Condition                            value, which SHALL be selected          value with @xsi:type="CD", where
                                                    Entry                                from ValueSet                           the @code SHALL be selected from
                                                                                         2.16.840.1.113883.3.88.12.3221.7.4      ValueSet
                                                                                         Problem DYNAMIC                         2.16.840.1.113883.3.88.12.3221.7.4
                                                                                                                                 Problem DYNAMIC (CONF:7335).
      473 StructDocs                                5.6                                  This section uses the linking,
                                                    Condition                            severity, clinical status and comment
                                                    Entry                                content specifications defined
                                                                                         elsewhere in the technical
                                                                                         framework.




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      474 StructDocs                                5.6                              The value of negationInd should not Remove
                                                    Condition                        normally be set to true. Instead, to
                                                    Entry                            record that there is "no prior history
                                                                                     of chicken pox", one would use a
                                                                                     coded value indicated exactly that.
                                                                                     However, it is not always possible to
                                                                                     record problems in this manner,
                                                                                     especially if using a controlled
                                                                                     vocabulary that does not supply pre-
                                                                                     coordinated negations , or which do
                                                                                     not allow the negation to be recorded
                                                                                     with post-coordinated coded
                                                                                     terminology.

      475 StructDocs                                5.6
                                                    Condition
                                                    Entry
      476 StructDocs                                            2             A-S    General Header Template            Use of the CDA Header




      477 StructDocs                                            2             A-S




      478 StructDocs                                                          A-Q

      479 StructDocs                                                          A-T   Table 18: H&P Vital Sign section is
                                                                                    in both Required and optional
                                                                                    columns
      480 StructDocs                                                         Neg-Mi Vital Signs Organizer               2.16.840.1.113883.10.20.22.4.26
                                                                                    [organizer: templateId
                                                                                    2.16.840.1.113883.10.20.21.4.26(op
                                                                                    en)]
      481 StructDocs                                                          A-S
      482 StructDocs                                                          A-S

      483 StructDocs                                                          A-Q


      484 StructDocs                                                          A-T




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                                                              V3 Ballot Submission/Resolution Form

      485 StructDocs                                                        A-T

      486 StructDocs                                1         1.3 Scope    Neg-Mi At present, the entry-level templates These entry-level templates are
                                                                                  cover only those required for         intended to only satisfy the
                                                                                  Meaningful Use.                       requirements for MU Stage 1.
      487                                           1         1.2          Neg-Mi This ballot package represents a
                                                              Purpose             partial harmonization of these works
                                                                                  and includes all required CDA
                                                                                  templates in Final Rules for
                                                                                  Meaningful Use
      488                                           1         1.2          Neg-Mj When complete, this guide will
                                                              Purpose             provide a single source for
                                                                                  implementing the following CDA
                                                                                  documents




      489                                           3         Table 18     Neg-Mi Post Operative Diagnosis              Postoperative Diagnosis


      490                                           3         Table 18     Neg-Mi Post Procedure Diagnosis              Postprocedure Diagnosis


      491 StructDocs                                General




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                                                                  V3 Ballot Submission/Resolution Form

      492 StructDocs                                General       Appendix     Yes   Neg-Mj
                                                                  B




      493 StructDocs                                1.4                               A-T     … an open source application first     ...an open source application first
                                                    Approach                                  developed for the Centers for          developed for the Centers for
                                                                                              Disease and Prevention and in active   Disease Control and Prevention and
                                                                                              use…                                   in active use...
      494 StructDocs                                General       1.7.1              Neg-Mi
                                                                  Levels of
                                                                  Constraint




      495 StructDocs                                1.7.2                             A-Q
                                                    Conformance
                                                    Statements




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                                                                  V3 Ballot Submission/Resolution Form

      496 StructDocs                                General       1.7.2
                                                                  Conforman
                                                                  ce
                                                                  Statements




      497 StructDocs                                General       1.7.2        Neg-Mi e.x. 8. SHALL contain exactly one          e.x. 8. SHALL contain exactly one
                                                                  Conforman           [1..1] confidentialityCode, which          [1..1] confidentialityCode
                                                                  ce                  SHOULD be selected from ValueSet           (CONF:XXXX).
                                                                  Statements          2.16.840.1.113883.1.11.16926                a. confidentialityCode/@code
                                                                                      BasicConfidentialityKind STATIC            SHOULD be selected from ValueSet
                                                                                      2010-04-21 (CONF:5259).                    2.16.840.1.113883.1.11.16926
                                                                                                                                 BasicConfidentialityKind STATIC
                                                                                                                                 2010-04-21 (CONF:5259).




      498 StructDocs                                1.7.2                       A-S     In open templates, all of the features
                                                    Conformance                         of the CDA R2 base specification
                                                    Statements                          are allowed except as constrained by
                                                                                        the templates. By contrast, a closed
                                                                                        template specifies everything that is
                                                                                        allowed and nothing further may be
                                                                                        included.

      499 StructDocs                                General       1.7.2        Neg-Mj
                                                                  Conforman
                                                                  ce
                                                                  Statements




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                                                              V3 Ballot Submission/Resolution Form

      500 StructDocs                                General   1.7.2        Neg-Mj
                                                              Conforman
                                                              ce
                                                              Statements


      501 StructDocs                                General   1.7.2        Neg-Mj
                                                              Conforman
                                                              ce
                                                              Statements




      502 StructDocs                                General                Neg-Mi


      503 StructDocs                                General   1.7.5        Neg-Mj
                                                              Vocabulary
                                                              Conforman
                                                              ce




      504 StructDocs                                General                Neg-Mi 1. This                               1. This
                                                                                  representedCustodianOrganization      representedCustodianOrganization
                                                                                  SHALL contain exactly one [1..1] id   SHALL contain one or more [1..*]
                                                                                  (CONF:5522).                          id (CONF:5522).




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      505 StructDocs                                1.7.5                       Neg-Mj
                                                    Vocabulary
                                                    Conformance




      506 StructDocs                                1.8.3 Non-                  Neg-Mj
                                                    Consolidated
                                                    Entries

      507 StructDocs                                1.9 Content                 Neg-Mj
                                                    of the
                                                    Package



      508 StructDocs                                2.1 US         1            Neg-Mj 1. SHALL contain exactly one [1..1] 2. SHALL contain exactly one [1..1]
                                                    Realm                              realmCode="US" (CONF:5249).         realmCode (CONF:5249).
                                                    Clinical                                                                a. This realmCode SHALL contain
                                                    Document                                                               exactly one [1..1] @code="US"
                                                    Header                                                                 (CONF:XXXX).
      509 StructDocs                                2.1 US         3            Neg-Mi 3. SHALL contain exactly one [1..1] SHALL contain exactly one [1..1]
                                                    Realm                              templateId/@root="2.16.840.1.1138 templateId (CONF:XXXX) such
                                                    Clinical                           83.10.20.22.1.1" (CONF:5252).       that it
                                                    Document                                                                   a. SHALL contain exactly one
                                                    Header                                                                 [1..1]
                                                                                                                           @root="2.16.840.1.113883.10.20.2
                                                                                                                           2.1.1" (CONF:5252).

      510 StructDocs                                2.1 US         6             A-S     6. SHALL contain exactly one [1..1]   6. SHALL contain exactly one [1..1]
                                                    Realm                                title (CONF:5254).                    title (CONF:5254).
                                                    Clinical                             a. can either be a locally defined    a. MAY contain a locally defined
                                                    Document                             name or the display name              name or the display name
                                                    Header                               corresponding to                      corresponding to
                                                                                         clinicalDocument/code                 clinicalDocument/code
                                                                                         (CONF:5255).                          (CONF:5255).




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                                                               V3 Ballot Submission/Resolution Form

      511 StructDocs                                2.1 US      7            A-S    7. SHALL contain exactly one [1..1]   7. SHALL contain exactly one [1..1]
                                                    Realm                           effectiveTime (CONF:5256).            effectiveTime (CONF:5256).
                                                    Clinical                        a. The value of @value, if present,    a. The value of @value, if present,
                                                    Document                        SHALL be precise to the day and       SHALL be precise to the day
                                                    Header                          SHOULD be precise to the minute.      (CONF:XXXX)
                                                                                    If precise to minute, SHOULD           b. The value of @value, if present,
                                                                                    include time-zone offset              SHOULD be precise to the minute
                                                                                    (CONF:5257).                          (CONF:XXXX).
                                                                                                                            ii. If precise to minute, SHOULD
                                                                                                                          include time-zone offset
                                                                                                                          (CONF:5257).

      512 StructDocs                                2.1 US      8           Neg-Mi 8. SHALL contain exactly one [1..1]    8. SHALL contain exactly one [1..1]
                                                    Realm                          confidentialityCode, which             confidentialityCode
                                                    Clinical                       SHOULD be selected from ValueSet       (CONF:XXXX).
                                                    Document                       2.16.840.1.113883.1.11.16926            a. confidentialityCode/@code
                                                    Header                         BasicConfidentialityKind STATIC        SHOULD be selected from ValueSet
                                                                                   2010-04-21 (CONF:5259).                2.16.840.1.113883.1.11.16926
                                                                                                                          BasicConfidentialityKind STATIC
                                                                                                                          2010-04-21 (CONF:5259).

      513 StructDocs                                2.1 US      9           Neg-Mi 9. SHALL contain exactly one [1..1]    9. SHALL contain exactly one [1..1]
                                                    Realm                          languageCode/@code, which              languageCode (CONF:XXXX).
                                                    Clinical                       SHALL be selected from ValueSet         a. languageCode/@code SHALL be
                                                    Document                       2.16.840.1.113883.1.11.11526           selected from ValueSet
                                                    Header                         LanguageValueSet DYNAMIC               2.16.840.1.113883.1.11.11526
                                                                                   (CONF:5372).                           LanguageValueSet DYNAMIC
                                                                                                                          (CONF:5372).

      514 StructDocs                                2.1 US      9            A-Q    9. SHALL contain exactly one [1..1]
                                                    Realm                           languageCode/@code, which
                                                    Clinical                        SHALL be selected from ValueSet
                                                    Document                        2.16.840.1.113883.1.11.11526
                                                    Header                          LanguageValueSet DYNAMIC
                                                                                    (CONF:5372).

      515 StructDocs                                2.1.1       12.a         A-S    i. Such patientRoles SHALL contain i. Each patientRole SHALL contain
                                                    RecordTarge                     at least one [1..*] id (CONF:5268). at least one [1..*] id (CONF:5268).
                                                    t




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                                                                V3 Ballot Submission/Resolution Form

      516 StructDocs                                2.1.1       12.a          A-S    ii. Such patientRoles SHALL            ii. Each patientRole SHALL contain
                                                    RecordTarge                      contain at least one [1..*] US Realm   at least one [1..*] US Realm Clinical
                                                    t                                Clinical Document Header Address       Document Header Address
                                                                                     (templateId:2.16.840.1.113883.10.2     (templateId:2.16.840.1.113883.10.2
                                                                                     0.22.5.2) (CONF:5271).                 0.22.5.2) (CONF:5271).

      517 StructDocs                                2.1.1       12.a.iii      A-S    1. Such telecoms SHOULD contain        1. Each telecom SHOULD contain
                                                    RecordTarge                      @use, which SHOULD be selected         @use (CONF:XXXX)
                                                    t                                from ValueSet                           a telecom/@use SHOULD be
                                                                                     2.16.840.1.113883.11.20.9.20           selected from ValueSet
                                                                                     Telecom use (US Realm Clinical         2.16.840.1.113883.11.20.9.20
                                                                                     Document Header) DYNAMIC               Telecom use (US Realm Clinical
                                                                                     (CONF:5375).                           Document Header) DYNAMIC
                                                                                                                            (CONF:5375).
      518 StructDocs                                2.1.1       12.a          A-S   iv. Such patientRoles SHALL             iv. Each patientRole SHALL contain
                                                    RecordTarge                     contain exactly one [1..1] patient      exactly one [1..1] patient
                                                    t                               (CONF:5283).                            (CONF:5283).
      519 StructDocs                                2.1.1       12.a.iv      Neg-Mi 2. This patient SHALL contain           2. patient SHALL contain exactly
                                                    RecordTarge                     exactly one [1..1]                      one [1..1]
                                                    t                               administrativeGenderCode/@code,         administrativeGenderCode
                                                                                    which SHALL be selected from            (CONF:XXXX)
                                                                                    ValueSet 2.16.840.1.113883.1.11.1        a.
                                                                                    Administrative Gender (HL7 V3)          administrativeGenderCode/@code
                                                                                    DYNAMIC (CONF:6394).                    SHALL be selected from ValueSet
                                                                                                                            2.16.840.1.113883.1.11.1
                                                                                                                            Administrative Gender (HL7 V3)
                                                                                                                            DYNAMIC (CONF:6394).

      520 StructDocs                                2.1.1       12.a.iv      Neg-Mi 4. This patient SHOULD contain          4. patient SHOULD contain zero or
                                                    RecordTarge                     zero or one [0..1]                      one [0..1] maritalStatusCode
                                                    t                               maritalStatusCode/@code, which          (CONF:XXXX)
                                                                                    SHOULD be selected from ValueSet         a. maritalStatusCode/@code
                                                                                    2.16.840.1.113883.1.11.12212            SHOULD be selected from ValueSet
                                                                                    MaritalStatus DYNAMIC                   2.16.840.1.113883.1.11.12212
                                                                                    (CONF:5303).                            MaritalStatus DYNAMIC
                                                                                                                            (CONF:5303).

      521 StructDocs                                2.1.1       12.a.iv      Neg-Mi 7. This patient MAY contain zero or
                                                    RecordTarge                     more [0..*] sdwg:raceCode, which
                                                    t                               SHALL be selected from ValueSet
                                                                                    2.16.840.1.113883.1.11.14914 Race
                                                                                    DYNAMIC (CONF:7263).

      522 StructDocs                                2.1.1       12.a.iv      Neg-Mi 9. This patient SHOULD contain
                                                    RecordTarge                     zero or one [0..1] guardian
                                                    t                               (CONF:5325).




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                   86                                                                              March 2003
                                                                  V3 Ballot Submission/Resolution Form

      523 StructDocs                                2.1.1       12.a.iv.9      Neg-Mi c. This guardian, if present, SHALL   c. This guardian, MAY contain zero
                                                    RecordTarge                       contain exactly one [1..1] telecom    or more [1..1] telecom
                                                    t                                 (CONF:5382).                          (CONF:5382).
      524 StructDocs                                2.1.1                       A-S d. This guardian, if present, SHALL     d. This guardian, if present, SHALL
                                                    RecordTarge                       contain exactly one [1..1]            contain exactly one [1..1]
                                                    t                                 guardianPerson (CONF:5385).           guardianPerson (CONF:5385).




      525 StructDocs                                2.1.1        12.a.v        Neg-Mi 1. This providerOrganization, if      1. This providerOrganization, if
                                                    RecordTarge                       present, SHALL contain exactly one    present, SHALL contain one or
                                                    t                                 [1..1] id (CONF:5417).                more [1..*] id (CONF:5417).
      526 StructDocs                                2.1.2 Author 13            Neg-Mi i. SHALL be precise to the day and    a. Such authors SHALL contain
                                                                                      SHOULD be precise to the minute       exactly one [1..1] time
                                                                                      (CONF:5446).                          (CONF:5445).
                                                                                                                             i. SHALL be precise to the day
                                                                                                                            (CONF:5446)
                                                                                                                             ii. SHOULD be precise to the
                                                                                                                            minute (CONF:XXXX).
      527 StructDocs                                2.1.2 Author 13.b          Neg-Mi i. This assignedAuthor SHALL          i. This assignedAuthor SHALL
                                                                                      contain exactly one [1..1] id         contain one or more [1..*] id
                                                                                      (CONF:5449).                          (CONF:5449).
      528 StructDocs                                2.1.3         14.a         Neg-Mi i. This assignedEntity SHALL          i. This assignedEntity SHALL
                                                    dataEnterer                       contain exactly one [1..1] id         contain one or more [1..*] id
                                                                                      (CONF:5443).                          (CONF:5443).
      529 StructDocs                                2.1.5         16.a.i       Neg-Mi 1. This                               1. This
                                                    Custodian                         representedCustodianOrganization representedCustodianOrganization
                                                                                      SHALL contain exactly one [1..1] id SHALL contain one or more [1..*]
                                                                                      (CONF:5522).                          id (CONF:5522).
      530 StructDocs                                2.1.7         18            A-S a. This legalAuthenticator, if present, a. This legalAuthenticator, if
                                                    legalAuthenti                     SHALL contain exactly one [1..1]      present, SHALL contain exactly one
                                                    cator                             time (CONF:5580).                     [1..1] time (CONF:5580).
                                                                                      i. SHALL be precise to the day and i. SHALL be precise to the day
                                                                                      SHOULD be precise to the minute. (CONF:XXXX)
                                                                                      If precise to minute, SHOULD           ii. SHOULD be precise to the
                                                                                      include time-zone offset              minute. (CONF:XXXX)
                                                                                      (CONF:5581).                            a. If precise to minute, SHOULD
                                                                                                                            include time-zone offset
                                                                                                                            (CONF:5581).




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                     87                                                                          March 2003
                                                                V3 Ballot Submission/Resolution Form

      531 StructDocs                                2.1.8        19           A-S    a. Such authenticators, if present,   a. Each authenticator SHALL
                                                    Authenticato                     SHALL contain exactly one [1..1]      contain exactly one [1..1] time
                                                    r                                time (CONF:5608).                     (CONF:5608).
                                                                                     i. SHALL be precise to the day and     i. SHALL be precise to the day
                                                                                     SHOULD be precise to the minute.      (CONF:XXXX)
                                                                                     If precise to minute, SHOULD           ii. SHOULD be precise to the
                                                                                     include time-zone offset              minute. (CONF:XXXX)
                                                                                     (CONF:5634).                            a. If precise to minute, SHOULD
                                                                                                                           include time-zone offset
                                                                                                                           (CONF:5634).
      532 StructDocs                                2.2 US      6            Neg-Mj 6. SHALL contain exactly one [1..1]
                                                    Realm                           postalCode, which SHALL be
                                                    Clinical                        selected from ValueSet
                                                    Document                        2.16.840.1.113883.3.88.12.80.2
                                                    Header                          PostalCodeValueSet DYNAMIC
                                                    Address                         (CONF:7294).
      533 StructDocs                                2.2 US      7            Neg-Mj 7. SHOULD contain zero or one
                                                    Realm                           [0..1] country, which SHALL be
                                                    Clinical                        selected from ValueSet
                                                    Document                        2.16.840.1.113883.3.88.12.80.63
                                                    Header                          CountryValueSet DYNAMIC
                                                    Address                         (CONF:7295).
      534 StructDocs                                2.2 US                   Neg-Mi [addr: templateId
                                                    Realm                           2.16.840.1.113883.10.20.21.5.2(ope
                                                    Clinical                        n)]
                                                    Document
                                                    Header
                                                    Address
      535 StructDocs                                2.3 US                   Neg-Mi [name: templateId
                                                    Realm                           2.16.840.1.113883.10.20.21.5.1(ope
                                                    Clinical                        n)]
                                                    Document
                                                    Header
                                                    Name
      536 StructDocs                                2.3 US      4             A-S    a. Second given is middle name        a. the second occurrence of given
                                                    Realm                            (CONF:7163).                          (given[2]) if provided, SHALL
                                                    Clinical                                                               include middle name or middle
                                                    Document                                                               initial (CONF:7163).
                                                    Header
                                                    Name




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                   88                                                                         March 2003
                                                                    V3 Ballot Submission/Resolution Form

      537 StructDocs                                2.4          3                A-S     a. The serviceEvent/effectiveTime    a. serviceEvent/effectiveTime
                                                    serviceEvent                          element SHOULD be present with       SHOULD contain exactly one [0..1]
                                                    in a CDA                              effectiveTime/low element and        low (CONF:XXXX).
                                                    Header                                SHALL include effectiveTime/high      i. effectiveTime/low SHALL be
                                                                                          element if a width element is not    accurate to the day (CONF:XXXX)
                                                                                          present. The                          ii. effectiveTime/low MAY be
                                                                                          serviceEvent/effectiveTime element   accurate to the second.
                                                                                          SHALL be accurate to the day, and    (CONF:7602).
                                                                                          MAY be accurate to the second.       b. If a width element is not present,
                                                                                          (CONF:7602).                         the serviceEvent/effectiveTime
                                                                                                                               SHALL include exactly one [1..1]
                                                                                                                               high.
                                                                                                                                i. effectiveTime/high SHALL be
                                                                                                                               accurate to the day (CONF:XXXX)
                                                                                                                                ii. effectiveTime/high MAY be
                                                                                                                               accurate to the second.
                                                                                                                               (CONF:7602).
                                                                                                                               c. serviceEvent/effectiveTime
                                                                                                                               SHALL be accurate to the day
                                                                                                                               (CONF:XXXX)
                                                                                                                               d. serviceEvent/effectiveTime MAY
                                                                                                                               be accurate to the second.
                                                                                                                               (CONF:7602).



