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HITSP C83 CDA and CCD Content Module Component V 1.0


Type:Data Agreement
Start Date:2008-12-18
Scope:This section describes the contents of this specification and provides a high level definition of this Component and background information about the underlying standards that the Component is based on.
The purpose of the HITSP CDA and CCD Content Modules Component is to define the Content Modules for document based HITSP constructs utilizing clinical information. These Content Modules are based on IHE PCC Technical Framework Volume II, Release 4. That Technical Framework contains specifications for document sections that are consistent with all implementation guides for clinical documents currently selected for HITSP constructs.
Each HITSP Interoperability Specification (IS) is comprised of a suite of constructs that, taken as a whole, define how to integrate and constrain existing standards and specifications that will satisfy the requirements imposed by a given Use Case. The IS groups specific actions and actors to describe the relevant contexts using HITSP constructs that further identify and constrain standards where necessary. There are four types of HITSP constructs called Interoperability Specifications (IS), Transaction Packages (TP), Transactions (T), and Components (C). The current HITSP CDA and CCD Content Modules Component specification is used with other constructs to meet the requirements of one or more ISs. Review Section 1.2 Interoperability Specification Document Map from the relevant IS to better understand the context, dependenciesTwo types of Content Modules are specified, they are:
1.Entry Content Modules - a collection of Data Elements pertaining to a single instance of the specified concept. For example, the Allergy/Drug Sensitivity Entry Module describes all the Data Elements for one allergy.
2.Section Content Modules - a collection Entries pertaining to a single specified concept. For example, the Allergies and Other Adverse Reactions Section can contain a list of allergies (multiple Entry Content Modules). Section Content Modules are typically selected from specifications created by SDOs, such as CCD, HL7 Implementation Guides, and IHE Integration Profiles. In order to synchronize the sections, certain template IDs have changed from the previous IDs specified in HITSP/C32. Template ID changes also may have been needed in order to harmonize previously existing HITSP CDA based constructs.
This new Component harmonizes the requirements for document sections that previously existed in the HITSP/C28 Emergency Care Summary Document Using IHE Emergency Department Encounter Summary (EDES), HITSP/C32 - Summary Documents Using HL7 Continuity of Care Document (CCD), HITSP/C38 - Patient Level Quality Data Document Using IHE Medical Summary (XDS-MS) and HITSP/C48 Encounter Document constructs, and in new constructs such as HITSP/C84 Consult and History & Physical Note Document and HITSP/C78 Immunization Document..
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Relationship Organization Item
references HITSP HITSP C84 Consult and History & Physical Note Component Compare these items   
Relationship Organization Item
is composed of HITSP 8.36 Location   
is composed of HITSP Administered Date   
is composed of HITSP Administration Timing   
references HITSP Advance Directive Free Text Type   
references HITSP Advance Directive Type   
is composed of HITSP Adverse Event Date   
is composed of HITSP Adverse Event Type   
is composed of HITSP Age (at Death)   
is composed of HITSP Age (at Onset)   
is composed of HITSP Allergy/Drug Sensitivity Product   
references HITSP Author Name   
references HITSP Author Time   
is composed of HITSP Cause of Death   
is composed of HITSP Coded Brand Name   
is composed of HITSP Contact Address   
references HITSP Contact Name   
references HITSP Contact Phone/Email/URL   
references HITSP Contact Relationship   
references HITSP Contact Type   
references HITSP Custodian of the Document   
references HITSP Date   
references HITSP Date Range   
is composed of HITSP Delivery Method   
is composed of HITSP Dispense Date   
is composed of HITSP Document Timestamp   
is composed of HITSP Dose   
is composed of HITSP Dose Indicator   
is composed of HITSP Dose Restriction   
is composed of HITSP Drug Manufacturer   
is composed of HITSP Duration   
references HITSP Effective Date   
is composed of HITSP Effective Date of Financial Responsibility   
is composed of HITSP Encounter Date/Time   
is composed of HITSP Encounter Free Text Type   
is composed of HITSP Encounter ID   
is composed of HITSP Encounter Provider   
is composed of HITSP Encounter Type   
is composed of HITSP Ethnicity   
is composed of HITSP Ethnicity   
references HITSP Family Member Biological Sex   
references HITSP Family Member Condition   
