Release 4 R5 Final QA

This page is part of the FHIR Specification (v4.0.1: R4 (v5.0.0-draft-final: Final QA Preview for R5 - Mixed Normative and STU see ballot notes ) in it's permanent home (it will always be available at this URL). ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

4.4.1.391 7.18.3 Value Set http://hl7.org/fhir/ValueSet/substance-category Clinical Document Architecture (CDA)

  Title: Substance Category Codes Definition:
Orders and Observations FHIR Infrastructure icon Work Group Maturity Level : 2 N/A Trial Use Use Context Standards Status : Any This is a value set defined at http://www.hl7.org/Special/committees/orders/index.cfm . Summary Defining URL: http://hl7.org/fhir/ValueSet/substance-category Version: 4.0.1 Name: Informative SubstanceCategoryCodes

Substance category codes Committee: Orders and Observations CDA icon Work Group OID: 2.16.840.1.113883.4.642.3.476 (for OID based terminology systems) Source Resource is HL7's most widely adopted HL7 v3 icon XML / JSON standard. It provides both a standardized header containing metadata about the document as well as the ability to convey a wide variety of clinical content organized into various sections. The document content can be un-encoded, such as a PDF, through to a fully encoded HL7 v3 instance.

This value set is NOTE: While FHIR can be used in to create documents using the following places: CodeSystem: This value set is Composition Resource , FHIR can also be used to exchange traditional CDA R2 documents making use of the designated 'entire code system' value set for SubstanceCategoryCodes Resource: Substance.category (CodeableConcept / Extensible ) 4.4.1.391.1 Content Logical Definition DocumentReference This value set includes codes from resource, and handling the following code systems: CDA document itself as a binary attachment (as XDS does).

Include all codes defined in http://terminology.hl7.org/CodeSystem/substance-category   7.18.3.1 4.4.1.391.2 Expansion CDA Similarities and Differences This expansion generated 01 Nov 2019

This value set contains 7 concepts Expansion based Clinical document focus: As its name implies, Clinical Document Architecture is limited to "clinical" use cases. The CDA model does not support exchange of content not deemed to have clinical relevance, such as financial information, and is limited to documents that deal with patients. (In some cases, such as the HL7 Structured Product Labeling standard, non-patient-specific CDA-like specifications are created to get around this limitation.) FHIR documents have no limitation on http://terminology.hl7.org/CodeSystem/substance-category version 4.0.1 their content and can have subjects other than patients.

All codes from system http://terminology.hl7.org/CodeSystem/substance-category Code Display Human readability approach: CDA and FHIR both require that content be human-readable and define specific rules for how the human readable text is presented.

Definition Clinical Statement vs. resources: allergen Allergen A substance that causes an allergic reaction. biological Biological Substance A substance that In CDA, the "content" of the document is produced by or extracted from expressed using a biological source. body Body Substance A substance complex and extremely abstract model based on HL7's "Clinical Statement" project. Its purpose is to allow implementers to express pretty much any clinical concept in any degree of rigor and granularity. (In practice, there are limitations built into the CDA model that comes directly from a human or an animal (e.g. blood, urine, feces, tears, etc.). chemical Chemical Any organic or inorganic substance make the expression of a particular molecular identity, including -- (i) certain clinical concepts challenging). This model provides significant power, but also presents challenges. The first is that RIM modeling expertise is required in order to express any combination particular piece of such substances occurring in whole clinical information. It isn't obvious how to represent things like allergies or surgery or blood pressure "out of the box". Templates are required to support interoperability. The second is that common clinical concepts can be (and frequently are) modeled differently in different circumstances. With FHIR, all clinical (and non-clinical) content in part as a result message is handled by referencing existing resource definitions. These resources make it clear how to represent common structures like allergies and blood pressure "out of a chemical reaction or occurring in nature the box" and (ii) any element or uncombined radical (http://www.epa.gov/opptintr/import-export/pubs/importguide.pdf). food Dietary Substance A food, dietary ingredient, or dietary supplement for human or animal. drug Drug or Medicament A substance intended ensure that there's only one way for use core content to be represented. It does however create the limitation that an appropriate resource must have been defined in order to share content. In the diagnosis, cure, mitigation, treatment, or prevention early stages of disease in man or other animals (Federal Food Drug and Cosmetic Act). material FHIR development, it may be necessary to make use of the Basic Material A finished product which is resource if an appropriate standard resource has not normally ingested, absorbed or injected (e.g. steel, iron, wood, plastic and paper).   yet been defined.

See Templates and Profiles: As discussed above, CDA relies on the full registry of value sets defined as part presence of FHIR. Explanation templates in order to understand the meaning of instances. While the columns meaning can theoretically be determined by looking at RIM attributes and codes, the reality is that may appear on this page: Lvl A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly often not safe or sufficient. As such, pretty much every CDA instance includes templateId attribute values scattered throughout the instance to define meaning. With FHIR, meaning is defined by the resource. Profiles can be used to organize codes for user convenience, define extensions, but may follow code system hierarchy - see Code System they never refine the meaning of core elements. While the profiles used in constructing a particular instance can be declared within the instance via tags such declaration is not required.

Mark-up language: CDA defines its own XML syntax for further information Source The source narrative content, loosely based on HTML. FHIR makes use of the definition a constrained set of XHTML which is somewhat more expressive than the code (when CDA markup. Conversions from FHIR to CDA will need to take these constraints into account (or alternatively provide a fully rendered version of the value set draws in codes defined elsewhere) document).

7.18.3.2 Code CDA Interoperability Considerations

CDA is a type of HL7 v3 icon specification. Therefore, all considerations that apply to v3 messaging also apply to CDA. In addition, the following topics are specific to CDA implementations.

What to map: The code (used right-hand side (clinical content) portion of the CDA model qualifies as an abstract model as discussed above . While the code in CDA header can reasonably be mapped to the HL7 Composition resource instance). If and related resources, mappings between FHIR and CDA should be done at the code is template level rather than the CDA specification itself.

Human readable granularity: With FHIR, narrative only exists for the resources at the root of each section. With CDA, narrative exists for each section. Usually this means the narrative in italics, CDA and FHIR will correspond. However, in some cases, a section will contain other sub-sections. In CDA, these "container" sections can have narrative. In FHIR, they cannot. Applications will need to have some way of managing this indicates that if converting.

Discrete to human-readable linkages: To ensure semantic traceability, both FHIR and CDA allow establishing linkages between text in the code is not selectable ('Abstract') Display The display (used narrative and specific discrete elements in the display element encoded part of a Coding ). document. If there converting between FHIR and CDA, these linkages need to be converted as well. However, this is no display, implementers should not simply display complicated by the code, but map fact that the concept into their application Definition An explanation of granularity at which linkages can occur is different between the meaning two specifications. In CDA, linkages can only occur at the level of a section or one of a couple of the concept Comments Additional notes about how entry types. With FHIR, linkages can occur at any level at all, including individual datatype components or even portions of extensions. Converting from CDA to use FHIR will be straight-forward, however there will be information loss when converting the code other way.