      538 StructDocs                                3                            Neg-Mj
                                                    DOCUMEN
                                                    T-LEVEL
                                                    TEMPLATE
                                                    S



      539 StructDocs                                3                            Neg-Mi
                                                    DOCUMEN
                                                    T-LEVEL
                                                    TEMPLATE
                                                    S
      540 StructDocs                                3.1                          Neg-Mi 3.1 Continuity of Care Document        3.1 Continuity of Care Document
                                                    Continuity of                       (CCD)/C32                              (CCD)/C32
                                                    Care
                                                    Document
                                                    (CCD)/C32




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                       89                                                                             March 2003
                                                                   V3 Ballot Submission/Resolution Form

      541 StructDocs                                3.1.1 Header                Neg-Mj 1. Conforms to US Realm Clinical         1. SHALL contain exactly one [1..1]
                                                    Constraints                        Document Header Template                 templateId (CONF:XXXX) such
                                                    Specific to                        (templateId:                             that it
                                                    CCD                                2.16.840.1.113883.10.20.22.1.1).              a. SHALL contain exactly one
                                                                                                                                [1..1]
                                                                                                                                @root="2.16.840.1.113883.10.20.2
                                                                                                                                2.1.1" (CONF:XXXX).
      542 StructDocs                                3.1.1.2                             3. SHALL contain exactly one [1..1]     3. SHALL contain exactly one [1..1]
                                                    ClinicalDocu                        code/@code="34133-9"                    code (CONF:XXXX)
                                                    ment/code                           Summarization of Episode Note            a. SHALL xontain exactly one
                                                                                        (CodeSystem:                            [1..1] @code="34133-9"
                                                                                        2.16.840.1.113883.6.1 LOINC)            Summarization of Episode Note
                                                                                        (CONF:8451).                            (CodeSystem:
                                                                                                                                2.16.840.1.113883.6.1 LOINC)
                                                                                                                                (CONF:8451).
      543 StructDocs                                3.1.1.3      4.a.iii.b       A-S    i. The code MAY be the National         i. code/@code MAY be selected
                                                    documentati                         Uniform Claims Committee Provider       from 2.16.840.1.113883.6.101
                                                    onOf/service                        Taxonomy Code. (CONF:8462).             National Uniform Claims
                                                    Event                                                                       Committee Provider Taxonomy
                                                                                                                                Code DYNAMIC (CONF:8462).
      544 StructDocs                                3.1.1.4                      A-S    1. CCD SHALL contain one or more        1. SHALL contain at least one [1..*]
                                                    Author                              ClinicalDocument / author /             ClinicalDocument/ author
                                                                                        assignedAuthor / assignedPerson         (CONF:XXXX)
                                                                                        and/or ClinicalDocument / author /       a. Each author shall contain exactly
                                                                                        assignedAuthor /                        one [1..1] assignedAuthor
                                                                                        representedOrganization.                (CONF:XXXX)
                                                                                        (CONF:8456).                              i. the assignedAuthor SHALL
                                                                                                                                contain at least one [1..*]
                                                                                                                                assignedPerson or at least one [1..*]
                                                                                                                                representedOrganization
                                                                                                                                (CONF:XXXX)
      545 StructDocs                                3.2.1                       Neg-Mj 1. Conforms to US Realm Clinical         1. SHALL contain exactly one [1..1]
                                                    Consultation                       Document Header Template                 templateId (CONF:XXXX) such
                                                    Note Header                        (templateId:                             that it
                                                    Constraints                        2.16.840.1.113883.10.20.22.1.1).              a. SHALL contain exactly one
                                                                                                                                [1..1]
                                                                                                                                @root="2.16.840.1.113883.10.20.2
                                                                                                                                2.1.1" (CONF:XXXX).
      546 StructDocs                                3.2.1.3                      A-S    a. A participant element, if present,   a. SHALL contain exactly one [1..1]
                                                    Participant                         SHALL contain an associatedEntity       associatedEntity (CONF:XXXX)
                                                                                        element which SHALL contain              i. This associatedEntity SHALL
                                                                                        either an associatedPerson or           contain SHALL contain at least one
                                                                                        scopingOrganization element.            [1..*] associatedPersonor at least
                                                                                        (CONF:8378).                            one [1..*] scopingOrganization
                                                                                                                                (CONF:XXXX)




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                      90                                                                               March 2003
                                                                  V3 Ballot Submission/Resolution Form

      547 StructDocs                                3.2.1.3       4             A-S    b. A special class of participant is   b. A special class of participant is
                                                    Participant                        the supporting person or               the supporting person or
                                                                                       organization: an individual or an      organization: an individual or an
                                                                                       organization that has a relationship   organization that has a relationship
                                                                                       to the patient, including including    to the patient, including including
                                                                                       parents, relatives, caregivers,        parents, relatives, caregivers,
                                                                                       insurance policyholders, and           insurance policyholders, and
                                                                                       guarantors. In the case of a           guarantors. In the case of a
                                                                                       supporting person who is also an       supporting person who is also an
                                                                                       emergency contact or next-of-kin, a    emergency contact or next-of-kin,
                                                                                       participant element should be          there SHOULD be exactly one [0..1]
                                                                                       present for each role recorded.        participant for each role recorded.
                                                                                       (CONF:8379).                           (CONF:8379).
      548 StructDocs                                3.2.1.3       4             A-S    d. When                                d. When
                                                    Participant                        associatedEntity/@classCode is         associatedEntity/@classCode is
                                                                                       PRS, NOK, or ECON, then                "PRS", "NOK", or "ECON", then
                                                                                       associatedEntity/code SHALL be         associatedEntity SHALL contain
                                                                                       present having a value drawn from      exactly one code (CONF:XXX).
                                                                                       the PersonalRelationshipRoleType        i. code SHALL contain exactly one
                                                                                       domain or from SNOMED, any             [1..1] @code selected from
                                                                                       subtype of "Person in the family"      PersonalRelationshipRoleType
                                                                                       (303071001) DYNAMIC.                   domain or from SNOMED, any
                                                                                       (CONF:8381).                           subtype of "Person in the family"
                                                                                                                              (303071001) DYNAMIC.
                                                                                                                              (CONF:8381).
      549 StructDocs                                3.2.1.4       5            Neg-Mi a. The inFulfillmentOf element
                                                    inFullFillmen                     records the prior orders that are
                                                    tOf                               fulfilled (in whole or part) by the
                                                                                      service events described in this
                                                                                      document. For example, the prior
                                                                                      order might be an order for a
                                                                                      Consult, and this Consultation Note
                                                                                      would be in fulfillment of that order.
                                                                                      (CONF:8383).
      550 StructDocs                                3.2.1.4       5            Neg-Mi b. This inFulfillmentOf SHOULD         b. This inFulfillmentOf SHALL
                                                    inFullFillmen                     contain exactly one [1..1]             conatin exactly one [1..1] order
                                                    tOf                               order/id/@root (CONF:8385).            (CONF:XXXX)
                                                                                                                              i. SHOULD contain exactly one
                                                                                                                             [1..1] id (CONF:8385).
      551 StructDocs                                3.2.1.5                     A-S The authorization elements may be 6. MAY contain zero or more [0..*]
                                                                                      present. The Consultation Note         authorization {CONF:XXXX)
                                                                                      provides no guidance on the
                                                                                      encoding of authorization elements.




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                                                                  V3 Ballot Submission/Resolution Form

      552 StructDocs                                4 SECTION-                 Neg-Mi
                                                    LEVEL
                                                    TEMPLATE
                                                    S
      553 StructDocs                                4.1 Advance                 A-S     6. MAY contain exactly one [1..1]
                                                    Directives                          entry (CONF:7957).
                                                    Section
                                                    42348-3


      554 StructDocs                                4.24                       Neg-Mi 5. SHOULD contain exactly one         5. SHOULD contain one or more
                                                    Immunizatio                       [1..1] entry (CONF:7969).             [1..*] entry (CONF:7969).
                                                    ns Section
                                                    11369-6




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                     92                                                                    March 2003
                                                                        V3 Ballot Submission/Resolution Form


                                                                                                                                    Committee Resolution

                                                          In person
                                                          resolution   Comment                                   Disposition
Comments                                                  requested    grouping   Disposition        Withdrawn   Committee     Disposition Comment

At least in laboratory reporting in the US, more than
one interpretation code can be provided with a
laboratory observation. Constraining this to a single
interpretation code per observation means the EHR
would possibly be dropping significant
interpretation codes provided by the originating
laboratory.
In the case of a laboratory result being included in a
CDA, it is extremely unlikely that the original result
from the lab will contain a hash '#' mark as
indicated, since a text attribute and narrative are
unlikely to be present in the original lab result. That
means the EHR is 'adding' this information and
creating a new observation. Where the EHR is
adding to the lab result (or result reported by another
diagnostic source) the EHR is the author not the
originating diagnostic source.

I believe you actually need two Result Observation
templates, one which faithfully reproduces the
observation from the originating diagnostic source
and does not include things "added" by the generator
of the document such as the has mark, where the
diagnostic source is the author of this observation. A
second template for observations that the EHR has
created and supplemented based on observations
from some other diagnostic source. The EHR would
be the author of this second observation. Both could
be present in a document and associated by a REFR
act relationship (not the best one from V3 but the
best one available in CDA).

I do know that Labs will have a real problem with




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                               93                                                         March 2003
                                                           V3 Ballot Submission/Resolution Form

This seems to imply that only "final" results are to
be included in this template. How are "corrected"
results which are a type of final result
communicated? Since the V3 state machine doesn't
actually have a "corrected" state, this was handled in
V3 Lab results as separate control act which has as
its subject the observation being corrected. The
control act code attribute carried the trigger event for
a corrected result. Fior CDa, that would be handled
via a subject act relationship (with the observation
as the target) to an "ACT" with a code attribute
carrying the corrected trigger event. This ties in with
"faithfully" reporoducing the result as reported by
the diagnostic source.




For example, section 1.3 says: All CDA templates
required for Final Rules for Meaningful Use are
included in this guide.
The syntax is confusing. I would not have
interpreted that it meant other participants are
allowed as well without the prior clause; I would
interpret it to mean that exactly one participant is
allowed, AND that participant must have exactly
one type code that is equal to LOC.




Which are normative, DSTU, informative or other?
E.g., is cda.xsl one of these statuses, and if so,
would changes to it require reballoting?
Clarify that codes such as en-US are also OK.




I'm glad that more than one patient ID are now
allowed - this was a weird IHE constraint.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           94                    March 2003
                                                          V3 Ballot Submission/Resolution Form

Patients may not have a US address, if visiting from
overseas. Many foreign addresses do not contain
"state" for example. The same is true for guardians,
employers, etc. Adjust conformance statements
throughout to accommodate this.
I could be wrong, but I thought that minors could
have more than one guardian.

No reason to limit to one phone number.


These numeric state codes are not referenced
anywhere in the IG, and may confuse implementers
into using them rather than the normal state codes
(e.g., 12 vs. FL). I realize that the OIDs for the
values sets are different, but see no reason to include
this table at this point. If and when it is needed, its
use should be clear.
A very common scenario is that a clerk in the
medical records department creates a "push button"
CCD upon request of the patient. There is no single
identifiable human author in this case (the clerk may
have clicked the button, but did not author the
document). The author is an Organization in this
case. Need to explain how to represent this, and
change the cardinality of assignedPerson.

My understanding of this was that it conveyed legal
stewardship of the document. This wording seems
very watered down, implying little more than web
hosting.
Circular. Why does information recipient contain an
intended recipient which, in turn, contains an
information recipient?




My be a foreigner receiving treatment in the US.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          95                    March 2003
                                                     V3 Ballot Submission/Resolution Form

As an XML attribute, there can only be one, but is
there a precedence we can define?


This is on the same level as "HV" for vacation
home, both with parent "H"




Immunization status is too vague. For each
document type that can contain immunizations,
specify the scope of time for immunizations
explicitly.




Contradiction between 3.3.1.10 section title and
section text. Is this meant to be the Physician of
Record Participant? (Section 2.19.1, Diagnostic
Imaging Report Implementation Guide)




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     96                    March 2003
                                                         V3 Ballot Submission/Resolution Form

"PRF" typeCode is used instead of "ATND" which
is not consistent with the 3.3.1.11 section text and
section 2.19.1 of the Diagnostic Imaging Report
Implementation Guide.




Suggest URL links to pages on the ONC S&I
Framework wiki where each specific change is
discussed and rationale is provided. The changes
should be "what" and "why." If not possible to
provide documentation on every change all at once, I
suggest the top priority for change logging be given
to explaining any changes that affect Stage 1 MU
(changes to templates or constraints for Medications,
Allergies, Procedures, Results, Problems) since these
will have the widest impact on developers. In other
words, changes that deviate from CCD and HITSP
C83/C80 are more significant impacts than changes
that deviate from other templates (e.g., some
HealthStory or IHE)




I applaud the inclusion of this paragraph which
makes it clear that null flavors are allowed unless
specifically prohibited by a SHALL NOT statement.
This is an improvement over some other Igs that are
silent on the subject.
Lack of reference to HITSP C83 and C80
(mentioned only once). Because some value sets are
included herein, and because C80 is implicitly
required by reference from C83, there should be
clear statements whether value sets are different than
the C80 value sets that are already required in Stage
1 MU.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         97                    March 2003
                                                          V3 Ballot Submission/Resolution Form

It says there are five required sections (Allergies,
Medications, etc.) for CCD, but the CCD
specification does not actually require these
sections. I have no objection to those sections as
they are required for MU, but technically I don't
think it is correct to say there are required in CCD
(or C32 for that matter). For example, in Table 31,
these sections are (correctly) listed as Optional

There is no section called "Plan" or is the Plan of
Care section being renamed? The table in 4 is not
consistent with section 4.35 which just says "Plan."
Which is the correct name? I suggest keeping the
name as Plan of Care for compatibility and
specificity (there could be "Plans" for other things
besides care)
Eliminate Constraint 6 "exactly one entry" because
there may be more than one AD document

Is it correct to say that a section can be within
another section, or was the intent to say that the
Procedures (not "the Procedure History section")
may be included in the History of Present Illness
section or may be included in a standalone
Procedures section?
CONF-144 says there must be a string containing
'problems' but the same XML contains no such
string. Should it say "problem" instead of
"problems"?
Fixed typo at beginning of 1st sentence. The last
sentence ("Local policy…") is confusing, because
there do not appear to be two things that could be
divided into two sections. What are the two things,
and IF they are divided into two sections, what
would the second section be?


The list of categories of results is not exhaustive, so
the text should say "such as" or "e.g.,"

The ballot comment spreadsheet formatting for the
Section Column should be changed to show 2 or
more decimals. Otherwise, it truncates trailing
zeroes and appears to refer to the wrong section. For
example I entered 4.50 and it displayed 4.5, so I had
to change the numeric format manually.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          98                    March 2003
                                                          V3 Ballot Submission/Resolution Form

This is a "SHOULD" in CCD (CONF-388), and
making it a SHALL will force changes to MU-
compliant systems.
CONF-7576 appears to contradict CONF-7572 and
CONF-7574. 7572 says there SHALL be at least one
Med Entry containing a Med Activity. But CONF
7576 allows for there to be such a Med Activity OR
a Med Use None Known entry. Please clarify
whether CONF-7576 is the correct statement, in
which case CONF-7572 should be changed from
SHALL to MAY.
Leave it as it was before in both CCD and HITSP
C83. Why change the name to something more
fuzzy?
This is a "SHOULD" in CCD (CONF-381). Why
make it required?

Inconsistent spelling of this vocabulary. I suggest
changing all to SNOMED CT (space, no hyphen)
throughout because IHTSDO spells it that way

The way of expressing only one participant "like
this" is to be present is confusingly worded. It
appears to be a SHALL but it actually is a
conditional SHALL. So when used for actual
constraints, such as 7508 and 7513 in section 5.14,
it is hard to understand and the constraints appear to
be contradictory even though perhaps they are not. I
suggest expressing this type of constraint differently,
e.g., starting with the condition, e.g., IF medication
timing is represented with start and stop dates, there
shall be exactly one LOW effectiveTime and exactly
one HIGH effectiveTime.

Problem status value set is a superset of HITSP C80
(which only contained 3 values: now there are 8).
While this does not "break" existing systems, the
expansion means that some systems will send values
that other systems don't fully understand. Also, the
value set appears to have overlap (e.g., is "chronic"
can be "active" or "inactive" and similar overlap
exists for for "intermittent" and "recurrent")




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          99                    March 2003
                                                         V3 Ballot Submission/Resolution Form

N-m: Constraints imposed by CDA should be
separated from those imposed elsewhere in the guide
and identified by the HMD row index (or via some
other mechanism) to enable the reader to understand
the source of the constraint.
CDA:xxxx in the above could be valued using the
HMD row index to specifically identify the source of
the constraint.
Related to lack of change log: it would help to have
in the IG, or an accompanying spreadsheet, a cross-
walk to the original implementation guides,
indicating whether the Consolidation Guide
constraints was taken "as is" from one of them, is
brand new, or has been modified based on an
existing IG.
SHALL on Problem Status (CONF-7320)
CDA Consolidation says that problem status is
required on allergies, whereas previously this entry
was optional in CCD, IHE and HITSP. This creates
unnecessary incompatibility with prior work, and as
all three had a different and CONSISTENT
constraint, this represents a change that goes beyond
the scope of work stated for the guide.

Code in the Allergy Problem Act is fixed to 48765-2
from LOINC. This represents a change from CCD,
IHE and HITSP specifications where
act/code/@nullFlavor = NA. These constraints
being consistent, we feel this change goes beyond
the scope of the guide. Furthermore, they introduce
needless incompatibility with prior work.

The condition act in the CDA Consolidation guide is
constrained for use with problems only, not
problems or allergies or other clinical statements
(e.g., an out of normal range lab result) as supported
in CCD, IHE and HITSP. This change results in
needless incompatibility with prior work.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        100                    March 2003
                                                          V3 Ballot Submission/Resolution Form

Medication Use None Known
N-M: There are several distinct cases where drug
treatment information may not be present. IHE uses
the following different values, of which only the first
is supported in the CDA Consolidation guide for this
template. This template should allow for
“unknown”, but also for “known none”.
Medication 182904002 Drug Treatment Unknown
To indicate lack of knowledge about drug therapy
Medication 182849000 No Drug Therapy Prescribed
To indicate the absense of any prescribed
medications
Medication 408350003 Patient Not On Self-
Medications To indicate no treatment


There might not have a telephone for a patient.


There are several Section templates, e.g.
Medications Section, that have "Optional Entries"
and "Required Entries" templates. I recommend a
decent explanation of this paradigm…probably
within section 1.7 Conformance.

I could be mistaken, but I don't think that the
example included in Figure 3 actually represents the
situation of "only one LIKE this allowed".
this ballot fails to help the non-CDA-expert to know
what an element is intended to represent in
business/clinical terms. For example, what is the
"effectiveTime" in 2.1 supposed to represent? The
time the document was written, or signed, or the
clinical time to which the document is referring, etc.
Similar for "code", "setId", versionNumber, and so
on.
while the intro to this section says "the author may
be a device, a person, or an organization", there is no
documentation of how a device or an organization
should be done.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         101                    March 2003
                                                           V3 Ballot Submission/Resolution Form

Noting the scenario of system generated documents
("Local policies MAY choose to delegate the
function of legal authentication to a device or system
that generates the clinical document"), many large
organizations (e.g. VA, DoD) will not be able to
provide a legal authenticating PERSON, as stated by
"In these cases, the legal authenticator is a person
accepting responsigbility for the document, not the
generating device or system). This element is a
SHOULD, so I guess it could be omitted in these
cases, or a representedOrganization could be
inserted, but this option is not provided.




several of the document level templates do have
participant constraints, but should these not be
further constraints on the general header participant
element?
there is a (partial) serviceEvent section, but it is not
anchored by "documentationOf". Several of the
document level templates do have documentationOf,
but should these not be further constraints on the
general header?
indeed, the intro for this section may be overly
specific, to "progress notes".

what is a "width" element? I have not seen such an
thing in a sample. If it is not an element or attribute,
the word needs to be described or replaced.

can we insert the Provider Taxonomy Code value
set?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          102                    March 2003
                                                          V3 Ballot Submission/Resolution Form




I suggest inclusion of a description of the "narrative
block" (text element), along the lines of section 4.3.5
(and 1.2.3) of CDA R2.
the current title implies that the following statements
are for elements that are optional, rather than a
template where you can omit the entries altogether

the current title implies that the following statements
are for required elements, rather than for a template
where you cannot omit the entries altogether.

this definition fits the concept of "plan" but not
"assessment"

this seems a bit overly specific to the procedure
note.



this seems a bit overly specific to the procedure
note.




this seems a bit overly specific to the procedure
note.




the current title implies that the following statements
are for elements that are optional, rather than a
template where you can omit the entries altogether




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         103                    March 2003
                                                          V3 Ballot Submission/Resolution Form

the current title implies that the following statements
are for required elements, rather than for a template
where you cannot omit the entries altogether.

needed for MU, I believe.


needed for MU, I believe.


needed for MU, I believe.


needed for MU, I believe.


very helpful for following trail from section through
all the potential entries. Need to include for all
sections and possibly entries (at least those with
"children")
the current title implies that the following statements
are for elements that are optional, rather than a
template where you can omit the entries altogether

the current title implies that the following statements
are for required elements, rather than for a template
where you cannot omit the entries altogether.

the current title implies that the following statements
are for elements that are optional, rather than a
template where you can omit the entries altogether

the current title implies that the following statements
are for required elements, rather than for a template
where you cannot omit the entries altogether.

the current title implies that the following statements
are for elements that are optional, rather than a
template where you can omit the entries altogether

the current title implies that the following statements
are for required elements, rather than for a template
where you cannot omit the entries altogether.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         104                    March 2003
                                                      V3 Ballot Submission/Resolution Form

required code, but no value set defined, nor is the
code described in any way.

Much experience has shown that implementers
commonly create (make up) different ways to
include "comments" fields in entry modules. Some
have used the occasionally required IHE <text> tag
associated with some of these entries to add such
information, some have used the generic "comments
module" (2.16.840.1.113883.3.88.11.83.11) to do so
(I assume this is the correct method), while others
have put them into originalText (even though the
text was not "originalText", but additional
comments).
As redundant as it may sound, I recommend a
conformance statement be inserted into each
section/entry to make it clear...in place... how to
provide comments.
Mostly I just recommend consistency in wording
across the several corresponding <text> elements
across the entry level templates.




Mostly I just recommend consistency in wording
across the several corresponding <text> elements
across the entry level templates.


Mostly I just recommend consistency in wording
across the several corresponding <text> elements
across the entry level templates.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     105                    March 2003
                                                          V3 Ballot Submission/Resolution Form

Mostly I just recommend consistency in wording
across the several corresponding <text> elements
across the entry level templates.


Mostly I just recommend consistency in wording
across the several corresponding <text> elements
across the entry level templates.


I recommend consistency in wording across the
several corresponding <text> elements across the
entry level templates.


Mostly I just recommend consistency in wording
across the several corresponding <text> elements
across the entry level templates.


I recommend consistency in wording across the
several corresponding <text> elements across the
entry level templates.


How is time zone offset to be represented? Can you
include an example?




Does this include the date as well? If not, it should
be included.


CCD should also include Diet/Nutrition (with        Yes
similar content and structure as Discharge Diet
section) as an optional section in CCD. Diet and
Nutrition prescriptions/goals may be a critical
component of a patient's care. The American
Dietetic Association would like to see Diet and
Nutrition information required for CCD and at least
listed as optional for many of the other templates.
How should we pursue making this change given
that this is an implementation guide and such
changes are likely out of scope?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         106                    March 2003
                                                                V3 Ballot Submission/Resolution Form

Add registered dietitian to list of providers




Add LOINC 34801-1 Evaluation and management
note – Nutrition + Dietetics



This template should be required in the CCD as it is
often critical information to share among providers.

The American Dietetic Association has established Yes
standardized language for the nutrition care process.
Coded terms for nutrition intervention and nutrition
monitoring and evaluation should optionally be
included in this section Reference: International
Dietetics and Nutrition Terminology (IDNT)
Reference Manual: Standardized Language for the
Nutrition Care Process. 3rd Ed. Chicago, IL:
American Dietetic Association; 2011. IDNT defines
"nutrition prescription" as "the patient/client's
individualized recommended dietary intake of
energy and/or selected foods or nutrients based on
current reference standards or dietary guidelines and
the patient/client's health condition and nutrition
diagnosis."
Shouldn't this reference template ID                       No
2.16.840.1.113883.10.20.22.2.24?