is composed of HITSP Family Member Date of Birth   
is composed of HITSP Family Member Demographics   
is composed of HITSP Family Member Ethnicity   
is composed of HITSP Family Member Genetic Test Code   
is composed of HITSP Family Member Genetic Test Date   
is composed of HITSP Family Member Genetic Test Information   
is composed of HITSP Family Member Genetic Test Name   
is composed of HITSP Family Member Genetic Test Result   
is composed of HITSP Family Member Identifier   
is composed of HITSP Family Member Information   
is composed of HITSP Family Member Medical History   
is composed of HITSP Family Member Multiple Birth Status   
is composed of HITSP Family Member Name   
is composed of HITSP Family Member Race   
references HITSP Family Member Relationship   
is composed of HITSP Family Member Relationship (to other family member)   
is composed of HITSP Family Member Relationship (to patient)   
is composed of HITSP Family Member Relationship Free Text   
is composed of HITSP Fill number   
is composed of HITSP Fill Status   
is composed of HITSP Fills   
is composed of HITSP Financial Responsibility Party Name   
references HITSP Financial Responsibility Party Phone/Email/URL   
is composed of HITSP Financial Responsibility Party Type   
is composed of HITSP Free Text Brand Name   
is composed of HITSP Free Text Product Name   
is composed of HITSP Free Text Sig   
is composed of HITSP Frequency   
is composed of HITSP Fulfillment History   
is composed of HITSP Fulfillment Instructions   
is composed of HITSP Gender   
is composed of HITSP Group Number   
is composed of HITSP Health Insurance Type   
is composed of HITSP Health Plan Coverage Dates   
is composed of HITSP Health Plan Insurance Information Source Address   
is composed of HITSP Health Plan Insurance Information Source ID   
is composed of HITSP Health Plan Insurance Information Source Name   
is composed of HITSP Health Plan Name   
is composed of HITSP Immunization Section   
is composed of HITSP Indicate Medication Stopped   
is composed of HITSP Indication   
references HITSP Information Source Name   
is composed of HITSP Interval   
is composed of HITSP Language   
is composed of HITSP Lot Number   
is composed of HITSP Marital Status   
contains HITSP Medical Equipment   
is composed of HITSP Medication Series Number   
is composed of HITSP Member ID   
is composed of HITSP Order Date/Time   
contains HITSP Order Expiration Date/Time   
is composed of HITSP Order Number   
is composed of HITSP Ordering Provider   
is composed of HITSP Patient Address   
is composed of HITSP Patient Date of Birth   
is composed of HITSP Patient Instructions   
is composed of HITSP Patient Name   
is composed of HITSP Patient Phone/Email/URL   
is composed of HITSP Patient Relationship to Subscriber   
is composed of HITSP Pedigree   
is composed of HITSP Performer   
is composed of HITSP Person Address   
is composed of HITSP Person Date of Birth   
is composed of HITSP Person ID   
is composed of HITSP Person Name   
is composed of HITSP Person Phone/Email/URL   
is composed of HITSP Pregnancy   
is composed of HITSP Prescription Number   
is composed of HITSP Problem Code   
is composed of HITSP Problem Date   
is composed of HITSP Problem Event Entry   
is composed of HITSP Problem Name   
is composed of HITSP Problem Type   
references HITSP Procedure Date / Time   
references HITSP Procedure ID   
references HITSP Procedure Provider   
references HITSP Procedure Type   
references HITSP Product Coded   
is composed of HITSP Product Concentration   
is composed of HITSP Product Form   
is composed of HITSP Product Free-Text   
references HITSP Provider Address   
references HITSP Provider Name   
references HITSP Provider Phone Email URL   
references HITSP Provider Role Coded   
references HITSP Provider Role Free Text   
references HITSP Provider Type   
references HITSP ProviderĀ“s Organization Name   
references HITSP ProviderĀ“s Patient ID   
is composed of HITSP Quantity Dispensed   
is composed of HITSP Quantity Ordered   
is composed of HITSP Race   
is composed of HITSP Reaction   
is composed of HITSP Reaction Coded   
references HITSP Reaction Free-Text   
references HITSP Reference   
references HITSP Reference Document ID   
references HITSP Reference Document URL   
is composed of HITSP Refusal   
is composed of HITSP Refusal Reason   
is composed of HITSP Religious Affiliation   
is composed of HITSP Result Date/Time   
contains HITSP Result ID   
is composed of HITSP Result Interpretation   
is composed of HITSP Result Reference Range   
is composed of HITSP Result Status   
is composed of HITSP Result Value   
is composed of HITSP Route   
is composed of HITSP Severity Coded   
is composed of HITSP Severity Free-Text   
is composed of HITSP Site   
is composed of HITSP Social History Date   
is composed of HITSP Social History Free Text   
is composed of HITSP Social History Observed Value   