Wording is confusing--is it the patient's stated
reason for the visit or the provider's interpretation of
the patient's reason for the visit?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                               107                    March 2003
                                                           V3 Ballot Submission/Resolution Form

This can be ambiguous. Can this information be
provided by a PHR as documented by the patient, or
is the presumption that this is documented by a
member of the healthcare team?

It may be misleading to reference naturally ocurring
substances as manufactured materials without
indicating that this class may also include biologics.




The Substance Registration System/UNII scope
includes foods, drugs, biologics, devices and
cosmetics. Change the description to correspond
with this scope so as it is not limited solely to active
drug ingredients.
Add at least one example of a food allergen to table
39: Ingredient Name Value Set; e.g., peanut (UNII:
QE1QX6B99R)




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          108                    March 2003
                                                          V3 Ballot Submission/Resolution Form

Based upon work thru IHE, we agree with and cite
their comments:

Lack of Change Log, and as a result, sufficient time
to review the material.
HL7 Publishing procedures require a change log to
be provided for materials that update preexisting
work. The information provided with the CDA
Consolidation ballot indicated that the entire content
of previous DSTUs had changed. The log was
insufficient to enable the reader to identify artifacts
that had change. Such information was only made
publically available to balloters about 10 days before
ballot close, which was insufficient time to properly
review the content.
The changes in this document represent
approximately 150 templates and 1000
conformances statements that needed to be manually
compared against more than 150 templates and 1800
conformance statements in other guides. About 10
of the templates in original use were retained
without change, representing substantive change in
more than 90% of the previously balloted content,
without adequate aids to the reader to understand the
ramifications for existing implementations.
Due to the complexity of the analysis, most
implementers, would I suspect, simply reimplement
using the new guide rather the reusing existing code.
Assuming a reader was able to compare templates at
1 minute per conformance statement needing review,




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         109                    March 2003
                                                        V3 Ballot Submission/Resolution Form

based upon work thru IHE committee, we agree with
and cite their comments:

Volume of Substantive Change, and lack of
migration strategy between existing implementations
and the new guide.
The new guide substantively changes 90% of
existing work, and does not identify the changes
needed to enable existing software implementations
to be modified to support the new guide. Without a
migration strategy to move from old to new, and
given the volume of changes, implementers will
either embark upon costly (and reduntant) gap
analysis and upgrade of existing solutions, or simply
start over again. Neither is desirable given current
pressures upon the healthcare industry to deliver
software that will support “Meaningful Use Stage
2”. While CCD was but one part of meaningful use,
it was a fairly major one, requiring a great deal of
investment in testing and tools.
If the new guide had only strengthened existing
constraints, or at least provided a set of templates
that represented the strengthened constraints, the
situation would have been better. Even with a costly
gap analysis, existing software could have been
reused by adding a new template identifier to
existing implementations, and adding new features
where constraints had been strengthened. is unclear
Based upon comments in rows 1 and 2, it
whether or not these changes introduce an
unnecessary and costly backwards imcompatibility.

Immunization section was not consolidated.
Therefore this ballot is incomplete in terms of all
consolidation issues




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       110                    March 2003
                                                          V3 Ballot Submission/Resolution Form

Based upon work thru IHE, we agree with and cite
their comments:

Lack of Change Log, and as a result, sufficient time
to review the material.
HL7 Publishing procedures require a change log to
be provided for materials that update preexisting
work. The information provided with the CDA
Consolidation ballot indicated that the entire content
of previous DSTUs had changed. The log was
insufficient to enable the reader to identify artifacts
that had change. Such information was only made
publically available to balloters about 10 days before
ballot close, which was insufficient time to properly
review the content.
The changes in this document represent
approximately 150 templates and 1000
conformances statements that needed to be manually
compared against more than 150 templates and 1800
conformance statements in other guides. About 10
of the templates in original use were retained
without change, representing substantive change in
more than 90% of the previously balloted content,
without adequate aids to the reader to understand the
ramifications for existing implementations.
Due to the complexity of the analysis, most
implementers, would I suspect, simply reimplement
using the new guide rather the reusing existing code.
Assuming a reader was able to compare templates at
1 minute per conformance statement needing review,




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         111                    March 2003
                                                        V3 Ballot Submission/Resolution Form

based upon work thru IHE committee, we agree with
and cite their comments:

Volume of Substantive Change, and lack of
migration strategy between existing implementations
and the new guide.
The new guide substantively changes 90% of
existing work, and does not identify the changes
needed to enable existing software implementations
to be modified to support the new guide. Without a
migration strategy to move from old to new, and
given the volume of changes, implementers will
either embark upon costly (and reduntant) gap
analysis and upgrade of existing solutions, or simply
start over again. Neither is desirable given current
pressures upon the healthcare industry to deliver
software that will support “Meaningful Use Stage
2”. While CCD was but one part of meaningful use,
it was a fairly major one, requiring a great deal of
investment in testing and tools.
If the new guide had only strengthened existing
constraints, or at least provided a set of templates
that represented the strengthened constraints, the
situation would have been better. Even with a costly
gap analysis, existing software could have been
reused by adding a new template identifier to
existing implementations, and adding new features
where constraints had been strengthened. is unclear
Based upon comments in rows 1 and 2, it
whether or not these changes introduce an
unnecessary and costly backwards imcompatibility.

Immunization section was not consolidated.
Therefore this ballot is incomplete in terms of all
consolidation issues




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       112                    March 2003
                                                           V3 Ballot Submission/Resolution Form

Since this is a US Realm specification, recommend Yes
using the Two- letter State Abbreviations published
in Appendix B of the US Postal Service (USPS) Pub
28 Postal Addressing Standards.

http://pe.usps.com/text/pub28/welcome.htm

Since this is a US Realm specification, clarify that Yes
vocabularies named by US federal agencies
responsible for healthcare (HHS, ONC, CMS) must
be implemented in support of national initiatives.
The Office of National Coordinator is curently
working on a constrained set of LOINC terms for
results that may be named for Meaningful Use Stage
2.

Additionally not all laboratory tests have LOINC
codes created so local codes should also be allowed.




Since this is a US Realm specification, suggesting
adding reference for regional codes. Some federally
funded regional initaitves are defining regional
codes.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          113                    March 2003
                                                           V3 Ballot Submission/Resolution Form

Since this is a US Realm specification, clarify that Yes
vocabularies named by US federal agencies
responsible for healthcare (HHS, ONC, CMS) must
be implemented in support of national initiatives.
The Office of National Coordinator is curently
working on a constrained set of LOINC terms for
results that may be named for Meaningful Use Stage
2.

Additionally not all laboratory tests have LOINC
codes created so local codes should also be allowed.




Since this is a US Realm specification, suggesting
adding reference for regional codes. Some federally
funded regional initaitves are defining regional
codes.
Should the cardinality match?
5.27.4 is 1..*
5.27.5 is 1..1
Laboratory results can be reported in 4.23 (Hospital
Discharge Studies Summary Section) and 4.50
(Results Section) Please clarify when to report as
part of a discharge summary vs. the results section.

this is not at all clear by the example that follows.




what is 'mixed content'?

what is 'mixed content'?

See 4.21 Hospital Dischrge Medicatins Section
(optional entries)
Other Required entires (e.g., 4.28 Medications
Section) identify conformance to the optional entries
template.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          114                    March 2003
                                                            V3 Ballot Submission/Resolution Form

how does this status relate to the Allergy Status
observation? How can a Problem Act have a status
of Completed, Aborted, Active and Suspended,
when the Alert Status observation can be only
Active, Prior History and No Longer Active? For
that matter, what is the difference between an allert
that is Prior History and one that is No Longer
Active?
same comment as for allergies

forced severity observations on to the reaction rather
than the allergy. Existing IGs make no such
distinction. Has PC?
forced severity observations on to the reaction rather
than the allergy. Existing IGs make no such
distinction. Has PC?



Difficult to audit and trace template rules to the     No
source specifications used as input to this
consolidation. This is possible using the MDHT
consolidation model that was created by
programmatically merging templates from the source
models, but not in the TDB templates that were
created from a single hand-authored sample CDA
document instance.
There is value in retaining some abstract base         No
templates from the source specifications and not
creating redundant copies of conformance rules into
several templates that are closely related. This
duplication will make it difficult for implementers to
recognize common content in related templates, and
code implementations (e.g. in Java) will not benefit
from a common base class. One example is the CCD
Status Observation; its rules are now copied into 6
sub-templates (when consolidation is finished).

Vital Signs Organizer is based on Results Organizer No
template and should require conformance to that
template and NOT duplicate all inherited
conformance rules.
Vital Sign Observation is based on Result template No
and should require conformance to that template and
NOT duplicate all inherited conformance rules.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           115                    March 2003
                                                           V3 Ballot Submission/Resolution Form

Sections that have two templates With and Without     No
required entries include incorrectly duplicated
conformance rules in the sub-template. The sub-
template (entries required) shall conform to the
section without entries, so it should not duplicate
conformance rules for code and text.

The sub-templates of IHE Medication for Normal,
Split, Tapered, Conditional, and Combination are
omitted from this specification. No resolution was
reached for their removal and no guidance is
included on how equivalent C32 documents may be
exchanged without use of these templates.

Lack of implemeter guidance on changes from
HITSP C32. Implemeters of the current C32 v2.5
Meaningful Use requirements cannot determine
what must be changed to support this new
specification without reviewing every rule of every
template and comparing (how?) with previous
specifications.
I know the document sections for Discharge          No
Summary were already approved. However, I
wonder if "Discharge Instructions" should be added?
Discharge instructions are required for Meaningful
Use. Section 3.4 indicates that Joint Commission
requires "Information provided to the patient and
family". Should it be included in Discharge
Summary, it's own document type, or part of the
"Unstructured" document type?
The Conformance statement example is for Advance No
Directives, not Family History.

The Conformance statement example is for History      No
of Past Illness, not History of Present Illness.

Are the Implants (4.25) and Procedure Implants        No
(4.45) both required? How are they different?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          116                    March 2003
                                                     V3 Ballot Submission/Resolution Form

A distinction is drawn between 'open' and
'closed' templates, but no guidance is given on
how to indicate or determine whether a
template (or instance) assumes one of those
values. An example is given at 1.7.4 of how this
might be communicated, but the pattern is not
explicitly connected to the named modes.
Subsequent explicit use of "may" (e.g., in 4.18)
suggests a different approach.
Now I see that 'open' is appended to the OID:
let's state that in this definition. The example
alone is a bit subtle for certain readers.
Using a cardinality notation to indicate that an
element is not nullalble is novel. I think I'd
prefer not to see it that way but can't say why.

An Xpath example would make this easier to
read.

Articulate the convention for non-consolidated
entries; don't just show it.
E.g., 'in a shaded box,' or 'in a shaded box with
a note,' or 'with a note and with the
conformance id preceding rather than following
the statement'
If all xmls docs are samples, name them
congruently with 'sample' in the name

A consistent convention should be adopted with
regard to inherited constraints. This entry
repeats CDA constraint that id & code are
required but does not repeat CDA constraints
for classcode and moodcode. Further, it does
not indicate the lineage of inherited constraints.


Why does template id specify the root but not
the extension (which is noted at the top)?

Race code is listed twice. Update the CDA
spec to reflect the correct cardinality. Having
two just confuses the implementer.
Explain the "/C32" in the title. Even those who
know what it is may not understand the specific
assumptions regarding the relationship
between CCD and C32.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                    117                    March 2003
                                                        V3 Ballot Submission/Resolution Form

Header constraints illustrate the xpath,
helpfully. Class constraints should do so as
well.
E.g., allergy/alert observation: I assume this is
the observation class in the clinical statement,
but it's not specified.
It's more of a problem for 5.28 service delivery
location. There's no location in the clinical
statement--unless it's "playing entity." But it still
needs an act to connect it to the entry.

Allergy/alert observation is, on examination,
specifically a medication-related event
(according to CONF 7403). That should either
be relaxed to include food and environmental
allergies or renamed to make the scope
obvious.
Link to allergy/alert observation is broken


Why is family history section limited to one
entry?

"Hospital" misspelled


Having the LOINC code in the section header
may be helpful to some, but rationale not clear

Immunization history may need a more flexible
medication act, as it may not be possible to
record details (e.g., time) of medication, as in
5.14 medication activity CONF:7508

Problem list: diagram bears no clear
relationship to the text; could use exposition.

Need a general statement on when it's
appropriate to organize by section, subsection,
entry, or organizer. Different approaches are
mildly confusing.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       118                    March 2003
                                                         V3 Ballot Submission/Resolution Form

Appendix B answers many questions I had
while reading; this introductory section should
explain in more detail what that appendix does.
In addition, it's still not clear whether the new
OIDs are meant to replace, supersede, or
coexist with the existing OID, and what the
original stewards' positions are. Please clarify.

At several points, an entry states that the
structured data 'should reference the narrative':
this assumes that the narrative is orginal and
the entry is an encoding of that narrative. But if
the information is extracted from a structured
repository and the narrative is constructed from
that information, the reference should point the
other way. The direction should allow for either
case.
We require PQ; do we not need to require the
units and stipulate the unit system?

These Approach section implies that a model-driven
approach was taken in the creation of this
implementation guide. However it's unclear what
model driven approch was used to create these ballot
materials.

 - What is the Methodology? The consolidated guide
should document the process for instantiating new
documents and how to test those documents against
a valid model.

 - The ballot materials include the Word document
IG and a set of sample documents, but there are no
model-driven, re-usable artifacts that allow
implementers to create documents that conform to
selected templates to support the statement that
model-driven tools were used. This IG does not
appear to be different from any of the other CDA IG
that have been produced in the past.
 - While it was noted that "Post-ballot, the Tdb will
be the source for generation of platform-independent
validation rules as Schematron", if this consolidated
specification is to be considered at all to be "model-
driven", the schematron should be part of the IG.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        119                    March 2003
                                                        V3 Ballot Submission/Resolution Form

Many if not all the XML samples appear to have
been hand crafted using cut & paste given
inconsistencies found between sections in (at least)
two sample documents: Progress Note and MU
CCD. If one of the goals for this project was to
generate properly structured and cross referenced
implementation guides using a model driven
approach (i.e., MDHT), this goal was not met.

There are also inconsistencies in the documentation
of document types and required/optional sections
(table 18) in the IG and Table 31: Sections and
Required/Optional Document Types.

- Allergy section not identical despite comment in
Progress note stating "Allergies Section - Optional -
Copy from CCD sample". CCD example uses Alerts
section template ID:
2.16.840.1.113883.10.20.22.2.6 whereas Progress
Note example uses Allergies section template ID:
2.16.840.1.113883.10.20.22.2.6.1

Page 108 Assessment and Plan section templateID is
inconsistent with the OID in other chapters of the IG
(p. 101, 197).




Doesn't the use of the MSK nullFlavor have the
potential to disclose sensitive data?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       120                    March 2003
                                                           V3 Ballot Submission/Resolution Form

Missing the period between sentences.




If this intent of this guide is to "provide a single
source for implementing the following CDA
documents", these ballot materials have not
simplifed the process for implementers.
Inconsistencies found between templateIDs within
various sections of the IG and in the sample
documents is symptomatic of the need to use better
tools to ensure the guides and examples do not
introduce new ambiguities and errors in
implementation.

In addition, it was extremely difficult to review this
ballot unless one had participated in most of the
work group discussions since the process for
"creating a fully compliant CCD document, then
layering in the additional HITSP, IHE and
Meaningful Use constraints" was not documented in
the IG.
There is a problem with the narrative block if it is to
be created from structured content. A best-practices
mechanism is needed to ensure that a standard
approach describes the rules for creating the
narrative block from structured content when the
information included in the CDA is structured data
extracted from some system. Organizations are
currently forced to come up with their own rules
which results in very inconsistent rendering of CDA
documents.

This implementation guide should provide guidance
on how the narrative block is created from structured
content, if the narrative block is to be created at all.
The guide should provide a standard best-practices
mechanism for rendering structured content or the
guide should instruct that structured content is only
to be used as structured content and that narrative
content that originates as narrative content can only
be used as narrative content.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          121                    March 2003
                                                        V3 Ballot Submission/Resolution Form

The Specialized by Specialty area in Table 19
should reiterate the recommendation in the previous
paragraph (noted in Existing Wording column) as a
reminder to implementers, as these codes may
otherwise be used and conflict with the author or
performer of the service act or the practice setting
noted by the LOINC document type code.

It is difficult to validate the harmonization of the
standards without a comparision tool. Also need
reference to decisions when harmonization resulted
in one standard over another.
Table 31 indicates that Allergies and Other Adverse
Reactions section template is Optional in CCD
whereas Table 18 indicates this is a required section
(Table 18 on page 40).

In fact, all section templates defined for the CCD
document type are noted to be optional in Table 31
whereas Table 18 indicates that Allergies,
Medications, Problem List, Results and Procedures
(for inpatient) are required sections.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       122                    March 2003
                                                           V3 Ballot Submission/Resolution Form

There is no requirement in base CDA that the
content rendered in the narrative block match entries
that can be in that section resulting in the possibility
that the CDA document may contain structured data
that is not rendered (displayed) in that section. This
has the potential to be misleading to the clinician
reviewing the rendered document. In addition,
existing validation tools to detect differences
between the content of the narrative block and
structured data entries. Ithe clinician which seems
to be a conflicting requirement.

For example, in the Progress Note sample document,
the Assessment and Plan section contains three
observations in the narrative block, yet only one
structured content entry is included in the sample
document. The display name for the structured entry
does not match what was rendered in the narrative
block. These are issues that the consolidation
project should address.




While marked as “out of scope” for this version of
the CDA Consolidation IG, the guide includes the
conformance statement “6. MAY contain exactly one
[1..1] entry (CONF:7957)”, which allows for only
one external reference to an advance directive
document for the Advance Directive Section .

Per the CCD, a patient may have more than one
document: A healthcare proxy, living will, power of
attorney and DNR could all exist, each as a separate
document. The CCD, HITSP Template
2.16.840.1.113883.3.88.11.83.116, and IHE
Advance Directive Observation
1.3.6.1.4.1.19376.1.5.3.1.4.13.7 permit reference to
one advance directive document for each Advance
Directive Entry/Observation .
Suggest breaking out US Realm header constraints
from "best practice universal realm" header
constraints, to allow specification of UV constraints
for non-US realm IGs




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componentOf/encompassingEncounter is used in
most IGs. It would be useful to have a header
template for this ACT that consolidates the
requirements in one place, and that can be invoked
as needed by each of the IGs.
inFulfillmentOf/order is used in several IGs. It
would be useful to have a header template for this
ACT that consolidates the requirements in one place,
and that can be invoked as needed by each of the
IGs.
use conformance language


Healthcare providers may need to be identified not
only by their local institutional ID (assigned by
scoping organization), but also by National Provider
ID. Role.id should allow both to be recorded.
Also applies to other participations
(legalAuthenticator, etc.)

as a US realm header, NPI is required
Also applies to other participations


note 3.6.1.4 5.a.iii.2.a is a similar requirement on a
different participation. Should apply to all header
participations

Avoid use of 2nd person direct address


PCPR is an appropriate code in on a small number
of uses, and should not be specified in the general
US realm header requirements. This may be
appropriate as a further header constraint in specific
document types.
I would rather see a specific requirement (in a
separate row) for each section, using conformance
language and explicit cardinality.
Identification of LOINC codes for the document
types in this table is inappropriate, as many
document types allow different codes. It is unclear
what is the conformance language for these codes.




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Identification of conformance language in a footnote
is inappropriate. Please use explicit conformance
language in the main table rows for conditionality

This is not a required Section


This is a required Section


This is not a required Section


This is not a required Section


Why are new templateIDs assigned to every
document level template? I thought the approach
was to consolidate under existing templateIDs




Place invalid codes in a separate table for clarity.


Table 18 lists required sections for Consult Note.
Specifying it can have a nonXMLBody is
inconsistent.
It is true that Consult Notes (in general) may not
have a structured body, this IG does not have to be
the guiding authority for such. This document
section should specify only structured body Consult
Notes. Unstructured documents are described by
Section 3.9
DIR is a Universal Realm IG. Since conformance to
US Realm Header is a separate template ID, why
invoke it here?
title, and twice in text




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While this is consistent with the balloted DIR spec,
it is an unnecessary constraint, and conflicts with
generic requirement in Section 2.4:
3.a. The serviceEvent/effectiveTime element
SHOULD be present with effectiveTime/low
element and SHALL include effectiveTime/high
element if a width element is not present.
Procedure Note is a Universal Realm IG. Since
conformance to US Realm Header is a separate
template ID, why invoke it here?
Procedure Note is a Universal Realm IG, and it
specifies this as a MAY, not SHALL. Such
requirements should be part of the US Realm
Header, not the Procedure Note additional
requirements for the header
The following requirement has not been included in
this consolidation:
CONF-PN-42: Sections and subsections SHALL
have a title and the title SHALL NOT be empty.
Presumably this applies not only to specified
sections, but also to additional sections added by an
implementation
I would rather see a table representation of the
section requirements, similar to that used in IHE,
rather than the verbose text. Especially with
forthcoming IGs with many entries (e.g., the
Radiology and Cardiology report IGs), it is critical
for non-technical users to be able to effectively
review the content at a summary level, similar to the
tabular presentation at the document level.

While this is consistent with the balloted DIR spec,
it is bad practice, and may conflict with generic style
sheets. It conflicts with CONF-PN-42: Sections and
subsections SHALL have a title and the title SHALL
NOT be empty.
While this is consistent with the balloted DIR spec,
it is bad practice, and may conflict with generic style
sheets
Where is the delimiter for “the following” - should it
be the end of a numbered section?

This is a further sub-constraint on title, not a
separate constraint.




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When selecting a code from a value set, it is not
selecting just @code, but also @codeSystem,
@codeSystemName, and @displayName. Need a
general description of this pattern.
When specifying a specific code value, it is not
specifying just @code, but also @codeSystem,
@codeSystemName, and @displayName. Need a
general description of this pattern, and a simplified
requirement statement - no need to repeat the OID in
every invocation - one Coding System OID Table in
the document is sufficient.

Lack of Change Log, and as a result, sufficient time Yes   Change Log
to review the material.
N-M: HL7 Publishing procedures require a change
log to be provided for materials that update
preexisting work. The information provided with
the CDA Consolidation ballot indicated that the
entire content of previous DSTUs had changed. The
log was insufficient to enable the reader to identify
artifacts that had change. Such information was
only made publically available to balloters about 10
days before ballot close, which was insufficient time
to properly review the content.
The changes in this document represent
approximately 150 templates and 1000 conformance
statements that needed to be manually compared
against more than 150 templates and 1800
conformance statements in other guides. About 10
of the templates in original use were retained
without change, representing substantive change in
more than 90% of the previously balloted content,
without adequate aids to the reader to understand the
ramifications for existing implementations.
Due to the complexity of the analysis, most
implementers, would I suspect, simply reimplement
using the new guide rather the reusing existing code.
Assuming a reader was able to compare templates at
2 minutes per conformance statement needing
review, that amounts about 90 hours of effort, or
more than two weeks of analysis. Even at 30
minutes per template, that’s still about two weeks of
analysis.
I spent approximately 20 hours build a tool to enable




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Volume of Substantive Change, and lack of             Yes    Substantive
migration strategy between existing implementations          Change
and the new guide.
The new guide substantively changes 90% of
existing work, and does not identify the changes
needed to enable existing software implementations
to be modified to support the new guide. Without a
migration strategy to move from old to new, and
given the volume of changes, implementers will
either embark upon costly (and reduntant) gap
analysis and upgrade of existing solutions, or simply
start over again. Neither is desirable given current
pressures upon the healthcare industry to deliver
software that will support “Meaningful Use Stage
2”. While CCD was but one part of meaningful use,
it was a fairly major one, requiring a great deal of
investment in testing and tools.
If the new guide had only strengthened existing
constraints, or at least provided a set of templates
that represented the strengthened constraints, the
situation would have been better. Even with a costly
gap analysis, existing software could have been
reused by adding a new template identifier to
existing implementations, and adding new features
where constraints had been strengthened.
Instead, the new guide strengthens some existing
constraints, and weakens others, meaning that there
is no backwards compatibility with existing
solutions. rules in the “Conformance Statements”
N-m: The                                              Yes    Conformance
section are not applied uniformly throughout the
guide.

N-M: The use of (open) and (closed) and the            Yes   Conformance
meaning of these is not described in the guide.
Please include definitions for these terms in the
overview.
A-S: I have rarely seen “closed” templates be used, Yes      Conformance
and ever rarer yet, a mix of “open” and “closed”
templates in a single guide. I believe that each guide
should discuss its philosophy regarding whether the
templates it defines are open or closed, and provide
a general rule on how the templates it defines are
created.




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A-S: The repetition of “open” and/or “closed” for      Yes   Conformance
each template is distracting. Perhaps guides should
only note variations from the general rule when there
are exceptions.
N-M: While it is clear that a value set is defined     Yes   Conformance
separately from its binding (STATIC or
DYNAMIC), I have never seen an implementation
guide EVER bind statically to a value set in one
place, and dynamically in another, nor would this be
considered good practice, as it would introduce
different interpretations of the value set in the same
guide. The static or dynamic bindings used with the
guide should be described in the value set, rather
than in each use of the value set. This will simplify
text for the reader, as one can remove unnecessary
repetition of “static” and “dynamic” in all
appearances where the value set is used within a
single guide.
                                                      Yes    Conformance
1. SHALL contain exactly one [1..1] participant
(CONF:2777) such that it
    a. SHALL contain exactly one [1..1]
@typeCode="LOC" (CodeSystem:
      2.16.840.1.113883.5.90 HL7ParticipationType)
(CONF:2230).
Is less Preferable than THIS:
1. SHALL contain exactly one [1..1] participant
(CONF:2777) such that it
a. SHALL contain exactly one [1..1] @typeCode
whose value comes from the HL7ParticipationType
Code System (2.16.840.1.113883.5.90) (CDA:xxxx)
b. SHALL contain @typeCode="LOC" meaning
“Location” (CONF:2230).


N-m: Constraints imposed by CDA should be            Yes     Conformance
separated from those imposed elsewhere in the guide
and identified by the HMD row index (or via some
other mechanism) to enable the reader to understand
the source of the constraint.
CDA:xxxx in the above could be valued using the
HMD row index to specifically identify the source of
the constraint.




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N-m: Constraints should been rephrased so that it    Yes   Conformance
reads in English first, with data used for machine
processing in following. See the example above.

A-S: Note that the second constraint takes the form Yes    Conformance
@typeCode=”CODE” meaning “Display Name”. It
need not repeat the value set constraint since that
was already fixed in the preceding constraint.
The general pattern for coded data becomes:
• Shall contain @code whose value comes from the
‘CodeSystemName’ Code System (codeSystem
OID)
• Shall contain @code whose value comes from the
‘ValueSetName’ Value Set (valueSet OID)
• Contains @code = ‘code’ meaning ‘displayName’
from the ‘CodeSystemName’ code system
(codeSystem)


N-m: The text “exactly one [1..1]” can be omitted Yes      Conformance
on attribute constraints because shall contain @code
implies shall contain exactly one [1..1] @code
according to XML rules for attributes.
At the outset of this project, the Documentation     Yes   Failure to
Workgroup outlined a set of requirements. This             Meet
guide failed to meet many of these requirements            Requirements
which we feel are essential to support
implementation.
N-m: 6. The guide will use readily understandable Yes      Failure to
terms and methods, or when domain specific terms           Meet
or methods are used, will explain the domain               Requirements
specific content to enable implementers who are not
familiar with the domain (e.g., HL7 V3 Modeling)
to understand what is being said
e.g.: open/closed not defined, static/dynamic
repeated unnecessarily,


N-M: 8. The new implementation guide (IG) must Yes         Failure to
collapse the numerous CDA IGs upon which C32               Meet
and other clinical content specifications are based,       Requirements
to present a single "collapsed" view.
e.g., there is no way to see the “collapsed” view.
This is simply a brand new guide that does not relate
its constraints to those from CDA, CCD, IHE or
HITSP implementation specifications.




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N-M: 9. "Schema" validation criteria will identify Yes     Failure to
invalid document exchanges without requiring any           Meet
specific knowledge of inputs. A document that is not       Requirements
"schema" valid is not a communication conforming
to the implementation guide.
No validation criteria was delivered.


N-M: 10. Automated solutions will be used to        Yes    Failure to
generate the multiple representations, to ensure           Meet
consistency of information in the guide                    Requirements
An automated solution was used to generate ONE
representation, rather than the multiple
representations desired.

N-M: 11. Auxiliary materials, including A) sample Yes      Failure to
files, conformance data, Schematron, B) schema,            Meet
UML models, et cetera, must be supplied with all           Requirements
delivery formats to further support implementation.
No conformance data, schema or UML models were
provided to support implementation.


N-M: 12. Auxiliary materials will be supplied in     Yes   Failure to
standards based formats to support use with off-the-       Meet
shelf tools. For example, XSD, Schematron, or XMI          Requirements
files.
No XDS, Schematron or XMI files were provided.


N-M: 13. Tabular data will be made available in     Yes    Failure to
either CSV or XML formats to enable easy import            Meet
into off-the-shelf products.                               Requirements
No tabular data was provided.

N-M: 15. Conformance rules will provide an          Yes    Failure to
explanation of the purpose of the requirement to           Meet
help implementers understand what the rules are            Requirements
trying to accomplish.
There were no explanations of requirements behind
conformance rules. The only explanatory text was
on templates.




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N-m: 16. Conformance rules must provide             Yes       Failure to
examples of conforming results, and should provide            Meet
examples of non-conforming content when that will             Requirements
aid implementation.
Conforming examples were not provided inline with
templates, but only as separately accessible files.


N-M: 17. The guide will provide necessary             Yes     Failure to
information in multiple views to enable access via a          Meet
broad variety of learning styles, as well as examples         Requirements
of conforming content
• Tree views
• Tabular views
• Graphical views
• Summary views
• UML models of conforming content
• Conformance statements in English prose

There are two views of the data, a narrative
summary of the template, and the set of
conformance statements. No tree views, tabular
views of the conformance rules, graphical views or
UML models of conforming content (with one
exception) were produced. The English prose still
needs work as there are distractions contained within
it that can be simplified.
N-M: Each template must have a constraint that        Yes     Contraints
indicates the class of item to which it applies.
e.g., template 2.16.840.1.113883.10.20.22.2.21 can
only be applied to a cda:section element. It is
invalid to try to assert it on a cda:ClinicalDocument
or cda:entry element.

N-m: Constraints on section code are clear, but         Yes   Clarity
confusing (and similar coded entries)
The cda:section shall contain only one [1..1] code
element.
 cda:code/@code shall contain the value ‘Code’
meaning ‘Display Name’
 cda:code/@codeSystem shall contain the value
‘codeSystemOID’ meaning ‘LOINC’.




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N-M: As specified, this template cannot be asserted Yes   Datatype
within the clinical document because <templateId>         flavor vs.
is not valid on <addr> elements. It most closely          Template
represents the notion of a “data type” flavor in the
HL7 Release 2 data types. In order to detect
conformance to this constraint, a system must
examine each address appearing in the relevant
participation, determine if it meets the requirements
specified, and if it fails, move on to the next.

N-m: The ORIGINAL general header requirements Yes         Datatype
were that each of the participants must have an           flavor vs.
address. Was the intent here was that EACH <addr>         Template
element conform to the US Realm Clinical
Document Header Address template, and if not,
why?
N-M: As specified, this template cannot be asserted Yes   Datatype
within the clinical document because <templateId>         flavor vs.
is not valid on <name> elements. It most closely          Template
represents the notion of a “data type” flavor in the
HL7 Release 2 data types. In order to detect
conformance to this constraint, a system must
examine each name appearing in the relevant
participation, determine if it meets the requirements
specified, and if it fails, move on to the next.

N-m: The ORIGINAL general header requirements Yes         Datatype
were that each of the participants must have a name.      flavor vs.
Was the intent here is that EACH <name> element           Template
conforms to the US Realm Clinical Document
Header Name template, and if not, why?

Advance Directives Section                          Yes   Advance
[2.16.840.1.113883.10.20.22.2.21]                         Directives
N-M: The CDA Consolidation guide allows for only          Section
one external reference to an advance directive
document, yet a patient may have more than one
document: A healthcare proxy, living will, power of
attorney and DNR could all exist, and each as a
separate document.

A-T: Change constraint 1 as follows: SHALL         Yes    Allergies and
contain exactly one [1..1]                                Adverse
code/@code/@code="48765-2" Allergies, adverse             Reaction
reactions, alerts (CodeSystem:                            Section
2.16.840.1.113883.6.1 LOINC) (CONF:7528).




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N-M: TemplateId 2.16.840.1.113883.10.20.21.2.6.1 Yes         Allergies and
changes the SHOULD requirement on the value for              Adverse
the title of the section to a SHALL.                         Reaction
The title shall be required, the value constraint            Section
should not be different from that of
2.16.840.1.113883.10.20.21.2.6

A-S: The Constraint:                                  Yes    Allergies and
SHALL contain at least one [1..*] entry                      Adverse
(CONF:7531) such that it SHALL contain exactly               Reaction
one [1..1] Allergy Problem Act                               Section
(templateId:2.16.840.1.113883.10.20.22.4.30)
(CONF:7532).
Can be restated more simply as:
SHALL contain at least one [1..*]
entry/act[templateId/@root =
'2.16.840.1.113883.10.20.22.4.30'] (CONF:7532).

N-m: CCD, IHE and HITSP do not require DIRECT Yes            Allergies and
containment of the act within the section. The act           Adverse
could have been contained within a subsection. This          Reaction
represents a change in the CDA Consolidation guide           Section
that is not backwards compatible with prior work.

SHOULD on effectiveTime                                Yes   Allergy
N-M: CDA Consolidation says an Allergy                       Observation
Observation should contain effectiveTime.
IHE requires effectiveTime with a low=’UNK’ when
start time is unknown. And allows high to be present
or absent. Relaxing this constraint to using ‘should’
creates unnecessarily incompatibility between the
CDA Consolidation guide and current
specifications, as the two support all of the same use
cases. The CCD, IHE and HITSP constraints on this
were CONSISTENT, and thus we also believe that
this change goes beyond the scope of work stated for
this guide.




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SHALL on Problem Status                              Yes   Allergy
N-M: CDA Consolidation says that problem status is         Observation
required on allergies, whereas previously this entry
was optional in CCD, IHE and HITSP. This creates
unnecessary incompatibility with prior work, and as
all three had a different and CONSISTENT
constrain, this represents a change that goes beyond
the scope of work stated for the guide.
The “Problem Status” entry in CCD is problematic
in many ways and subject to several comments later,
which is why this was OPTIONAL instead of
required.
Upon seeing requirement of Problem Status on the
Allergy Observation one would also expect it to be
required on the Problem Observation, but it does not
appear there.


N-M: Problem status uses a value set that contains Yes     Problem
overlapping concepts, across multiple axes. A              Status
problem can be intermittent, recurrent, and presently
active or inactive. The inclusion of “Rule Out” (a
possible diagnosis) and “Ruled Out” (negated) in
this value set has the potential to introduce errors in
implementation and interpretation of content.
Ruled out can only be used in a problem or allergy
observation that itself has been negated.
Suggested Resolution: Use the HITSP Problem
Status Value Set 2.16.840.1.113883.3.88.12.80.68


N-M: The allergy problem act maps to the Problem Yes       Allergy
Act in CCD, and the Allergy Concern in IHE. The            Problem Act
mapping table is incorrect its mapping to “Nothing”.

Code                                                Yes    Allergy
N-M: Code in the Allergy Problem Act is fixed to           Problem Act
48765-2 from LOINC. This represents a change
from CCD, IHE and HITSP specifications where
act/code/@nullFlavor = NA. These constraints
being consistent, we feel this change goes beyond
the scope of the guide. Furthermore, they introduce
needless incompatibility with prior work.




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Condition                                              Yes   Condition
N-M: The condition act in the CDA Consolidation
guide is constrained for use with problems only, not
problems or allergies or other clinical statements
(e.g., an out of normal range lab result) as supported
in CCD, IHE and HITSP. This change results in
needless incompatibility with prior work.


Value                                              Yes       Condition
A-T: SHALL contain exactly one [1..1] value, which
SHALL be selected from ValueSet
2.16.840.1.113883.3.88.12.3221.7.24 Problem
DYNAMIC (CONF-CONSOL-533)

Condition Entry                                     Yes      Condition
N-m: The name Condition Entry and Problem
Observation are used to refer to this template in
different places in the guide. Only one name should
be used consistently.

The mapping table incorrectly maps this template to Yes      Condition
the IHE Concern Act and Problem Concern Act.

templateId                                        Yes        Medication
N-M: Constraint 3 is incomplete, and as written,
would prohibit the medication template from being
further constrained by other guides.
SHALL contain exactly one [1..1] templateId/@root
(CONF:7499) where templateId/@root =
‘2.16.840.1.113883.10.20.21.4.16’


In Medications, but also in general: N-m: 6.a.i When Yes     Text
text/reference/@value is present, it SHALL point to          References
the corresponding narrative.
The point is, you SHOULD use reference, and if you
do, you SHALL point to the text.
While this has been discussed greatly, I would note Yes      Text
that the relaxation of the constrain from SHALL to           References
SHOULD on text/reference in entries results in large
changes that cycle through the entire set of
templates. This single change results in a great
degree of substantive change in the guide that was
unnecessary.




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effectiveTime                                          Yes    Medication
N-M: Constraints on medication effectiveTime are
incomplete and contradictory.

N-M: The medication entry only references            Yes      Medication
medication supply orders, not medication dispense
events. The latter could also be recorded with
medication intent as evidence that the medication is
being used.
repeatNumber                                         Yes      Medication
N-m: The discussion of use of repeatNumber is a
dispense (Supply) act is not appropriate in this
section on substanceAdministration.

repeatNumber                                           Yes    Medication
N-m: The discussion of use of repeatNumber is a
substance administration act is not appropriate in
this section on supply.

Medication Use None Known                               Yes   Medication
N-M: There are several distinct cases where drug
treatment information may not be present. IHE uses
the following different values, of which only the first
is supported in the CDA Consolidation guide for this
template. This template should allow for
“unknown”, but also for “known none”.
Medication 182904002 Drug Treatment Unknown
To indicate lack of knowledge about drug therapy
Medication 182849000 No Drug Therapy Prescribed
To indicate the absense of any prescribed
medications
Medication 408350003 Patient Not On Self-
Medications To indicate no treatment



Reference doesn't indicate target section number.
The link works fine when reviewing the document
electronically, but isn't necessarily helpful when
working with a printed copy. This general comment
applies generally through the document

If gender is unknown then use a nullFlavor
indicating Unknown?




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It may be helpful to explicitly indicate that the
birthTime MAY be precise to minute.
Need to help out the inexperienced on the nuances
of this field.
NOTE: this refinement is applicable throughout the
document for the effectiveTime element.




It seems like this would also be a good place to
introduce the CDA Level 1, 2, and 3 concepts and
how section templates for which coded entries are
optional vs. required will be indicated (See item #8
below)




Need a better/more complete description of how the
template IDs for optional vs. required coded entries
as well as how that plays into CDA Level 1, 2, and 3
is needed.




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Need closing angle bracket to have wellformed
XML




Does this mean that the code itself is required to be
displayed (code/@code) or that the
content/semantics of the code element with its
various attributes SHALL be displayed?




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I think it would be helpful to point out the
possibility of using the "compression" attribute and
using compression on the unstructured content
before using the Base64Encoding. Those who are
not intimate with the ED datatype overlook this
possibility when creating documents and when
dealing with incoming documents.

The concept of templateIds for Required vs.
Optional entries are introduced in Table 31 without
indicating how they fit into the big scheme of things.
It seems like there should be linkage back to
Document Level templates that use the section
templates that are required vs. optional

Incorrect code and displayName indicated? In
section title also.




The Required Entries section should repeat the
constraints from the Optional part but add the
requirement constraint for Entries.
Leaving this as a SHOULD doesn't make sense if
you are going to have a separate template for
Required entries.
This comment applies across the board for
Act/Observation/etc. level templates: No mention is
made of using the displayName attribute or the
originalText element, nor the semantics of one vs.
the other. It may not be necessary to describe in
every section how these attributes/elements are
intended to be used, but it would clear up a lot of
confusion if it were described at least once in this
document and then referred to.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        140                    March 2003
                                                           V3 Ballot Submission/Resolution Form

The approach defined in CDA Release 2, section
4.3.5.1 is itself not clear. Is the hash required or not
for "in-document" references? Is it required that the
target of an "in-document" reference (i.e. into the
narrative text of the section) be a <content> element
as CDA Release 2, section 4.3.5.1 suggests? I
would recommend that this be well clarified one way
or the other. I would also recommend that the target
can be any tag/element and not necessarily a
<content> tag. I would also recommend that the
hash SHALL be used in referencing within the
document for consistency with HTML, etc.

Same comments as for item #23 above. Wording for
references in originalText elements should be
standardized throughtout all of section 5.x


What is the semantic meaning of Observation/text
vs. Observation/code/@displayName vs.
Observation/code/originalText? Are any these to be
used as a "comment field"? This document needs to
clearly define these fields throughout and for
Act/text (and all derivatives of Act such as
Observation, substanceAdministration, etc.) the
intent and purpose of the element should be clearly
stated for each template. Note that section 5.6; 5.a
is a good example of describing the use of the <text>
element.

This is a duplicate of Dave Parker's item #39. I also
feel that this is a clarification of vital importance...
The concept of handling comments is introduced in
the HL7 v3 RIM documentation but no examples are
ever given. HITSP C83 formalized that even more
with a template. However, there were still no
examples and people seemed generally unsure of
how to use it inside other template. Therefore I
believe it is truly necessary to use the "MAY
contain...Comment Annotation" conformance in
EVERY section, entry, Act, Observation, etc.
template where it could possibly be used.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          141                    March 2003
                                                              V3 Ballot Submission/Resolution Form

This document represents a huge step forward in
collapsing multiple layered specifications to lower
the learning curve for newcomers and reduce the
number of documents that must be searched to
understand what goes where and what it means, etc.
At the very least, a list of references to the various
datatypes used and their definition in the RIM and
CDA documentation as well as a reminder that all
attributes of those datatypes can be used unless there
are specific constraints not to should be made
explicit in this document.

The narrative text of the section can be the basis for Yes
establishing the COMPonent machine readable
entries, or the section can be DeRIVed from the
machine readable entries. The Section is the smallest
complete unit of the structure. Entries are not
complete without their anchoring human readable
form in the Section.
The narrative text of the section can be the basis for Yes
establishing the COMPonent machine readable
entries, or the section can be DeRIVed from the
machine readable entries. The Section is the smallest
complete unit of the structure. Entries are not
complete without their human readable
"counterpart" in the Section. This "pairing" of the
human readable and machine processable is what
creates the potential to be validated. This
potentail is a core principle in the design of a
CDA document.



Rationale:                                              Yes
- the document content module and the entry-level
content elements have instance id's, but the section
does not.
- sections that have no entries need an id to identify
the narrative text that comes in from the section
- Content Consumers have the option of importing
content at the section level and the options requires a
capability to trace the source of the content. Without
an instance id, how could that capability be
implemented?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                             142                    March 2003
                                                              V3 Ballot Submission/Resolution Form

                                                         No



All other rows in Table 2. use the LOINC code
display name as the Document Type


How would one know if they had received the
complete discharge information? What would tell
you which CDAs to expect? If there were only one
Discharge Summary document, this would be
known to be only 1 expected document. But, with
some many different Dischage Summary documents,
I wouldn't know if I should have collected 1 or 2 or 3
or more to be sure I had all the needed discharge
information. Does the Discharge Summarization
note produced by a physician have different content
from a Discharge summarization produced by an
Attending Physician? If yes? Why?


Should the first occurance of
2.16.840.1.113883.10.20.21.2.4 have a .1 at the end
to make the Entries Required OID distinguised from
the OID that does not require entries?

A search of this OID for the DEV code reveals that
the code is mainly applicable to insulins and
inhalation products. The FDA recommends that this
code system be expanded to include all types of
medical devices regualated by the FDA. The UDI is
in the HL7 SPL.

The FDA Amendments Act specifies the creation of
a Unique Device Identification (UDI) System that
requires the label of devices to bear a unique
identifier which will standardize device
identification and identify the device through
distribution and use. The UDI is in the HL7 SPL.
Without seeing the actual report, rationale, or use
cases, etc that were used to crete this list these
reports appear to be three of the same documents.
There is a potential problem of redundancy, to
inconsistency of coding.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                             143                    March 2003
                                                          V3 Ballot Submission/Resolution Form

Suggest expanding this section capture other digital
images and information used for diagnostics (i.e.
EKG and hemodynamic waveforms, scalar
measurements, etc.). This section is currently limited
to radiographic images.

The FDA Amendments Act specifies the creation of
a Unique Device Identification (UDI) System that
requires the label of devices to bear a unique
identifier which will standardize device
identification and identify the device through
distribution and use. The UDI is in the HL7 SPL.
The FDA Amendments Act specifies the creation of
a Unique Device Identification (UDI) System that
requires the label of devices to bear a unique
identifier which will standardize device
identification and identify the device through
distribution and use. The UDI is in the HL7 SPL.
The FDA Amendments Act specifies the creation of
a Unique Device Identification (UDI) System that
requires the label of devices to bear a unique
identifier which will standardize device
identification and identify the device through
distribution and use. The UDI is in the HL7 SPL.

The OID for the medical equipment section name is
not the same in table 31 and table 18. Is this correct?