is composed of HITSP Social History Type   
is composed of HITSP Status of Medication   
is composed of HITSP Subscriber Address   
is composed of HITSP Subscriber Date of Birth   
is composed of HITSP Subscriber ID   
is composed of HITSP Subscriber Name   
is composed of HITSP Subscriber Phone/Email/URL   
is composed of HITSP Treating Provider   
is composed of HITSP Type of Medication   
Is composed of HITSP Vehicle   
references HITSP Vital Sign Result   
Relationship Organization Item
is composed of HITSP List of Surgeries Section   
is composed of HITSP Payer Section   
Relationship Organization Item
is composed of HITSP ENTRY CONTENT MODULES   
is composed of HITSP SECTION CONTENT MODULES   
Relationship Organization Item
references HITSP IHE Technical Framework   
Relationship Organization Item
is composed of HITSP Administrative Gender V2_VD   
is composed of HITSP Administrative Gender V3 _VD   
is composed of HITSP Admission Source_VD   
is composed of HITSP Advance Directive Type_VD   
is composed of HITSP Allergies/Adverse Event (Reaction)_VD   
is composed of HITSP Allergy/Adverse Event Product_VD   
is composed of HITSP Allergy/Adverse Event Severity_VD   
is composed of HITSP Allergy/Adverse Event Type_VD   
is composed of HITSP Body Site_VD   
is composed of HITSP Contact Type_VD   
is composed of HITSP ContactRelationship_VD   
is composed of HITSP Country_VD   
is composed of HITSP Diagnosis Priority_VD   
is composed of HITSP Diagnosis Type_VD   
is composed of HITSP Discharge Disposition_VD   
is composed of HITSP Document Class_VD   
is composed of HITSP Document Type_VD   
is composed of HITSP Encounter Type_VD   
is composed of HITSP Ethnicity_VD2   
is composed of HITSP Family Relation Type_VD   
is composed of HITSP Financially Responsible Party Type_VD   
is composed of HITSP Functional Assessment   
is composed of HITSP Gene Names_VD   
is composed of HITSP Genetic Disease_VD   
is composed of HITSP Genetic Reference Sequences_VD   
is composed of HITSP Genetic Sequence Variations_VD   
is composed of HITSP Genetic Test Result Identifiers_VD   
is composed of HITSP Genetic Test Result Values_VD   
is composed of HITSP Health Insurance Type_VD   
is composed of HITSP Immunization Information Source_VD   
is composed of HITSP Immunization Services Funding Eligibility_VD   
is composed of HITSP Laboratory Observations_VD   
is composed of HITSP Laboratory Order   
is composed of HITSP Laboratory Test Results_VD   
is composed of HITSP Language Ability Mode_VD   
is composed of HITSP Language_VD   
is composed of HITSP Marital Status V2 _VD   
is composed of HITSP Marital Status V3_VD   
is composed of HITSP Medication Brand Name_VD   
is composed of HITSP Medication Clinical Drug Names_VD   
is composed of HITSP Medication Drug Class Names_VD   
is composed of HITSP Medication Fill Status_VD   
is composed of HITSP Medication Indication_VD   
is composed of HITSP Medication Ingredient Name_VD   
is composed of HITSP Medication Packaged Product Names_VD   
is composed of HITSP Medication Product Form_VD   
is composed of HITSP Medication Route HL7 V2_VD   
is composed of HITSP Medication Route_FDA _VD   
is composed of HITSP Medication Site_VD   
is composed of HITSP Medication Type_VD   
is composed of HITSP Medication Vehicle_VD   
is composed of HITSP MedicationStatus_VD   
is composed of HITSP MedicationType_VD   
is composed of HITSP No Immunization Reason_VD   
is composed of HITSP Nursing Diagnoses_VD   
is composed of HITSP ObservationInterpretation_VD   
is composed of HITSP Patient Class V2 _VD   
is composed of HITSP Patient Class V3 _VD   
is composed of HITSP Personal Relationship_VD   
is composed of HITSP Postal Code_VD   
is composed of HITSP Practice Setting_VD   
is composed of HITSP Problem Severity_VD   
is composed of HITSP Problem Type_VD   
is composed of HITSP ProblemType_VD2   
is composed of HITSP Problem_VD   
is composed of HITSP Procedures_VD   
is composed of HITSP Provider Role_VD2   
is composed of HITSP Provider Type_VD2   
is composed of HITSP Race_VD2   
is composed of HITSP ReligiousAffiliation_VD2   
is composed of HITSP Result Normalcy Status V3_VD   
is composed of HITSP Result Status V3_VD   
is composed of HITSP Results Normalcy Status V2.5_VD   
is composed of HITSP Results Status V2.5_VD   
is composed of HITSP RouteOfAdministration_VD   
is composed of HITSP Social History Type_VD   
is composed of HITSP State_VD   
is composed of HITSP Subscriber Relationship_VD   
is composed of HITSP Units of Measure_VD   
is composed of HITSP Vaccine Administered_VD   
is composed of HITSP Vaccine Manufacturer_VD   
is composed of HITSP Vital Signs Result Type_VD   
HITSP Acronyms List
HITSP Harmonization Framework
HITSP Interoperability Specification Overview
HITSP TN 901 -Technical Note for Clinical Documents
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