The FDA Amendments Act specifies the creation of
a Unique Device Identification (UDI) System that
requires the label of devices to bear a unique
identifier which will standardize device
identification and identify the device through
distribution and use. The UDI is in the HL7 SPL.
pg 54-66
In addition to the interpretations of the clinicians
(i.e. the reports) and radilology images and
impressions this section could also include the larger
world of digital information from devices other than
radiology (i.e. EKG and hemodynamic waveforms,
scalar measurements, etc.).




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         144                    March 2003
                                                         V3 Ballot Submission/Resolution Form

This section should include adverse events resulting
from medical devices (i.e. hip implants, electrical
burns, fragments remaining in patient etc.). The
FDA has a well defined set of Device problem codes
that describe device failures or issues related to the
device that are encountered during the an adverse
event These codes are included in the National
Cancer Institute (NCI) Enterprise Vocabulary
Service (EVS)
The FDA agrees that this section should be included
and capture the unique device identification.

The FDA would like to be involved in this
consolidation effort. The FDA Amendments Act
specifies the creation of a Unique Device
Identification System that requires the label of
devices to bear a unique identifier which will
standardize device identification and identify the
device through distribution and use.


The FDA agrees that this section should be included
and capture the unique device identification. The
FDA would like to be involved in this consolidation
effort.

The FDA suggests that device identification be
inlcuded in the Supply activities CCD templateID
2.16.840.1.113883.10.20.1.34 and/or the product
instance CCD templateId
2.16.840.1.113883.10.20.1.52?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        145                    March 2003
                                                      V3 Ballot Submission/Resolution Form

The FDA agrees that this section should be included
and captures the unique device identification. The
FDa would like to be involved in this consolidation
effort.

The FDA Amendments Act specifies the creation of
a Unique Device Identification (UDI) System that
requires the label of devices to bear a unique
identifier which will standardize device
identification and identify the device through
distribution and use. The UDI is in the HL7 SPL.

Why is the supply activities (templateId
2.16.840.1.113883.10.20.22.4.17 different from the
supply activities CCD templateID under implants
2.16.840.1.113883.10.20.1.34?




The FDA agrees that this section should be included
and captures the unique device identification.

The FDA Amendments Act specifies the creation of
a Unique Device Identification (UDI) System that
requires the label of devices to bear a unique
identifier which will standardize device
identification and identify the device through
distribution and use. The UDI is in the HL7 SPL.

Change may to shall so that the unique device
identification can be included to meet the FDA
statutory requirements.

Will this section link or refer to the HL7 Detailed
Clinical Model for Medical Devices?



Recommend adding FDA use case Adverse Events
Drug Reporting which is in Meaningful Use stage 2
as a new CDA template.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     146                    March 2003
                                                        V3 Ballot Submission/Resolution Form

The Immunization section does not appear to
contain specifications for important immunization
related data. It may be my lack of familiarity with
the content in this document. I would like to see the
immunization section improved and include
examples which illustrate what goes in there or
where else it might go. I would be very happy to
participate in this effort.
Does this limit the use of this guide? When will it
"be complete"?




This is in the sample.
Why is this limited to no more than one religious
affiliation? What if a person follows more than one
religion?




Why is this limited to no more than one race? What
if a person falls into more than one race category?



How does this compare to the raceCode in the
previous conformance statement?




Why limit this to exactly one telecom? What about
home, cell, work, etc. Other participant telecoms are
not limited to exactly one.
Why is this limited to no more than one guardian?
You can legally have more than one guardian.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       147                    March 2003
                                                              V3 Ballot Submission/Resolution Form

This is not how the vast majority of people represent
state abbreviations. Florida is normally "FL",
Alabama is "AL", Federated States of Micronesia is
"FM".

The common state abbreviations are obviously the
most normal to use and they are actually present in
all of the samples within the ballot document and the
provided examples that are part of the ballot
package.




Items (a) and (b) describe how OIDs should be
represented in general. This would apply to all
documents that use OIDs. I recommend moving
items (a) and (b) into a more general area for the
whole document.




With very few exceptions, each ID in the entries is
not described. Is it intented to be an ID internal to
the document, or is it a globally unique ID that has
some other purpose external to the document. For
example, the entry ID is described in the "condition
entry", but it is not described for all entries where an
ID is required.
What does '(open)' mean throughout the guide?            No



A-S: "Any SHALL conformance statement may use No
nullFlavor, unless the attribute is explicity required
or the nullFlavor is explicitly disallowed." - Spelling
mistake; should be “explicitly”

A-S: "nullFlavor explictly disallowed" - Spelling       No
mistake; should be “explicitly”




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                             148                    March 2003
                                                            V3 Ballot Submission/Resolution Form

Font size is different than the other 2 listed code    No
systems.



sister-inlaw - Should be sister-in-law                 No




Lake Buena Vista Fl - Should be “Lake Buena Vista, No
FL”


Physical visit address - To be consistent with other   No
the names, should be renamed to ‘physical visit
address’.

search - Should be a capitalized search; ‘Search’      No



phonetic - Should be a capitalized phonetic;           No
‘Phonetic’


soundex - Should be a capitalized soundex;             No
‘Soundex’


templateID - Should be ‘templateId’, not               No
‘templateID’

templateID - Should be ‘templateId’, not               No
‘templateID’




assignedEntitys - Should be either “assignedEntity” No
or “assignedEntity’s”




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           149                    March 2003
                                                            V3 Ballot Submission/Resolution Form

"i. The code MAY be the National Uniform Claims No
Committee Provider Taxonomy Code" - What is the
Code?

8647-0 - Hospital consultations - (scale = nom) - Is   No
this assumed to be from the LOINC database?




ClininicalDocument - Spelling mistake. Should be       No
‘ClinicalDocument’.


elements - Should be singular; “element” instead of No
“elements”. Otherwise state cardinality of
authorization element.

ServiceEvent - Should be ‘serviceEvent’                No


ServiceEvent - Should be ‘serviceEvent’                No


templateID - Should be ‘templateId’, not               No
‘templateID’

2.16.840.1.113883.10.20.21.2.6. - Last period          No
should be removed.




2.16.840.1.113883.10.20.21.2.8 - Discrepancy           No
between table and section – table 31 lists template
ID as 2.16.840.1.113883.10.20.22.2.8

2.16.840.1.113883.10.20.21.2.9 - Discrepancy           No
between table and section – table 31 lists template
ID as 2.16.840.1.113883.10.20.22.2.9




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           150                    March 2003
                                                          V3 Ballot Submission/Resolution Form

Font not consistent with the rest of the LOINC codes No
present for each section heading.



10154-3 - Discrepancy between table and section -   No
table 31 lists code as 42344-2 in section title



"1. SHALL contain exactly one [1..1]                No
templateId/@root="1.3.6.1.4.1.19376.1.5.3.1.1.13.2.
1" (CONF:7832)" - Incorrect templateId one listed
represents Chief Complaint section

"2. SHALL contain exactly one [1..1]                No
code/@code="10154-3" Discharge Diet
(CodeSystem: 2.16.840.1.113883.6.1 LOINC)
(CONF:7833)" - Discrepancy between table and
section – table 31 lists code as 42344-2


Multiple occurances of 2.16.840.1.113883.10.20.2.9 No
- Discrepancy between table and section – table 31
lists templateId as 2.16.840.1.113883.10.20.22.2.20



11348-0 - Discrepancy between table and section –   No
table 31 lists code as 10164-2




"1. SHALL contain exactly one [1..1]                No
templateId/@root="2.16.840.1.113883.10.20.2.9"
(CONF:7828)" - Wrong templateId



"2. SHALL contain exactly one [1..1]                No
code/@code="11348-0" History of Past Illness
(CodeSystem: 2.16.840.1.113883.6.1 LOINC)
(CONF:7829)" - Discrepancy between table and
section – table 31 lists code 10164-2




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         151                    March 2003
                                                            V3 Ballot Submission/Resolution Form

48765-2 - Discrepancy between table and section –      No
table 31 lists code as 11535-2




"1. SHALL contain exactly one [1..1]              No
templateId/@root="2.16.840.1.113883.10.20.21.2.6.
1" (CONF:7979)" - Expected -
2.16.840.1.113883.10.20.22.2.24


"2. SHALL contain exactly one [1..1]               No
code/@code="48765-2" Allergies, adverse reactions,
alerts (CodeSystem: 2.16.840.1.113883.6.1 LOINC)
(CONF:7980)" - Discrepancy between table and
section – table 31 lists code as 11535-2

Font not consistent with the rest of the LOINC codes No
present for each section heading




Should optional and required sections be listed here. No
Per table 31 - 2.16.840.1.113883.10.20.22.2.2.1
listed


Shouldn't required entries be listed before optional   No
entries?


2.16.840.1.113883.10.20.2.10 - Discrepancy            No
between table and section – table 31 lists templateId
as 2.16.840.1.113883.10.20.22.2.19


"1. SHALL contain exactly one [1..1]                   No
templateId/@root="2.16.840.1.113883.10.20.2.10"
(CONF:7806). " - Discrepancy between table and
section – table 31 lists templateId as
2.16.840.1.113883.10.20.22.2.19
Should be Plan of Care                                 No




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           152                    March 2003
                                                            V3 Ballot Submission/Resolution Form

Optional Entries has a font consistency issue          No




Shouldn't required entries be listed before optional   No
entries?



Labeled as 'Procedure Speciments Removed' per          No
table 31



Shouldn't required entries be listed before optional   No
entries?


Shouldn't required entries be listed before optional   No
entries?


Shouldn't required entries be listed before optional   No
entries?


Example is empty in Figure 63: Episode observation No
example


Table 50: Procedure Act Status Code Value Set -     No
"Completed" - Should be lowercase; i.e. ‘completed’


Table 51: Act Priority Value Set - Preop - What is     No
the full name?


"a. This entryRelationship, if present, SHALL   No
contain exactly one [1..1] @typeCode="COMP" Has
Compenent (CodeSystem:
2.16.840.1.113883.5.1002
HL7ActRelationshipType) STATIC (CONF:8280)" -
Spelling mistake; should be “Component”




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           153                    March 2003
                                                               V3 Ballot Submission/Resolution Form

"a. SHALL contain exactly one [1..1]          No
@typeCode="COMP" Has Compenent
(CodeSystem: 2.16.840.1.113883.5.1002
HL7ActRelationshipType) STATIC (CONF:7887)" -
Spelling mistake; should be “Component”

Multiple occurences pf "TemplateId" - Should be           No
lowercase templateId; i.e. ‘templateId’ instead of
‘TemplateId’


This section needs to clarify whether PDF            No
documents need to conform to PDF-A as stated in
the IHE's XDS-SD (Cross-Transaction
Specifications and Content Specifications, Scanned
Documents Module) profile or are less restrictive to
any version of PDF.
We see a requirement for further guidelines on how No
to handle unstructured documents that contain
referenced documents should be handled in an XDS
repository?
The document combines the concepts of consent to
treat (or be treated) with privacy consent. I think
they are different enough (and complex enough) to
be combined in a single concept. Recommend
separating into 'Informed Consent to Receive
Treatment' and 'Privacy Consent'

traceability: there needs to be a clear method to
know where the conformance criteria orginated and
what, if any, changes have occurred.
inheritance & abstract constructs: there are various
sections and entries which have explict (e.g., vital
signs organizer / results organizer) or implicit (e.g.,
all Observations) relationships to other
sections/entries. Duplicating all of the common
conformance clauses can lead to editorial
management issues and create confusion. also, it
becomes difficult to see when common structures
exist. Creating "abstract" conformance clause sets
and defining conformance clause inheritance would
assist in development and implementation.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                              154                    March 2003
                                                        V3 Ballot Submission/Resolution Form

consistency in documentation: possibly a result of
the different sources for different information, but
the conformance clauses are not consistently state.
some tightly related conformance clauses are not
consistent (4.2 optional 3 (blank) verses required 3
(specifies content); there are a few erroneous xPath
statements (search for @code/@code).

conformance clause numbers: will there be any
effort to "re-number" the conformace clauses in a
consistent manner? If so, there are many duplicates
(e.g., all of the classCode="ACT") which could be
consolidated.
If this is to be a continuously evolving catalog then
generally the “voice” should be less rooted in the
"now".

Begs the question: what about all the other IGs and
templates they define? Will they be addressed in a
future project? If so will they create a parallel
document to this one along with all the attendant
maintenance issues? Or extend this artifact?


Please list the MU sections explicitly, alternatively
can note relation to MU Stage 1, Stage 2, etc., as
“metadata” for all templates (within each section) as
this guide moves forward. The FR sections are not
identified in this document.

This whole section describes the process used,
which is not really useful for implementation. What
would be better is info on the CDA template
architecture/concept this IG establishes.

Removed "of" and plurality of types.

Or maybe it is an incomplete sentence? It's not clear
what the list of document types is being discussed.
Just this project list or all document types going
forward?

Will this document become the normative library of
consolidated templates? See first comment on voice
of this document.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       155                    March 2003
                                                        V3 Ballot Submission/Resolution Form

The word “pre-review” doesn’t appear in this guide
again. How is the flagging accomplished?

Also, please provide an example in document
conventions.




Example? Will this explain the bracket syntax that
follows each template section title?

Suggest all of these tips be collected and presented
in a Document Conventions Section.
It's more factual to say this concept is from the
standard.




These statements aren't relevant to the end result of
the guide, as any differences in output should be
normalized in this document.




Explain how this is done, e.g., “.. identified by the
string “(open)” at the end of the template ID." See
the comment about a Document Conventions
section…
The term "controlled" is introduced but not defined,
nor is any explanation of an "uncontrolled"
vocabulary offered.
Please provide an example of the identifier.
Document conventions would be a nice thing to
have… :-)




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       156                    March 2003
                                                        V3 Ballot Submission/Resolution Form

Please provide an example of an extended xpath
statement.

This section and the next both say "this 'thing'
appears as a monospaced font", but there are no
examples to differentiate them.

File names are inconsistent, if they're all sample
files, they should be noted as such.

Generally throughout the template sections, there is
a lack of tying the CDA markup back to "business
names" as requested by the participants (they cited
C83, C154 as a sources).
The conformance strength level (shall, should)
should not correlated to the cardinality value.
Cardinality specifies the data element range of
occurrence, the conformance level of strength (shall,
should) indicates the stength of error if the
cardinality range was violated by a data element in a
CDA instance.
Is the default nullFlavor rule for "SHOULD" also
applicable to SHOULD?



Inconsistent wording style for the similiar time
constraint between Conf 5257 and (conf 5299, conf
5300)




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       157                    March 2003
                                                         V3 Ballot Submission/Resolution Form

This constraint is not clear regarding:
1. there is no description for the namespace "sdwg:"
in the IG, and how should it be handle. A CDA
instance with extended namespace will not pass
CDA.xsd validation, for such case, is the CDA
instance still considered as a valid CDS xml?
2. there is no description for the reason of why there
is a special constraint using extended namespace for
"raceCode", why there is no similar extended-
namespace-based constraint for ethnicGroupCode?



Recheck for typos, e.g. clincial, explicity


Recheck for consistency of language, e.g. “This
chapter describes...” vs “This chapter defines”
(defines is preferable)
In introductory material explain the criteria for
inclusion of MAY constraints. Consider recasting
some MAYs as guidance. Example 1: A Reaction
Observation MAY contain a Severity Observation –
but so “may” almost any other clinical statement.
See by contrast 4.21, which gives MAY-type
guidance in text: the constraints are SHALL and
SHOULD. Example 2: CONF:7555 MAY contain
0..1 repeatNumber – this is base CDA, mentioned
in order to support a narrative constraint explaining
interpretations of repeatNumber. Example 3: MAY
contain 0..1 approachSiteCode – this is base CDA,
mentioned in order to support a constraint on the
values.
Document the effect of the SDWG 3/17 decision to
include numeric ranges for cardinality as normative
and to interpret conformance verbs separately from
cardinality. This allows combinations such as MAY
1..1 which give a finer-grained control during
validation but, being previously unused, need
interpretation for those familiar with CDA as well as
those new to it.
Make the usage of conformance verb and cardinality
consistent throughout. Most constraints use the
existing practice (e.g. MAY 0..1), some use the
newer practice (e.g. MAY 1..1).




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        158                    March 2003
                                                           V3 Ballot Submission/Resolution Form

Recast the constraints which specify /@code in the
constraint context, after determining whether they
intentionally preclude a nullFlavor. The
Consolidation team proposed that an explicit
constraint be present to preclude a nullFlavor.
Related to #6 – Consider separating the cardinality
of a node/field from the cardinality of its content.
When the verb is other than SHALL this explicitness
adds clarity, e.g. SHOULD 1..1 code which, if
present, SHOULD be valued and, if valued, the
value SHALL be selected from such-and-such a
value-set. Separating node cardinality from content
cardinality may provide a computable approach for
distinguishing Mandatory from Required or
Required from Optional, etc.
This would remove some ambiguities, e.g. CONF:
7668: “MAY contain zero or one [0..1]
priorityCode/@code, which SHALL be selected
from ValueSet 2.16.840.1.113883.1.11.16866
ActPriority DYNAMIC”. Issue is that
<priorityCode nullFlavor='NI'/> is valid according
to this constraint, but it's not clear whether it's
intended to be.
The headings currently state that the entries in the
first group are optional (“Optional Entries”) and the
entries in the second group are required (“Required
Entries”). That is not the intended meaning.

Review the desirability of doubled templateIds and
make the IG take a consistent approach. The
Medications Section “with entries” and some others
require two templateIds – one to satisfy conformance
to the section without entries, and a second for the
specialization that requires the appropriate entries. It
also repeats constraints of its parent template
(CONF:7569, 7570, 7571, 7574, 7575; code, title,
text, etc.). This is confusing. See by contrast 4.40
which does not duplicate the shared constraints, and
does not double templateIds but at the expense of
requiring no templateId when entries are optional. A
more desirable approach would require only a single
templateId for each form and yet not duplicate
constraints.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          159                    March 2003
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Review the expression of mutually-exclusive choices
to eliminate conflicts. Example: CONF:7572-3
appear to be in conflict with 7574-5. The first pair
SHALL at least one Medication Activity. The
second pair MAY a Medication Use – None Known
. The narrative constraint 7576 which states that one
or the other must be present does not resolve this.
Options include: express the alternatives as
SHOULD/MAY plus an additional constraint to say
one or another must be present; support multiple
alternatives computably; eliminate the need for an
alternative by providing a code “None known” for
use in Medication Activity. Cf. 7515-17-29.
Make conformance verbs for entries in “Optional
Entries” vs “Required Entries” consistent or explain
when they are not. Entries Optional example: In
Sections 4.40, 4.48, 4.50, entries are not mentioned,
MAY, and SHOULD respectively. Entries Required
example: In Sections 4.40, 4.48, 4.50, entries are
SHOULD, SHALL, and SHALL respectively.

Move CONF-144 to be a subordinate of CONF-143.


Check for presence and format of constraint #s. In
section 4.40, under “Required Entries”, two
constraints have no constraint #, and one has an
unusual form (CONF-CONSOL-549).
There are two constraint formats. Correct the one
which duplicates the term. Example, section 5.5,
constraint 7a – Contains @typeCode="SUBJ" SUBJ
(has subject).
The section “Condition Entry” begins “This section
describes...” Does this para belong someplace else?

Do not title clinical statements “...Entry”. Example:
5.60, Condition Entry. (In this case, the templates
Condition & Condition Entry perhaps should be
titled Condition Act, Condition Observation –
similar to the pattern of Problem Act & Problem
Observation.)




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       160                    March 2003
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Relationship of similar templates is not always clear.
Example: Condition (Act), Condition (Observation).
The template describes talk about “problems”. There
is also a Problem Act & Problem Observation. Since
these templates may be used outside their original
context, it would be helpful for the template
descriptions to mention closely-similar templates
and provide a way to know which is appropriate
when.
Where the constraint context is an attribute, omit
cardinality which is irrelevant to attributes. E.g.
SHALL contain exactly one [1..1[ code/@code
Would it be useful to make more use of named sub-
entry patterns such as Header Address? Example:
CONF:7501-2-3 (should contain a reference to the
corresponding narrative) could be expressed as a
single constraint such as SHOULD contain a
NarrativePointer.
The templateId in the subheading is ...21.4.8. The
templateId required by constraint is ...22.4.8. The
Reaction Observation uses ...22.4.8. (CONF:7582).
The correction also needs to be made in Figure 1,
Constraints Format Example.
Resolve inconsistencies in constraints format. E.g.
section 5.5, list item 8a Contains
@typeCode="SUBJ" SUBJ (has subject) vs list
item 8b SHALL contain exactly one [1..1]
@inversionInd = "true"
Format the code and insert “The” at the start.


Make this useful guidance easier to follow by
breaking it into 3 paras.

This paragraph contains a bolded MAY. Practice is
to avoid using conformance verbs in narrative text,
and especially not to give them the same formatting
as in constraints.


2.1.6 requires name, 3.3.1.4 does not. Should these
specifications for health chart be aligned?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        161                    March 2003
                                                         V3 Ballot Submission/Resolution Form

The XPath is wrong (duplicates responsibleParty)
and the final cardinality is both difficult in English
and misleading in logic (allows >1 assignedPerson,
>1 representedOrganization)


Review language of “If” constraints. It is clearer to
employ "If" only for a conditional that can be tested
within the document. For real-world conditions, use
"When" or "To record...", and cast these as guidance
to the data recorder, i.e. in paragraph text, not as
constraints. Examples: If only the date and the
length of procedure are known --> When only the
date and the length of procedure are known. If the
phone is an office phone,... --> To record that the
phone is an office phone,...

Review overlap of header constraints with General
Header Constraints. Example: 8488
serviceEvent/effectiveTime in a Consent. Most of
the subconstraint is identical to GH 7602.
Fix the XPath here and elsewhere if it recurs.


Fix the XPath and resolve which is the intended
constraint - 28570-0 or the value set?




This template name is not user-friendly. The need is
to distinguish three cases, currently titled Procedure
Activity Procedure, Procedure Activity Observation,
and Procedure Activity Act. Some acceptable
variation of the following concepts might be found:
Treating Procedure, Informing Procedure, Unclassed
Procedure.
Review the consolidated set of template names: Do
they have a regular pattern and allude to the
differences among similar templates?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        162                    March 2003
                                                      V3 Ballot Submission/Resolution Form

In the template description, should “(post-
condition)” be “(post-procedure)”?

Needs fix – the XML is wrong -- "This code @code"
but there was no @code in 7656



DIR was designed to be a universal realm document.
This was explicitly stated by DICOM WG 6, and
was the key reason why we could not use the US
realm header.

I suggest removing the requirement that DIR follow
the universal realm header, perhaps moving the non-
US specific stuff into a separate template that may
be used for universal realm documents.




Fix font size
Incorrect templateId used




This HL7 valueSet includes pharma name parts. We
need to create a subset of this valueSet including
only those applicable to person names:
AC academic
AD adopted
BR birth
CL callme
IN initial
LS legal status
NB nobility
PR professional
SP spouse
TITLE title
VV voorvoegsel




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     163                    March 2003
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Should be a valueSet binding




Only minors or other dependents need to have a
guardian

I don't see differences in the conformance statements
over the participant in the US Realm header -now
that they are in the consolidated guide - consider not
repeating. (note minor differences in template
descripton and
Consider creating separate templates for each of the
participants contained in the header. This will be
better for re-use across current and new documents.


Allergy/Alert Observation template - link is broken


Negation Ind ="true" is an acceptablle way to asssert
that something was NOT observed. Not likeley to
have a controlled term in an EHR that is "no hx of
chicken pox". It will be a clinical assertion.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        164                    March 2003
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This is an entry - not a section




condition wrapper should not be required - a
problem (condition) entry should be able to stand on
its own for sending simple instances of a problem or
symptom. Update to a MAY




Therefore this section contains procedure templates
represented with three RIM classes: Act,
Observation and Procedure



Please add tables of templates: At least Templates by
Containment and perhapsTemplates Organized
Hierarchically.
The Discharge Diagnosis section/entry describes the
relevant problems or diagnoses at the time of
discharge that occurred during the hospitalization or
that need to be followed after hospitalization. This
section includes an optional entry to record patient
conditions




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       165                    March 2003
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Result organizer should not be required. Allow
simple send of a single result observation without an
organizer




style (font) of narrative (primitive) conformance
statements should be consistent with other parts of
the guide
primitive conformance statements should be written
with proper syntax




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       166                    March 2003
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primitive conformance statements should be written
with proper syntax




What does " SHOULD ... one [1..1] " mean and how
would this be represented in a UML model (RMIM)
snippet and be differentiated from SHALL 1..1?

There are 2 "service location value sets in HL7 -
they should either be consolidated or we should use
the VALUE SET: HealthcareServiceLocation
(2.16.840.1.113883.1.11.20275) in all IGs as it is
updated regularly and used by CDC for reporting of
HAI and other quality metrics where location is
required
this modeCode and valueSet is OK to have - not sure
why it is explicitly stated (it’s a MAY) and is not
highly valueable from a clinical perspective whereas
"proficiencyLevelCode" with valueSet of
LanguageAbilityProficiency
(2.16.840.1.113883.1.11.12199)
(Example:Excellent, good, fair, poor.) is much more
useful clinically especially in transfer of care
situations allowing clinicans to prepare for the
patient in terms of interpreters etc.. It is not
judgemental.


links don’t work




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                      167                    March 2003
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This extensive commenting would be better as a
general comment about effectiveTime rather than
amongst computable conformance statements




Does this mean the implementer has to look to C83
for further information?




What does this mean? Also this is an entry template
- not a section template
what is the "technical framework" - should there be
a link here?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     168                    March 2003
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negationInd is a valid way to explicitly state
something did not occur.




Why is this called a condition entry instead of a
problem entry?

The section should include a sub-section the General
Header Template and additional sections on consist
approach to aspects not constrained by the General
Header Template. For example, there is already a
section on use of serviceEvent.
Add a subsection on the use of document type code.
Explain preference for post-coordination of
document type with procedures and service events.
Review the descriptions in the 9 document types for
consistency.
What is the status of the existing guides after the
Consolidation IG is published?
Remove from Optional column, Vital Signs are
required in H&P.

double-check Vital Signs Observation, allergies,
results section for mismatch.

Should be 22.4.**, not 20.21.4.**
Add componentOf example to H&P sample
Add vital signs, allergies, results, general status
example sections to H&P sample
How do you specify no known allergies? In the case
of “No Known Allergies”, is the outer act
necessary?
• Bullets 1 and 2 in the History of Present Illness
section on page 115, reflect the same values as the
History of Past Illness section on the previous page.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       169                    March 2003
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Reason for Visit Section 29299-5
Missing LOINC code in CONF Statement 7837
Is the intent to cover all of MU Stages 1,2,3 with
this ballot? This should be properly scoped to Stage
1 since that is all that is defined currently.
What is being only partially harmonized? This is a
general statement that leads to ambiguity.



This document will need additional navigational
capabilities with links between various artifacts. For
instance, there should be hyperlinks from Table 18
to all the specific sections that are referenced (not
just to the document type). And the links should be
bi-directional - for instance between "Result
Observation" definition and "Vital Sign
Observation" definition and back. Without this
capability, this document will be very difficult to
use.
The name is inconsistent - leading to navigation
problems between this table entry and section 4.37.

The name is inconsistent - leading to navigation
problems between this table entry and the section
4.38.
There needs to be more materials provided with the
ballot package in order to evaluate the specification
more easily. There are significant consistency issues
throughout the document. I have captured a number
of them, but do not include every single instance.
My comments should be applied through the entirety
of the document and there needs to be a
conformance statement consistency review as part of
ballot reconciliation.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        170                    March 2003
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This specifications makes a large number of          Yes
substantive changes from the specifications of which
it is derived. In order to properly review and
understand the nature and potential impact of all of
these changes, it is necessary to have a properly
documented change log that explicitly points out all
of the changes from the previous materials
(specifications including CCD, IHE PCC and HITSP
C83 etc.). This is also very important for
implementers whom will need to change their
implementations to support a modified specification.

The word Control is missing from the CDC title.



There is often confusion regarding the requirement
of entries when no data is available.(e.g. No lab
results on file). This confusion has been
compounded by MU requiring certain sections (e.g.
diagnostic test results). The question implementers
often ask is, if I do not have any information on file
for a section that requires entries, how do I produce
a valid document and note that there are no entries.
There needs to be guidance in this area (either
stating that the section need not be present (though
systems need to be able to create the section properly
if information does exist), or that the section must
always be present and explicitly mention the
requirements of the entry the denotes the no
information is on file or is included in the document.


There will be future specifications that make
reference to this guide. As such there will be a need
to pull in conformance statements from multiple
sources (e.g. this guide and a document type guide
that further constrains this guide for a specific
document type). In this case, it will be necessary to
uniquely identify conformance constraints across
multiple guides. Is there a mechanism for doing so?
Perhaps put a guide identifier as part of the
conformance ID?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          171                    March 2003
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It is preferable to specify each requirement in a
separate conformance statement for the purposes of
clarity. In section 1.7.2, example conformance
statement group 5, does this well. Example 4 is
confusing as it seems to indicate an attribute value
requirement yet does not include an element level
requirement. The attribute is only valid as a member
of an element. The conformance statements should
clearly state the element level requirement
(cardinality), and then the attribute requirements
(e.g. code="ABC" from codeSystem XYZ.)

Element cardinality requirements and vocabulary
requirements should be indicated as separate
requirements (preferably vocabulary requirements
will be listed as sub-items to the element level
cardinality requirement). This will help reduce
confusion as to whether the criteria is meant to
address an element level need (cardinality), or a
vocabulary need (may not be clear when it is a
vocabulary need as to whether the element is also
required, unless they are broken into separate
conformance statements). This needs to be applied
consistently throughout the document. I have
included some examples in some of my comments to
follow, but this needs to be applied throughout the
document (the proposed and existing wording to the
left is provided only to illustrate the point.
This section mentions open and closed templates. I
see no examples of closed templates in this
document (I would vote negatively on any closed
templates because of the purpose of this
specification). It would be nice to let
readers/implementers know that there are no closed
templates contained within this guide.

There are no explanations for conformance
requirements. In order to ensure proper
implementation it is important to indicate the intent
and purpose of each conformance criteria in order to
help ensure proper implementation.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       172                    March 2003
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Not every section and entry contains an example.
All conformance statements need to contain a full
sample (or set of samples, where needed to
demonstrate differing conditions) in order to
properly illustrate the requirements. This will help
insure proper implementation.
templateId's need to have an indication as to their
context. TemplateIds can be specified at any
number of levels (e.g. section template, entry
template, entryRelationship template etc.) The full
context of each templateId needs to be clearly stated
(perhaps as the first constraint for the template).
This is done in places, but is not consistent. This
needs to be applied across the entire document.

Only one UML diagram exists (for problem list) in
this guide. There should be a UML diagram for
each section and entry set.
The codeSystem needs to always be indicated and
clear. There should be an explanation of how to
read the codeSystem requirement in section 1.7.5.
For example, "if the following constraint is specified
“@moodCode="EVN" Event (CodeSystem:
2.16.840.1.113883.5.1001 HL7ActMood)”
codeSystem="2.16.840.1.113883.5.1001" and
codeSystemName="HL7ActMood"

Most conformance statements about entity
identifiers ("id" element), restrict the cardinality to
only 1 id. There are many instances where an entity
is likely to have more than one id dependent on the
assigning authority. Either relax all the
requirements are specify why only one id is allowed,
and the source of what that identifier is supposed to
be. the existing and proposed wording to the left is
provided as an example (there are some examples in
further comments to help illustrate). This comment
is included to be applied to all id elements (rather
than including comments ad nauseum).




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         173                    March 2003
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There is no indication in this document as to
whether the value sets are closed or open (
closed=value must be contained within this value
set; open=value set is minimal and recommended set
but use of other codes within the code system are
allowed). This document needs to indicate whether
all value sets are closed or open, or provide better
guidance how the value set requirements are to be
interpreted. (An open value set could potentially be
handled by having a conformance statement that
states the codeSystem is ABC and another statement
that says the code SHOULD be from the value set.).
This is acceptable, but needs to be made clear to the
reader.
It is not clear in this section as to whether non-
consolidated items are present for reference only or
represent actual requirements for conformant
documents. This needs to be explicitly stated,
MU_CCDSample.xml (file name incorrect). This
document does not conform to C32 MU nor HITSP
C32 (2.5). This entry is confusing. What it
represents should be clearly denoted. If this is
supposed to be an MU document, it needs to
conform/validate as such.
There are two requirements here. 1) that there shall
be 1 realmCode. 2) that the
realmCode/@code="US". As currently written the
requirement is confusing

It may be clearer if we structured this item as an
item that one and only one like it must be present.




Suggest using the conformance verbs and structured
used elsewhere in this guide.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       174                    March 2003
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Suggest separating out all conformance requirements
into separate statements. (this is done in 2.1.1-
12.a.iv.3




Suggest separating out all conformance requirements
into separate statements.




Suggest separating out all conformance requirements
into separate statements.




Does this preclude the possibility of having a
country code? Table 3 does not provide an example
where this is indicated. If the country code is
allowed, an example should be provided in order to
reduce confusion.


Suggest using the element name unmodified (do not
append an element name with s to indicate multiple
instances, but rather reword the requirement. This
comment should be applied generally across the
document. There needs to be consistency.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     175                    March 2003
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As written this statement does not allow for a
nullFlavor (if the patient gender is unknown or not
documented), per the rules specified in section 1.7.6.
The new wording requires an
administrativeGenderCode, and if the @code is
included, it SHALL be from the value set specified




There is a new namespace included that is not
defined anywhere in this document. The name
space needs to be described. Note that this
namespace is not consistent with C83 4.1.1 (sdtc vs
sdwg). Potential compatibility issues?

The purpose of this requirement is not clear. Why
should there not be more than 1 guardian (children
may have more than one guardian




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        176                    March 2003
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It is not clear why a guardian must have 1 and only 1
telecom.

The wording "if present" is not consistent with other
parts of this document. Since the parent has a
cardinality of [0..1] it is understood that the child
requirements are only in the instance where the
element is present. This comment should be applied
generally across the document. There needs to be
consistency.
It is not clear why only one id is allowed.




It is not clear why only one id is allowed.


It is not clear why only one id is allowed.


It is not clear why only one id is allowed.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       177                    March 2003
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The source of this dynamic value set is not
indicated. Who is the authoring authority and where
can the current set be procured from.



The source of this dynamic value set is not
indicated. Who is the authoring authority and where
can the current set be procured from.



templateId is not an element allowed in the addr
(type "AD") element. Including a templateId is
confusing. What is the requirement and use of the
templateId? Where does this templateId need to be
specified?

templateId is not an element allowed in the name
(type "PN") element. Including a templateId is
confusing. What is the requirement and use of the
templateId? Where does this templateId need to be
specified?




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     178                    March 2003
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Requirements need to be separated and consistent
with the rest of the guide




Certain templates are listed as required, however,
there is no indication as to how to specify that there
is no data to be included in the document (e.g. if
creating a CCD, but there are no results that are
clinically relevant to the purpose the document is
being created). This needs to be clearly specified in
order to enable consistent and correct
implementations.
Table 18 indicates that there are several required
sections in the CCD document type, yet section 4
SECTION LEVEL TEMPLATES Table 31 states
that all of the sections are optional for CCD. The
difference needs to be reconciled.
The specifications included in this guide are not
C32, nor is it backward compatible to C32. Unless
this document is proposing a new version of C32, it
is not correct to assert C32 here.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        179                    March 2003
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as currently written, it does not require that the
templateId be explicitly included in the document.




as currently written, it does not require that the
templateId be explicitly included in the document.




The context already suggest that the element may
not be present, so there is no need to indicate "if
present". Requirements need to be separated




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                     180                    March 2003
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May need additional wordsmithing.




It is not clear as to whether this is a requirement or a
description of the requirement above.




If this is a conformance statement as to an allowed
element, it should be written as such




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          181                    March 2003
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It is not clear how to read table 31, and if there are
specific requirements being listed. Each
requirements should have an identifier.

There may be more than one advance directive. The
statement that it can contain exactly one seems
confusing. Why is this being mentioned? Why not
zero or more? One or more? The statement as is
does not mentioning any requirements or really
providing any guidance.
Why would there be a limit to the number of
immunization entries? This is done in numerous
places in this document. All need to be reviewed.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        182                    March 2003
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mmittee Resolution                                                                                                                                 Ballot Comment Tracking




                                                Against


                                                          Abstain
                                                                    Change    Substantive                                                    On Behalf of   Submitter




                                         For
           Responsible Person                                       Applied   Change        Submitted By       Organization   On behalf of   Email          Tracking ID Referred To




                                                                                            Austin Kreisler


                                                                                                               SAIC




                                                                                            Austin Kreisler




                                                                                                               SAIC




           55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                                             183                                                                    March 2003
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                                                             Austin Kreisler




                                                                                SAIC

                                                             Doug Pratt
                                                                                Siemens

                                                             Doug Pratt
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                                                             Doug Pratt




                                                                                Siemens

                                                             Doug Pratt
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                                                             Doug Pratt
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                                                             Doug Pratt
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                                                             Doug Pratt
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                                                             Doug Pratt

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                                                             Doug Pratt
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                                                             Doug Pratt


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                                                             Doug Pratt



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                                                             Doug Pratt


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55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         185              March 2003
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                                                             Doug Pratt
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                                                             Doug Pratt



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                                                                                                          Helmut.Koenig@s
                                                             Doug Pratt                   Helmut Koenig
                                                                                                          iemens.com



                                                                                Siemens




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         186                                               March 2003
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                                                                                                          Helmut.Koenig@s
                                                             Doug Pratt                   Helmut Koenig
                                                                                                          iemens.com




                                                                                Siemens




                                                                                                          David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                          ens.com




                                                                                Siemens
                                                                                                          David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                          ens.com
                                                                                Siemens


                                                                                                          David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                          ens.com
                                                                                Siemens



                                                                                                          David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                          ens.com


                                                                                Siemens




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         187                                               March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com



                                                                                Siemens



                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens
                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com
                                                                                Siemens


                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com

                                                                                Siemens

                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com
                                                                                Siemens



                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens
                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com
                                                                                Siemens



                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens



55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         188                                          March 2003
                                                    V3 Ballot Submission/Resolution Form


                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com
                                                                                Siemens



                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens
                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com
                                                                                Siemens
                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com
                                                                                Siemens

                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com
                                                                                Siemens




                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com




                                                                                Siemens




                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com



                                                                                Siemens




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         189                                          March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens



                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens




                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com



                                                                                Siemens



                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens



                                                                                                      David.Tao@siem
                                                             Doug Pratt                   David Tao
                                                                                                      ens.com


                                                                                Siemens




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         190                                          March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                                                                David.Tao@siem
                                                             Doug Pratt                             David Tao
                                                                                                                ens.com




                                                                                Siemens
                                                                                                                David.Tao@siem
                                                             Doug Pratt                             David Tao
                                                                                                                ens.com
                                                                                Siemens



                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.




                                                             David Parker, MD


                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         191                                                    March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             David Parker, MD




                                                                                Evolvent
                                                                                Technologies Inc.



                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        192                        March 2003
                                                    V3 Ballot Submission/Resolution Form


                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.



                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.



                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        193                        March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.

                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.



55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        194                        March 2003
                                                    V3 Ballot Submission/Resolution Form


                                                             David Parker, MD Evolvent
                                                                              Technologies Inc.




                                                             David Parker, MD




                                                                                Evolvent
                                                                                Technologies Inc.




                                                             David Parker, MD




                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        195                        March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.


                                                             David Parker, MD
                                                                                Evolvent
                                                                                Technologies Inc.



                                                             Diane Juskelis                         Margaret Dittloff   mkd@cbord.com



                                                                                                    Elaine Ayres -
                                                             Diane Juskelis                         American Dietetic EAyres@cc.nih.gov
                                                                                                    Association




                                                             Diane Juskelis




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         196                                                             March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com



                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




                                                                                   Elaine Ayres -
                                                             Diane Juskelis        American Dietetic EAyres@cc.nih.gov
                                                                                   Association




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         197                                            March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




                                                             Diane Juskelis        Margaret Dittloff   mkd@cbord.com




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         198                                          March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts




                                                                              Allscripts




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       199                March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts




                                                                              Allscripts
                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts
                                                                              Allscripts




                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts




                                                                              Allscripts




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       200                March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts




                                                                              Allscripts




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       201                March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts




                                                                              Allscripts
                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts
                                                                              Allscripts




                                                             Emma Jones on
                                                             behalf of
                                                             Allscripts




                                                                              Allscripts




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       202                March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Freida Hall


                                                                                 Quest Diagnostics




                                                             Freida Hall




                                                                                 Quest Diagnostics


                                                             Freida Hall
                                                                                 Quest Diagnostics




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          203                       March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Freida Hall




                                                                                 Quest Diagnostics


                                                             Freida Hall
                                                                                 Quest Diagnostics

                                                             Freida Hall
                                                                                 Quest Diagnostics


                                                             Freida Hall

                                                                                 Quest Diagnostics


                                                             Gaby Jewell
                                                                                 Cerner
                                                                                 Corporation
                                                                                 Cerner
                                                             Gaby Jewell
                                                                                 Corporation
                                                                                 Cerner
                                                             Gaby Jewell
                                                                                 Corporation


                                                             Gaby Jewell
                                                                                 Cerner
                                                                                 Corporation




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          204                       March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Gaby Jewell


                                                                                 Cerner
                                                                                 Corporation
                                                                                 Cerner
                                                             Gaby Jewell
                                                                                 Corporation

                                                             Gaby Jewell         Cerner
                                                                                 Corporation

                                                             Gaby Jewell         Cerner
                                                                                 Corporation
                                                                                 US Department of
                                                             Gregg Seppala
                                                                                 Veterans Affairs




                                                                                 US Department of                 David.Carlson@v
                                                             Gregg Seppala                        David Carlson
                                                                                 Veterans Affairs                 a.gov




                                                                                 US Department of                 David.Carlson@v
                                                             Gregg Seppala                        David Carlson
                                                                                 Veterans Affairs                 a.gov




                                                                                 US Department of                 David.Carlson@v
                                                             Gregg Seppala                        David Carlson
                                                                                 Veterans Affairs                 a.gov


                                                                                 US Department of                 David.Carlson@v
                                                             Gregg Seppala                        David Carlson
                                                                                 Veterans Affairs                 a.gov




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          205                                                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of                  David.Carlson@v
                                                             Gregg Seppala                     David Carlson
                                                                              Veterans Affairs                  a.gov




                                                                              US Department of                  David.Carlson@v
                                                             Gregg Seppala                     David Carlson
                                                                              Veterans Affairs                  a.gov




                                                                              US Department of                  David.Carlson@v
                                                             Gregg Seppala                     David Carlson
                                                                              Veterans Affairs                  a.gov




                                                                              US Department of                  matthew.greene2
                                                             Gregg Seppala                     Matthew Greene
                                                                              Veterans Affairs                  @va.gov




                                                                              US Department of                  matthew.greene2
                                                             Gregg Seppala                     Matthew Greene
                                                                              Veterans Affairs                  @va.gov

                                                                              US Department of                  matthew.greene2
                                                             Gregg Seppala                     Matthew Greene
                                                                              Veterans Affairs                  @va.gov

                                                                              US Department of                  matthew.greene2
                                                             Gregg Seppala                     Matthew Greene
                                                                              Veterans Affairs                  @va.gov




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       206                                                       March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m




                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m


                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m



                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m



                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m




                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m




                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m

                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m


                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       207                                                  March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m




                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m



                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m

                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m

                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m

                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m


                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m


                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m


                                                                              US Department of            Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs            m




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       208                                                  March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of                     Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs                     m




                                                                              US Department of                     Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs                     m




                                                                              US Department of                     Jaylyle@gmail.co
                                                             Gregg Seppala                     Jay Lyle
                                                                              Veterans Affairs                     m




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       209                                                            March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       210                                                            March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       211                                                            March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       212                                                            March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                                              US Department of                     Serafina.Versaggi
                                                             Gregg Seppala                     Serafina Versaggi
                                                                              Veterans Affairs                     @va.gov




                                                                              US Department of
                                                                                                                   Serafina.Versaggi
                                                             Gregg Seppala    Veterans Affairs Serafina Versaggi
                                                                                                                   @va.gov




                                                             Harry Solomon
                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       213                                                            March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Harry Solomon

                                                                              GE Healthcare


                                                             Harry Solomon

                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare



                                                             Harry Solomon


                                                                              GE Healthcare


                                                             Harry Solomon
                                                                              GE Healthcare


                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare


                                                             Harry Solomon

                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare


                                                             Harry Solomon

                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       214                   March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare


                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare




                                                             Harry Solomon



                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       215                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Harry Solomon


                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare


                                                             Harry Solomon

                                                                              GE Healthcare



                                                             Harry Solomon


                                                                              GE Healthcare




                                                             Harry Solomon



                                                                              GE Healthcare


                                                             Harry Solomon

                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare

                                                             Harry Solomon
                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       216                   March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Harry Solomon
                                                                              GE Healthcare



                                                             Harry Solomon


                                                                          GE Healthcare
                                                             JON HENDRICH SONOSITE, INC.




                                                             Keith W. Boone




                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       217                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Keith W. Boone




                                                                              GE Healthcare


                                                             Keith W. Boone
                                                                              GE Healthcare


                                                             Keith W. Boone
                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       218                   March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Keith W. Boone
                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare




                                                             Keith W. Boone



                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       219                   March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Keith W. Boone
                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare


                                                             Keith W. Boone
                                                                              GE Healthcare


                                                             Keith W. Boone

                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare




                                                             Keith W. Boone



                                                                              GE Healthcare



55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       220                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Keith W. Boone



                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare




                                                             Keith W. Boone



                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare


                                                             Keith W. Boone

                                                                              GE Healthcare




                                                             Keith W. Boone



                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       221                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Keith W. Boone



                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare




                                                             Keith W. Boone



                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       222                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Keith W. Boone




                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare




                                                             Keith W. Boone



                                                                              GE Healthcare


                                                             Keith W. Boone

                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       223                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Keith W. Boone


                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       224                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Keith W. Boone




                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare


                                                             Keith W. Boone
                                                                              GE Healthcare




                                                             Keith W. Boone




                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       225                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Keith W. Boone



                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare

                                                             Keith W. Boone
                                                                              GE Healthcare




                                                             Keith W. Boone



                                                                              GE Healthcare


                                                             Keith W. Boone

                                                                              GE Healthcare



                                                             Keith W. Boone


                                                                              GE Healthcare




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       226                   March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Keith W. Boone
                                                                               GE Healthcare


                                                             Keith W. Boone

                                                                               GE Healthcare


                                                             Keith W. Boone

                                                                               GE Healthcare


                                                             Keith W. Boone

                                                                               GE Healthcare




                                                             Keith W. Boone




                                                                               GE Healthcare



                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies


                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        227                   March 2003
                                                    V3 Ballot Submission/Resolution Form

                                                                               Evolvent
                                                             Kent Stevenson
                                                                               Technologies



                                                             Kent Stevenson

                                                                               Evolvent
                                                                               Technologies
                                                                               Evolvent
                                                             Kent Stevenson
                                                                               Technologies



                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies

                                                             Kent Stevenson    Evolvent
                                                                               Technologies




                                                             Kent Stevenson




                                                                               Evolvent
                                                                               Technologies




                                                             Kent Stevenson


                                                                               Evolvent
                                                                               Technologies




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        228                  March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Kent Stevenson




                                                                               Evolvent
                                                                               Technologies



                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies


                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies



                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies



                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies



                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        229                  March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies




                                                             Kent Stevenson


                                                                               Evolvent
                                                                               Technologies



                                                             Kent Stevenson

                                                                               Evolvent
                                                                               Technologies



                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies

                                                             Kent Stevenson    Evolvent
                                                                               Technologies

                                                             Kent Stevenson    Evolvent
                                                                               Technologies




                                                             Kent Stevenson



                                                                               Evolvent
                                                                               Technologies




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        230                  March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Kent Stevenson




                                                                               Evolvent
                                                                               Technologies


                                                             Kent Stevenson
                                                                               Evolvent
                                                                               Technologies




                                                             Kent Stevenson




                                                                               Evolvent
                                                                               Technologies




                                                             Kent Stevenson




                                                                               Evolvent
                                                                               Technologies




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        231                  March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Kent Stevenson




                                                                               Evolvent
                                                                               Technologies



                                                             Lisa R. Nelson




                                                             Lisa R. Nelson




                                                             Lisa R. Nelson




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        232                  March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Lisa R. Nelson



                                                             Lisa R. Nelson




                                                             Lisa R. Nelson




                                                             Lisa R. Nelson




                                                             Randy Levin


                                                                                 FDA



                                                             Randy Levin


                                                                                 FDA



                                                             Randy Levin




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          233             March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Randy Levin




                                                             Randy Levin


                                                                                 FDA



                                                             Randy Levin


                                                                                 FDA




                                                             Randy Levin




                                                                                 FDA



                                                             Randy Levin


                                                                                 FDA



                                                             Randy Levin


                                                                                 FDA




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          234             March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Randy Levin



                                                                                 FDA




                                                             Randy Levin




                                                                                 FDA




                                                             Randy Levin




                                                                                 FDA




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          235             March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Randy Levin




                                                                                 FDA




                                                             Randy Levin




                                                                                 FDA

                                                             Randy Levin
                                                                                 FDA




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          236             March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Randy Levin



                                                                                 FDA




                                                             Ryan W. Murphy




                                                             Ryan W. Murphy



                                                             Ryan W. Murphy




                                                             Ryan W. Murphy




                                                             Ryan W. Murphy




                                                             Ryan W. Murphy


                                                             Ryan W. Murphy




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          237             March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Ryan W. Murphy




                                                             Ryan W. Murphy

                                                             Ryan W. Murphy




                                                             Ryan W. Murphy




                                                             Ryan W. Murphy




                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       238                     March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration

                                                             Shanks Kande     Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       239                     March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration

                                                             Shanks Kande     Social Security
                                                                              Administration

                                                             Shanks Kande     Social Security
                                                                              Administration

                                                             Shanks Kande     Social Security
                                                                              Administration



                                                             Shanks Kande

                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       240                     March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande

                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       241                     March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration

                                                             Shanks Kande     Social Security
                                                                              Administration




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       242                     March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration


                                                             Shanks Kande
                                                                              Social Security
                                                                              Administration



                                                             Shanks Kande

                                                                              Social Security
                                                                              Administration




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       243                     March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Shanks Kande
                                                                               Social Security
                                                                               Administration


                                                             Shanks Kande
                                                                               Social Security
                                                                               Administration



                                                             Shanks Kande
                                                                               Social Security
                                                                               Administration


                                                             Shanks Kande
                                                                               Social Security
                                                                               Administration



                                                             Walter Suarez


                                                                               Kaiser Permanente

                                                             Walter Suarez                         Scott M Robertson
                                                                               Kaiser Permanente




                                                             Walter Suarez                         Scott M Robertson




                                                                               Kaiser Permanente




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                        244                                           March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Walter Suarez                          Scott M Robertson



                                                                                Kaiser Permanente


                                                             Walter Suarez                          Scott M Robertson

                                                                                Kaiser Permanente




                                                             Bob Yencha




                                                                                Lantana Group



                                                             Bob Yencha


                                                                                Lantana Group


                                                             Bob Yencha

                                                                                Lantana Group




                                                             Bob Yencha




                                                                                Lantana Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         245                                           March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Bob Yencha


                                                                                Lantana Group

                                                             Bob Yencha
                                                                                Lantana Group


                                                             Bob Yencha

                                                                                Lantana Group



                                                             Bob Yencha


                                                                                Lantana Group




                                                             Bob Yencha




                                                                                Lantana Group


                                                             Bob Yencha
                                                                                Lantana Group

                                                             Bob Yencha
                                                                                Lantana Group

                                                             Bob Yencha
                                                                                Lantana Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         246                   March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Bob Yencha


                                                                                 Lantana Group

                                                             Bob Yencha
                                                                                 Lantana Group


                                                             Bob Yencha
                                                                                 Lantana Group



                                                             Jingdong Li

                                                                                 Lantana
                                                                                 Consulting Group


                                                             Jingdong Li
                                                                                 Lantana
                                                                                 Consulting Group




                                                             Jingdong Li




                                                                                 Lantana
                                                                                 Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          247                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Jingdong Li




                                                                                 Lantana
                                                                                 Consulting Group

                                                             Kate Hamilton       Lantana
                                                                                 Consulting Group

                                                             Kate Hamilton       Lantana
                                                                                 Consulting Group




                                                             Kate Hamilton




                                                                                 Lantana
                                                                                 Consulting Group




                                                             Kate Hamilton


                                                                                 Lantana
                                                                                 Consulting Group


                                                             Kate Hamilton
                                                                                 Lantana
                                                                                 Consulting Group



55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                          248                      March 2003
                                                    V3 Ballot Submission/Resolution Form



                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group




                                                             Kate Hamilton




                                                                              Lantana
                                                                              Consulting Group


                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group




                                                             Kate Hamilton




                                                                              Lantana
                                                                              Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       249                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Kate Hamilton




                                                                              Lantana
                                                                              Consulting Group




                                                             Kate Hamilton


                                                                              Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group


                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group


                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group



                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       250                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Kate Hamilton


                                                                              Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group



                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group


                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group


                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group



                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       251                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group




                                                             Kate Hamilton



                                                                              Lantana
                                                                              Consulting Group


                                                             Kate Hamilton
                                                                              Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group




                                                             Kate Hamilton



                                                                              Lantana
                                                                              Consulting Group



                                                             Kate Hamilton

                                                                              Lantana
                                                                              Consulting Group

                                                             Kate Hamilton    Lantana
                                                                              Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                       252                      March 2003
                                                    V3 Ballot Submission/Resolution Form


                                                             Kate Hamilton      Lantana
                                                                                Consulting Group


                                                             Kate Hamilton
                                                                                Lantana
                                                                                Consulting Group




                                                             Brett Marquard                        Rick Geimer




                                                             Brett Marquard


                                                             Brett Marquard
                                                             Brett Marquard



                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group




                                                             Gaye Dolin




                                                                                Lantana
                                                                                Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         253                                    March 2003
                                                    V3 Ballot Submission/Resolution Form


                                                             Gaye Dolin         Lantana
                                                                                Consulting Group


                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group



                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group


                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group


                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group




                                                             Gaye Dolin



                                                                                Lantana
                                                                                Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         254                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Gaye Dolin



                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group




                                                             Gaye Dolin


                                                                                Lantana
                                                                                Consulting Group



                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group




                                                             Gaye Dolin



                                                                                Lantana
                                                                                Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         255                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Gaye Dolin

                                                                                Lantana
                                                                                Consulting Group




                                                             Gaye Dolin


                                                                                Lantana
                                                                                Consulting Group


                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group




                                                             Gaye Dolin



                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group




                                                             Gaye Dolin




                                                                                Lantana
                                                                                Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         256                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Gaye Dolin


                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group


                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group



                                                             Gaye Dolin

                                                                                Lantana
                                                                                Consulting Group




                                                             Gaye Dolin




                                                                                Lantana
                                                                                Consulting Group


                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         257                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Gaye Dolin




                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group



                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group


                                                             Gaye Dolin
                                                                                Lantana
                                                                                Consulting Group




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         258                      March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Gaye Dolin




                                                                                Lantana
                                                                                Consulting Group

                                                             Gaye Dolin         Lantana
                                                                                Consulting Group




                                                             Brett Marquard


                                                             Brett Marquard



                                                             Brett Marquard


                                                             Brett Marquard
                                                             Brett Marquard


                                                             Brett Marquard



                                                             Brett Marquard




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                         259                      March 2003
                                                    V3 Ballot Submission/Resolution Form


                                                             Brett Marquard


                                                             Chris Melo
                                                                                  Philips Healthcare


                                                             Chris Melo

                                                                                  Philips Healthcare




                                                             Chris Melo




                                                                                  Philips Healthcare

                                                             Chris Melo
                                                                                  Philips Healthcare

                                                             Chris Melo
                                                                                  Philips Healthcare




                                                             Corey Spears



                                                                                  McKesson
                                                                                  Corporation




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           260                        March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Corey Spears




                                                                                  McKesson
                                                                                  Corporation


                                                             Corey Spears
                                                                                  McKesson
                                                                                  Corporation




                                                             Corey Spears




                                                                                  McKesson
                                                                                  Corporation




                                                             Corey Spears



                                                                                  McKesson
                                                                                  Corporation




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           261                 March 2003
                                                    V3 Ballot Submission/Resolution Form




                                                             Corey Spears




                                                                                  McKesson
                                                                                  Corporation




                                                             Corey Spears




                                                                                  McKesson
                                                                                  Corporation




                                                             Corey Spears


                                                                                  McKesson
                                                                                  Corporation


                                                             Corey Spears
                                                                                  McKesson
                                                                                  Corporation




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Ballot]                           262                 March 2003
                                                    V3 Ballot Submission/Resolution Form




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                                                 Ballot Submission/Resolution Instructions

                                                                                                                                   Return to Ballot
  How to Use this Spreadsheet
 Submitting a ballot:

 SUBMITTER WORKSHEET:
 Please complete the Submitter worksheet noting your overall ballot vote. Please note if you have any negative line items, the ballot is considered
 negative overall. For Organization and Benefactor members, the designated contact must be one of your registered voters to conform with
 ANSI guidelines.

 BALLOT WORKSHEET:
 Please complete all lavender columns as described below - columns in turquoise are for the committees to complete when reviewing ballot
 comments.
 Several columns utilize drop-down lists of valid values, denoted by a down-arrow to the right of the cell. Some columns utilize a filter which
 appears as a drop down in the gray row directly below the column header row.
 If you need to add a row, please do so near the bottom of the rows provided.
 If you encounter issues with the spreadsheet, please contact Karen VanHentenryck (karenvan@hl7.org) at HL7 Headquarters.

 Resolving a ballot:
 Please complete all green columns as described below - columns in blue are for the ballot submitters.
 You are required to send resolved ballots back to the ballot submitter, as denoted by the Submitter worksheet.

 Submitting comments on behalf of another person:
 You can cut and paste other peoples comments into your spreadsheet and manually update the column titled "On behalf of" or you
 can use a worksheet with the amalgamation macro in it (available from HL7 Inc. or HL7 Canada (hl7canada@cihi.ca)). The
 amalgamation worksheet contains the necessary instructions to automatically populate the 'submitter', 'organization' and
 'on behalf of' columns. This is very useful for organizational members or international affiliates who have one representative
 for ballot comments from a number of different people.




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Instructions]                                                                                               August, 2002
                                           Ballot Submission/Resolution Instructions

  Column Headers
                                             Ballot Submitter (sections in lavender)

 Number                  This is an identifier used by HL7 Committees. Please do not alter.
 Ballot WG               Select the WG from the drop down list that will best be able to resolve the ballot comment.

                         In some situations, the ballot comment is general in nature and can best be resolved by a non-chapter
                         specific WG. This can include MnM (Modeling and Methodology) & INM (Infrastructure and
                         Management). Enter these WGs if you feel the ballot can best be resolved by these groups. In some
                         situations, chapter specific WGs such as OO (Observation and Orders) and FM (Financial Management)
                         will refer ballot comments to these WGs if they are unable to resolve the ballot comment. An explanation
                         of the 'codes' used to represent the Ballot WGs as well as the Ballots they are responsible for is included in
                         the worksheet titled 'CodeReference'
 Artifact                The type of Artifact this Change affects.
                         HD            Hierarchical Message Definition
                         AR            Application Roles
                         RM            Refined Message Information Model
                         IN            Interaction
                         TE            Trigger Event
                         MT            Message Type
                         DM            Domain Message Information Model
                         ST            Storyboard
                         ??            Other


 Section                 Section of the ballot, e.g., 3.1.2. Note: This column can be filtered by the committee, for example, to
                         consider all ballot line items reported against section 3.1.2.
 Ballot                  A collection of artifacts including messages, interactions, & storyboards that cover a specific interest area.
                         Examples in HL7 are Pharmacy, Medical Devices, Patient Administration, Lab Order/Resulting, Medical
                         Records, and Claims and Reimbursement.

                         Select from the drop down list the specific ballot that the comment pertains to. An explanation of the
                         'codes' used to represent the Ballots as well as the Ballot WGs that are are responsible for them is
                         included in the worksheet titled 'CodeReference'. Please refer to the list of available ballots on the HL7
                         site for more descriptive information on current, open ballots.
 Pubs                    If the submitter feels that the issue being raised directly relates to the formatting or publication of this
                         document rather than the content of the document, flag this field with a "Y" value, otherwise leave it blank
                         or "N".


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                                           Ballot Submission/Resolution Instructions

 Vote/Type               Negative Votes:

                         1. (Neg-Mj) Negative Vote with reason , Major. Use this in the situation where the content of the material is
                         non-functional, incomplete or requires correction before final publication. All Neg-Mj votes must be
                         resolved by committee.

                         2. (Neg-Mi) Negative Vote with reason, Minor Type. Use this when the comment needs to be resolved, but
                         is not as significant as a negative major.

                         Affirmative Votes:

                         3. (A-S) Affirmative Vote with Comment - Suggestion. Use this if the committee is to consider a
                         suggestion such as additional background information or justification for a particular solution.

                         4. (A-T) Affirmative Vote with Comment - Typo. If the material contains a typo such as misspelled words,
                         enter A-T.

                         5. (A-Q) Affirmative Vote with Question.

                         6. (A-C) Affirmative Vote with Comment.
 Existing Wording        Copy and Paste from ballot materials.
 Proposed Wording        Denote desired changes.

                         Reason for the Change. In the case of proposed wording, a note indicating where the changes are in the
 Comments
                         proposed wording plus a reason would be beneficial for the WG reviewing the ballot.
 In Person Resolution    Submitters can use this field to indicate that they would appreciate discussing particular comments in
 Required?               person during a WG Meeting. Co-Chairs can likewise mark this field to indicate comments they think
                         should be discussed in person. Please note that due to time constraints not all comments can be reviewed
                         at WGMs.




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                                           Ballot Submission/Resolution Instructions

                                         Committee Resolution (sections in turquoise)
 Comment Grouping        This is a free text field that WGs can use to track similar or identical ballot comments. For example, if a
                         committee receives 10 identical or similar ballot comments the WG can place a code (e.g. C1) in this
                         column beside each of the 10 ballot comments. The WG can then apply the sort filter to view all of the
                         similar ballot comments at the same time.
 Disposition             The instructions for selecting dispositions were too large for this section and have been moved to the
                         worksheet titled "Instructions Cont.."




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                                             Ballot Submission/Resolution Instructions

 Withdraw                 Withdraw
 (Negative Ballots        This code is used when the submitter agrees to "Withdraw" the negative line item. The Process
 Only)                    Improvement Committee is working with HL7 Headquarters to clarify the documentation on 'Withdraw" in
                          the HL7 Governance and Operations Manual. To help balloters and co-chairs understand the use of
                          "Withdraw", the following example scenarios have been included as examples of when "Withdraw" might
                          be used: 1) the WG has agreed to make the requested change, 2) the WG has agreed to make the
                          requested change, but with modification; 3) the WG has found the requested change to be persuasive but
                          out-of scope for the particular ballot cycle and encourages the ballotter to submit the change for the next
                          release; 4) the WG has found the requested change to be non-persuasive and has convinced the
                          submitter. If the negative ballotter agrees to "Withdraw" a negative line item it must be recorded in the
                          ballot spreadsheet.

                          The intent of this field is to help manage negative line items, but the WG may elect to manage affirmative
                          suggestions and typos using this field if they so desire.

                          This field may be populated based on the ballotter's verbal statement in a WGM, in a teleconference or
                          in a private conversation with a WG co-chair. The intention will be documented in minutes as appropriate
                          and on this ballot spreadsheet. The entry must be dated if it occurs outside of a WGM or after the
                          conclusion of WGM.

                          The field will be left unpopulated if the ballotter elects to not withdraw or retract the negative line item.

                          Note that a ballotter often withdraws a line item before a change is actually applied. The WG is obliged
                          to do a cross check of the Disposition field with the Change Applied field to ensure that they have
                          finished dealing with the line item appropriately.

                          Retract
                          The ballotter has been convinced by the WG to retract their ballot item. This may be due to a
                          decision to make the change in a future version or a misunderstanding about the content.

                       NOTE: If the line item was previously referred, but withdrawn or retracted once the line item is dealt with
                       in the subsequent WG update the disposition as appropriate when the line item is resolved.
 Disposition Committee If the Disposition is "Refer", then select the WG that is ultimately responsible for resolving the ballot
                       comment. Otherwise, leave the column blank. If the Disposition is "Pending" for action by another WG,
                       select the appropriate WG.




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                                            Ballot Submission/Resolution Instructions

 Disposition Comment Enter a reason for the disposition as well as the context. Some examples from the CQ WG include:
                     20030910 CQ WGM: The request has been found Not Persuasive because....
                     20031117 CQ Telecon: The group agreed to the proposed wording.
                     20031117 CQ Telecon: Editor recommends that proposed wording be accepted.


 Responsible Person       Identifies a specific person in the WG (or disposition WG) that will ensure that any accepted changes are
                          applied to subsequent materials published by the WG (e.g. updating storyboards, updating DMIMs, etc.).

 For, Against, Abstain    In the event votes are taken to aid in your line item resolutions, there are three columns available for the
                          number of each type of vote possible, for the proposed resolution, against it or abstain from the vote.
 Change Applied           A Y/N indicator to be used by the WG chairs to indicate if the Responsible Person has indeed made the
                          proposed change and submitted updated materials to the committee.
                          A Y/N indicator to be used by the WG chairs to indicate if the line item is a substantive change.
 Substantive Change       NOTE: This is a placeholder in V3 pending definition of substantive change by the ArB.
                          This column is auto filled from the Submitter Worksheet. It is used to refer back to the submitter for a
                          given line item when all the ballot line items are combined into a single spreadsheet or database. For
                          Organization and Benefactor members, the designated contact must be one of your registered voters to
 Submitted By             conform with ANSI guidelines.
                          This column is auto filled from the Submitter Worksheet. Submitter's should enter the name of the
                          organization that they represent with respect to voting if different from the organization that they are
                          employed by. It is used to link the submitter's name with the organization they are voting on behalf of for a
 Organization             given line item when all the ballot line items are combined into a single spreadsheet or database.
                        This column is autofilled from the Submitter Worksheet. It is used to track the original submitter of the line
                        item. Many International Affiliates, Organizational, and Benefactor balloters pool comments from a variety
 On Behalf Of           of reviewers, which can be tracked using this column.
                        This column is autofilled from the Submitter Worksheet. It is used to track the email address of the original
                        submitter of the line item. Many International Affiliates, Organizational, and Benefactor balloters pool
 On Behalf Of Email     comments from a variety of reviewers, which can be tracked using this column.
 Submitter Tracking ID #Internal identifier (internal to the organization submitting the ballot). This should be a meaningful number
                        to the organization that allows them to track comments. This can be something as simple as the
                        reviewer’s initials followed by a number for each comment, i.e. JD-1, or even more complex such as
                        ‘001XXhsJul03’ where ‘001’ is the unique item number, ‘XX’ is the reviewer's initials, ‘hs’ is the company


 Referred To              Use this column to indicate the WG you have referred this ballot comment to.



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                                          Ballot Submission/Resolution Instructions

 Received From           Use this column to indicate the WG from which you have received this ballot comment.
                         This is a free text field that WGs can use to add comments regarding the current status of referred or
 Notes                   received item.




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                                          Ballot Submission/Resolution Instructions




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                                             Ballot Submission/Resolution Instructions

                                                                                                         Back to ballot           Back to instructions
Ballot instructions continued...
For the column titled "Disposition" please select one of the following:

Applicable to All Ballot Comments (Affirmative and Negative)
1. Persuasive. The WG has accepted the ballot comment as submitted and will make the appropriate change in the next ballot cycle. At this point the
comment is considered withdrawn and the corresponding cell from the column titled ‘Withdrawn’ should be marked appropriately. Section 14.08.01.03
of the HL7 Governance and Operations Manual (GOM) states that if a ballot comment is to be withdrawn that “…the Work Group effecting reconciliation
agrees without objection that the poistion expressed by the negative response is persuasive” and therefore WGs must take a vote to accept the
comment as persuasive.

2. Persuasive with Mod. The WG believes the ballot comment has merit, but has changed the proposed solution given by the voter. Example
scenarios include, but are not limited to;
-The WG has accepted the intent of the ballot comment, but has changed the proposed solution
-The WG has accepted part of the ballot comment, and will make a change to the standard; the other part is not persuasive
-The WG has accepted part of the ballot comment, and will make a change to the standard; the other part may be persuasive but is out of scope
The standard will be changed accordingly in the next ballot cycle. The nature of, or reason for, the modification is reflected in the Disposition Comments.
At this point the comment is considered withdrawn and the corresponding cell from the column titled ‘Withdrawn’ should be marked appropriately.
Section 14.08.01.03 of the HL7 Governance and Operations Manual (GOM) states that if a ballot comment is to be withdrawn that “…the Work Group
effecting reconciliation agrees without objection that the poistion expressed by the negative response is persuasive” and therefore WGs must take a
vote to accept the comment as persuasive.

3. Not Persuasive. The WG does not believe the ballot comment has merit or is unclear. Section 14.08.01.02 of the HL7 GOM states that “Approval of
a motion to declare a negative response not persuasive shall require an affirmative vote of at least sixty percent (60%) of the combined affirmative and
negative votes cast by the Work Group during reconciliation.” A change will not be made to the standard or proposed standard. The WG must indicate a
specific reason why the ballot comment is rejected in the Disposition Comments. The ballot submitter has the option to appeal this decision following
HL7 procedures as defined in section 14.12 of the HL7 GOM.
Example scenarios include, but are not limited to;
- the submitter has provided a recommendation or comment that the WG does not feel is valid
- the submitter has not provided a recommendation/solution; the submitter is encouraged to submit a proposal for a future ballot
- the recommendation/solution provided by the submitter is not clear; the submitter is encouraged to submit a proposal for a future ballot

4. Not Persuasive with Mod. The comment was considered non-persuasive by the WG; however, the WG has agreed to make a modification to the
material based on this comment. For example, adding additional explanatory text. Additional changes suggested by the non-persuaive comment will
not be made to the standard or proposed standard. The WG must indicate a specific reason why the ballot comment is rejected in the Disposition
Comments. The ballot submitter has the option to appeal this decision following HL7 procedures as defined in section 14.12 of the HL7 GOM.

5. Not Related. The WG has determined that the ballot comment is not relevant to the domain at this point in the ballot cycle. Section 14.08.01.01 of
the HL7 GOM states that “Approval of a motion to declare a negative response not related shall require an affirmative vote of at least sixty percent
(60%) of the combined affirmative and negative votes cast by the Work Group during reconciliation.” Example scenarios include, but are not limited to;


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                                            Ballot Submission/Resolution Instructions
(60%) of the combined affirmative and negative votes cast by the Work Group during reconciliation.” Example scenarios include, but are not limited to;
- the submitter is commenting on a portion of the standard, or proposed standard, that is not part of the current ballot
- the submitter's comments may be persuasive but beyond what can be accomplished at this point in the ballot cycle without creating potential
controversy.
- the submitter is commenting on something that is not part of the domain

6. Referred and Tracked. This should be used in circumstances when a comment was submitted to your WG in error and should have been submitted
to another WG. If you use this disposition you should also select the name of the WG you referred the comment to under the Column "Referred To".

7. Pending Input from Submitter. This should be used when the WG has read the comment but didn't quite understand it or needs to get more input
from the submitter. By selecting "Pending Input from Submitter" the WG can track and sort their dispositions more accurately.

8. Pending Input from other WG. The WG has determined that they cannot give the comment a disposition without further input or a final decision
from another WG. This should be used for comments that do belong to your WG but require a decision from another WG, such as ArB or MnM.

Applicable only to Affirmative Ballot Comments
9. Considered for future use. The WG, or a representative of the WG (editor or task force), has reviewed the item and has determined that no change
will be made to the standard at this point in time. This is in keeping with ANSI requirements. The reviewer should comment on the result of the ballot
comment consideration. An Example comment is included here:
- the suggestion is persuasive, but outside the scope of the ballot cycle; the submitter is encouraged to submit a proposal to the WG using the agreed
upon procedures.

10. Considered-Question answered. The WG, or a representative of the WG (editor or task force), has reviewed the item and has answered the
question posed. In so doing, the WG has determined that no change will be made to the standard at this point in time. This is in keeping with ANSI
requirements.

11. Considered-No action required. Occasionally people will submit an affirmative comment that does not require an action. For example, some WG's
have received comments of praise for a job well done. This comment doesn't require any further action on the WG's part, other than to keep up the
good work.




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                                                          Ballot Submission/Resolution Instructions




     int the

econciliation




 Comments.




           of

st indicate a




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                                                         Ballot Submission/Resolution Instructions




en submitted


more input




t no change




 some WG's




               55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Instructions Cont..]                        August, 2002
                                                               V3 Ballot Submission/Resolution Form


  Note on entering large bodies of text:
  ------------------------------------------------------------------
  When entering a large body of text in an Excel spreadsheet cell:

  1) The cell is pre-set to word wrap

  2) You can expand the column if you would like to see more of the available data

  3) There is a limit to the amount of text you can enter into a "comment" text column so keep things brief.
     -For verbose text, we recommend a separate word document; reference the file name here and include it (zipped) with your ballot.

  4) To include a paragraph space in your lengthly text, use Alt + Enter on your keyboard.

  5) To create "bullets", simply use a dash "-" space for each item you want to
  "bullet" and use two paragraph marks between them (Alt + Enter as described
  above).
  ------------------------------------------------------------------




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 Note: This section is a placeholder for Q&A/Helpful Hints for ballot resolution. (These notes are from Cleveland Co-Chair meeting; needs to be edited, or replaced by use cases)

 Marked ballots
 Issue For second and subsequent membership ballots HL7 ballots only the substantive changes that were added since the last ballot, with the instructions that ballots returned on unmarked ite
 “not related”. How do you handle obvious errors that were not marked, for example, the address for an external reference (e.g. DICOM) is incorrect?
 Response You can correct the obvious typographical errors as long as it is not a substantive change, even if it is unmarked. We recommend conservation interpretation of “obvious error” as y
 make a change that will questioned, or perceived to show favoritism. If you are unclear if the item is an “obvious error” consult the TSC Chair or ARB.
 Comment With the progression of ballots from Committee - > Membership the closer you get to final member ballot, the more conservative you should be in adding content. In the early stag
 ballot, it may be acceptable to adding new content (if endorsed by the committee) as wider audiences will review/critique in membership ballot. The Bylaws require two levels of ballot for n
 to Section 14.01). Exceptions must approved by the TSC Char.

 Non-persuasive
 Issue Use with discretion· Attempt to contact the voter before you declare their vote non-persuasive· Fixing a problem (e.g. typo) in effect makes the negative vote non-persuasive.· In all case
 be informed of the TC’s action.
 Response The preferred outcome is for the voter to withdraw a negative ballot; It is within a chair’s prerogative to declare an item non-persuasive. However, it does not make sense to declar
 without attempting to contact the voter to discuss why you are declaring non-persuasive. If you correct a typo, the item is no longer (in effect) non-persuasive once you have adopted their re
 change, however the voter should then willingly withdraw their negative as you have made their suggestion correction.. In all cases, you must inform the voter.
 Comment


 Non-related
 Issue Use with discretion· Used, for example, if the ballot item is out of scope, e.g. on a marked ballot the voter has submitted a comment on an area not subject to vote.· Out of scope items
 Response
 Comment


 Non-standard ballot responses are received
 Issue The ballot spreadsheet allows invalid combination, such as negative typo.
 Response Revise the ballot spreadsheets to support only the ANSI defined votes, plus “minor” and “major” negative as requested by the committees for use as a management tool. Question w
 Suggestion will be retained
 Comment Separate Affirmative/Abstain and Negative ballots will be created. Affirmative ballots will support: naffirmativenaffirmative with commentnaffirmative with comment
 comment – suggestionnabstainNegative ballots will support:nnegative with reason – majornnegative with reason – minorNote: “major” “minor” need definition

 Substantive changes must be noted in ballot reconciliation
 Issue Who determines whether a ballot goes forward?
 Response Substantive changes in a member ballot will result in a subsequent ballot. These should be identified on the ballot reconciliation form. (Refer to Bylaws 15.07.03). The TSC Chair
 whether the ballot goes forward to another member ballot, or back to committee ballot.
 Comment · Co-chairs and Editors need a working knowledge of “substantive change” as defined on the Arb website.·

 What Reconciliation Documentation Should Be Retained?
 Issue · By-Laws Section 14.04.01 states: “All comments accompanying affirmative ballots shall be considered by the Technical Committee.” This means each line item must be reviewed. Y
 disposition "considered" to mark affirmative comments that have been reviewed. Committees are encouraged to include in the comment section what they thing of the affirmative comment a


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 disposition "considered" to mark affirmative comments that have been reviewed. Committees are encouraged to include in the comment section what they thing of the affirmative comment a
 they think action should be taken, and by who.
 Response ·
 Comment


 How do you handle negatives without comment?
 Issue How do you handle a negative ballot is submitted without comments?
 Response The co-chair attempts to contact the voter, indicating “x” days to respond. If there is no response, the vote becomes 'not persuasive' and the co-chair must notify the ballotter of this


 Appeals
 Issue How are appeals handled?
 Response · Negative votes could be appealed to the TSC or Board· Affirmative votes cannot be appealed
 Comment

 Some information is not being retained
 Issue · The disposition of the line item as to whether or not a change request has been accepted needs to be retained. · The status of the line item as it pertains to whether or not the respondent
 the line item is a separate matter and needs to be recorded in the column titled "withdrawn'

 Some information is not being retained
 Issue By-Laws Section 14.04.01 states: “All comments accompanying affirmative ballots shall be considered by the Technical Committee.”· There is divided opinion as to whether or not Tec
 Committee’s need to review all line items in a ballot.· Should there be a statement on the reconciliation document noting what the TC decided?
 Response “. . .considered” does not mean the committee has to take a vote on each line item. However, a record needs to be kept as to the disposition. There are other ways to review, e.g. se
 committee for review offline, and then discuss in conference call. The review could be asynchronous, then coordinated in a conference call. The ballot has to get to a level where the committ
 the item. The committee might utilize a triage process to manage line items.
 Comment Action Item: Add to the ballot spreadsheet a checkoff for “considered; this would not require, but does not prohibit, documentation of the relative discussion.

 Withdrawing Negatives
 To withdraw a negative ballot or vote, HQ must be formally notified. Typically, the ballotter notifies HQ in writing of this intent. If, however, the ballotter has verbally expressed the intention
 entire negative ballot in the TC meeting, this intent must be documented in the minutes. The meeting minutes can then be sent via e-mail to the negative voter with a note indicating that this i
 that he/she withdrew their negative as stated in the attached meeting minutes and that their vote will be considered withdrawn unless they respond otherwise within five (5) days.

 The ballotter may also submit a written statement to the TC. The submitter's withdrawal must be documented and a copy retained by the co-chairs and a copy sent to HL7 HQ by email or fax.

 Two weeks (14 days) prior to the scheduled opening of the next ballot, the co-chairs must have shared the reconciliation package or disposition of the negative votes with the negative balloter
 balloters then have 7 days to withdraw their negative vote. If, 7 days prior to the scheduled opening of the next ballot the negative vote is not withdrawn, it will go out
 with the subsequent ballot as an outstanding negative.


 Changes applied are not mapped to a specific response
 Issue Changes are sometimes applied to the standard that are not mapped directly to a specific ballot response , due to editing requirements
 Response: A column to record substantive changes and to track whether the change has been applied was added.


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 Response: A column to record substantive changes and to track whether the change has been applied was added.

 Asking for negative vote withdrawal:
 Please include the unique ballot ID in all requests to ballot submitters. E.g. if asking a ballot submitter to withdraw a negative please use the ballot ID to reference the ballot.


 The following sections contain known outstanding issues. These have not been resolved because they require a 'ruling' on interpretations of the Bylaws and the Policies and Procedures
 updating of those documents. If you ever in doubt on how to proceed on an item, take a proposal for a method of action, then take a vote on that proposal of action and record it in the sp
 the minutes.

 Tracking duplicate ballot issues is a challenge
 Issue Multiple voters submit the same ballot item.
 Response While items may be “combined” for purposes of committee review, each ballot must be responded to independently.
 Comment


 Editorial license
 Issue There is divided opinion as to the boundaries of "editorial license".
 Response
 Comment


 Divided opinion on what requires a vote
 Issue
 Response · Do all negative line items require inspection/vote of the TC? – Yes, but you can group· Do all substantive line items require inspection/vote of the TC? Yes· How should non
 be evaluated for potential controversy that would require inspection and vote of the TC? Prerogative of Chair, if so empowered
 Comment


 Ballet Reconciliation Process Suggestion
 Issue It might be useful to map the proposed change to the ARB Substantive Change document. This would involve encoding the ARB document and making allowances for “Guideline Not F
 Response ARB is updating their Substantive Change document; this process might elicit additional changes.
 Comment Action Item? This would require an additional column on the spreadsheet

 How are line item dispositions handled?
 Issue Line items are not handled consistently
 Response · A Withdrawn negative is counted as an affirmative (this is preferable to non-persuasive.)· A Not related remains negative in the ballot pool for quorum purposes, but does not imp
 e.g. it does not count as a negative in the 90% rule.· A Not persuasive remains negative in the ballot pool for quorum purposes, but does not impede the ballot, e.g. it does not count as a negat
 rule.· Every negative needs a response; not every negative needs to be “I agree with your proposed change.” The goal is to get enough negatives resolved in order to get the ballot to pass, wh
 quality standard.
 Comment

 How should negative line items in an “Affirmative Ballot” be handled?

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 How should negative line items in an “Affirmative Ballot” be handled?
 Issue Affirmative Ballots are received that contained negative line items. The current practice is to err on the side of caution and treat the negative line item as a true negative (i.e. negative ba
 Response · If a member votes “Affirm with Negative line item” the negative line item is treated as a comment but the ballot overall is affirmative.· Action Item: This must be added to the Ba
 Comment Revising the ballot spreadsheet to eliminate invalid responses will minimize this issue. Note on the ballot spread

 Difference Between Withdraw and Retract
 If a ballot submitter offers to withdraw the negative line item the ‘negative’ still counts towards the total number of affirmative and negative votes received for the ballot (as it currently seems
 bylaws). If the submitter offers to retract their negative then it does not count towards the overall affirmative and negative votes received for the ballot.




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, or replaced by use cases)


lots returned on unmarked items will be found

etation of “obvious error” as you do not want to

ing content. In the early stages of committee
uire two levels of ballot for new content (refer



       persuasive.· In all cases, the voter must

does not make sense to declare non-persuasive
nce you have adopted their recommended




to vote.· Out of scope items




management tool. Question will be removed.

ive with comment – typonaffirmative with




ws 15.07.03). The TSC Chair will determine




ne item must be reviewed. You can use the
of the affirmative comment and whether or not


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 of the affirmative comment and whether or not




 ust notify the ballotter of this disposition.




whether or not the respondent has withdrawn



 nion as to whether or not Technical

e other ways to review, e.g. send to the
 to a level where the committee could vote on




erbally expressed the intention to withdraw the
 th a note indicating that this is confirmation
hin five (5) days.

nt to HL7 HQ by email or fax.

otes with the negative balloters. The negative




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 the Policies and Procedures as well as
 action and record it in the spreadsheet and in




C? Yes· How should non-substantive changes




owances for “Guideline Not Found”.




m purposes, but does not impede the ballot,
g. it does not count as a negative in the 90%
er to get the ballot to pass, while producing a




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 true negative (i.e. negative ballot).
 This must be added to the Ballot Instruction



he ballot (as it currently seems to state in the




                55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Co-Chair Guidelines]               386                    March 2003
                                                             V3 Ballot Submission/Resolution Form




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Co-Chair Guidelines]               387                    March 2003
Ballot Committee Code   Ballot Committee Name Ballot Code Name

InM                     Infrastructure and      CT
                        Messaging               XML-ITS DataTypes

                                                XML-ITS Structures

                                                Datatypes Abstract
                                                MT
                                                TRANSPORT
                                                UML-ITS DataTypes

                                                CI, AI, QI
                                                MI

CBCC                    Community Based         MR
                        Collaborative Care


CDS                     Clinical Decision Support DS

CS                      Clinical Statement      CS

FM                      Financial Management    AB
                                                CO
                                                CR

II                      Imaging Integration     DI
                                                II

M and M                 Modelling and           RIM
                        Methodology             Refinement
                                                CPP
                                                MIF
                                                HDF

MedRec                  Medical Records (now    MR
                        merged with SD)

OO                      Orders and Observations BB
                                                CG
                                                CP
                                                LB
                                                ME
                                                OB
                                                OR
                                                RX
                                                SP
                                      TD


PA           Patient Administration   PA
                                      MM
                                      SC

PC           Patient Care             PC

PM           Personnel Management     PM

PHER         Public Health /          IZ
             Emergency Response       PH
                                      RR

Publishing   Publishing               V3 Help Guide (ref)
                                      Backbone (ref)

RCRIM        Regulated Clinical Research Information Management
                                      RP
                                      RT

Sched        Scheduling               SC

StructDocs   Structured Documents     CD
                                      QM

Vocab        Vocabulary               Vocabulary (ref)
                                      Glossary (ref)

ArB          Architectural Review Board
Attach       Attachments
CCOW         Clinical Context Object Workgroup
Ed           Education
Meaning

Version 3: (CMET) Common Message Elements, Release 1, 2, 3
Version 3: XML Implementation Technology Specification - Data Types, Release
1
Version 3: XML Implementation Technology Specification - Structures, Release 1

Version 3: Data Types - Abstract Specification, Release 1
Version 3: Shared Messages, Release 1, 2
Version 3: Transport Protocols
Version 3: UML Implementation Technology Specification - Data Types, Release
1
Version 3: Infrastructure Management, Release 1
Version 3: Master File/Registry Infrastructure, Release 1

Version 3: Medical Records: Composite Privacy Consent Directive, Release 1


Version 3: Clinical Decision Support, Release 1

Version 3: Clinical Statement Pattern, Release 1

Version 3: Accounting and Billing, Release 1,2
Version 3: Coverage, Release 1 (virtual CMET domain)
Version 3: Claims and Reimbursement, Release 1, 2, 3, 4

Version 3: Diagnostic Imaging, Release 1
Version 3: Imaging Integration, Release 1

Version 3: Reference Information Model, Release 1, 2
Version 3: Refinement, Extensibility and Conformance, Release 1, 2
Version 3: Core Principles and Properties
Version 3: Model Interchange Format
Version 3: HL7 Development Framework, Release 1

Version 3: Medical Records, Release 1, 2


Version 3: Blood Tissue Organ, Release 1
Version 3: Clinical Genomics, Release 1
Version 3: Common Product Model, Release 1
Version 3: Laboratory, Release 1
Version 3: Medication, Release 1
Version 3: Observations, Release 1
Version 3: Orders, Release 1
Version 3: Pharmacy, Release 1
Version 3: Specimen, Release 1
Version 3: Therapeutic Devices, Release 1


Version 3: Patient Administration, Release 1, 2
Version 3: Material Management, Release 1
Version 3: Scheduling, Release 1

Version 3: Care Provision, Release 1

Version 3: Personnel Management, Release 1

Version 3: Immunization, Release 1
Version 3: Public Health, Release 1
Version 3: Regulated Reporting, Release 1

Version 3: Guide
Version 3: Backbone

Version 3: Regulated Products, Release 1
Version 3: Regulated Studies, Release 1

Version 3: Scheduling, Release 1, 2

Version 3: Clinical Document Architecture, Release 1, 2
Version 3: Quality Measures, Release 1

Version 3: Vocabulary
Version 3: Glossary
Type of Document

Domain

Foundation

Foundation
Foundation
Domain
Foundations

Foundation
Domains
Domain



Domain

Domain

Domain

Domain
Domain
Domain

Domain
Domain

Foundation
Foundation
Foundation
Foundation
Foundation



Domain

Domain
Domain
Domain
Domain
Domain
Domain
Domain
Domain
Domain
Domain



Domain
Domain
Domain

Domain

Domain

Domain
Domain
Domain

Reference
Reference

Domain
Domain

Domain

Domain
Domain

Foundation
Reference
                                                            V3 Ballot Submission/Resolution Form

This page reserved for HL7 HQ. DO NOT EDIT.




                      Affirmative Negative



If you submit an overall affirmative vote, please make sure you have not included negative line items on the Ballot worksheet
Please be sure that your overall negative vote has supporting negative comments with explanations on the Ballot worksheet
You have indicated that you will be attending the Working Group Meeting and that you would like to discuss at least one of your comments with the responsible Committee during that time. Ple




Yes                   No


                                                                              Consi Consi            Pendi Pendi
                                                                              dered - dered -        ng      ng
                                                                     Consider No      Questi         input input
                                                                     ed for   action on              from from
                      Persuasive Not      Not persuasive     Not     future   requir Answe           submit other
Persuasive            with mod persuasive with mod           related use      ed      red            ter     WG
                                                                                              Referred and tracked

HD
AR
RM
IN
TE
MT
DM
ST
??




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Setup]                                      394                                                                          March 2003
                                                   V3 Ballot Submission/Resolution Form

                                                        ArB,Ard
                                                        en,Attac
                                                        h,Cardio
                                                        ,CBCC,
                                                        CCOW,
                                                        CDS,CG
                                                        ,CIC,Clin
                                                        ical
                                                        Stateme
                                                        nt,Confo
                                                        rm,Ed,E
                                                        HR,FM,II
                                                        ,Implem
                                                        entation,
                                                        InM,ITS,
                                                        Lab,M
                                                        and M,M
                                                        and M/
                                                        CMETs,
                                                        M and
                                                        M/
                                                        Templat
                                                        es,M
                                                        and M/
                                                        Tooling,
                                                        MedRec,
                                                        OO,PA,
                                                        PC,PHE
                                                        R,PM,P
                                                        S,PSC,
                                                        RCRIM,
                                                        RX,Sche
                                                        d,Securit




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Setup]                    395                   March 2003
                                                                           V3 Ballot Submission/Resolution Form




Committee during that time. Please note that due to time constraints not all comments can be reviewed at WGMs and that it is your responsibility to find out when this ballot comment can be scheduled for dis




              55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Setup]                                      396                                                                             March 2003
                                                   V3 Ballot Submission/Resolution Form




55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Setup]                   397                    March 2003
                                                                V3 Ballot Submission/Resolution Form




omment can be scheduled for discussion.




             55e7beb1-36c4-4a89-b8f8-a319f05b8a53.xls [Setup]                   398                    March 2003

				
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