Companion+Guide+Consensus

Companion Guide Consensus
This page will be used to capture consensus votes on the Companion Guide to Consolidated CDA for Meaningful Use Stage 2. If you are a committed member of the Transitions of Care Initiative, you are encouraged to participate in the consensus process. To have your name added to the list below, please email Russell Ott, rott@deloitte.com.

Comments from consensus voting have been reconciled and addressed in Draft 4 below. A comment resolution matrix detailing actions taken in response to each comment has also been included:
 * Update - October 22, 2012**

detailing changes from Draft 3 resulting from comments received.

Please adjust your consensus vote below as appropriate in response to comments resolved in Draft 4.

The file to be reviewed for consensus purposes is linked below:



Go back to the Companion Guide main page

Consensus Statement
The consensus of the participants listed below is that the Companion Guide to Consolidated CDA for Meaningful Use Stage 2, published in October 2012 and available accurately reflects the discussion and analysis conducted by the SWG between December 2011 and October 2012. Furthermore, after conducting an analysis of MU2 data requirements, it is the consensus of the participants that the recommendations for MU2 implementation contained in the Companion Guide are accurate and ready to use.

Consensus Participants
To add your vote to the table below, edit the page by clicking the "Edit" icon in the upper right hand side of the page. For more information on the S&I Framework consensus process, please reference the S&I Steering and Consensus Process wiki page.
 * A "yes" vote means you agree with the consensus statement.
 * A "yes with comments" vote means you agree with the consensus statement and have relevant comments.
 * A "no" vote means you disagree with the consensus statement. If you vote "no," please indicate a path to address the objection in a way that meets the known concerns of other participants. A "no" vote without such comments will be considered "abstain" votes.
 * An "abstain" vote means that you are declining to vote.

2. It remains unfortunate that no optional comments about other types of allergies, particularly food allergies or other nutrition or related diet statements were included. ||
 * **Name** || **Organization** || **Vote (Yes, No, Abstain)** || **Comments** ||
 * Elaine Ayres || National Institute of Health || yes, with comments || 1. Page 14: "MAY/NEED NOT: truly optional; can be included or omitted as the author decides with no implications." This type of statement for optional inclusion needs to be reworded. The omission of healthcare data may create unintended consequences. Would reword: MAY/NEED NOT: option, can be included or omitted.
 * Ruth Berge || GE Healthcare ||  ||   ||
 * Robin Barnes || AHRQ ||  ||   ||
 * Keith Boone || GE Healthcare ||  ||   ||
 * George Cole || Allscripts || yes, with comments || 1. Concerned about suggestions to use Language codes that, according to Final Rule, are not in the value set.

In particular, from page 28:... For situations where the patient language is unknown or declined to provide, the ability to capture these details is required by the 2014 Ed. CEHRT. Allowable representations include null values (e.g., ASKU) or special codes "undetermined" (UND) or "missing" (MIS) from ISO 639-2....

However, from Final Rule we have: § 170.314(a)(3) (Demographics) Response. We agree with the clarification provided by the HITSC. Accordingly, we are adopting ISO 639-2 constrained by ISO 639-1. This will constrain ISO 639-2 to only the active languages in ISO 639-1, but will permit the use of the alpha-3 codes of ISO 639-2. As such it is a better approach than adopting solely ISO 639-2 or 639-1.

As the special codes for undetermined and missing do not have ISO 639-1 code values it seems that these are not a part of the language value set.

2. from page 25: XML examples are available in the Companion Guide Header XML Examples file it would be useful to consider these examples as a part of the package to be evaluated. Hopefully the examples and snips have no Consolidated CDA valuation errors. ||
 * Denise Downing || AORN - Association of periOperative Registered Nurses ||  ||   ||
 * Mike Fitzmaurice || AHRQ ||  ||   ||
 * Larry Garber, MD || Reliant Medical Group ||  ||   ||
 * Leslie Kelly Hall || Healthwise || yes || As patients VDT their record, important to them will be knowing what things have been implanted during any procedure. In the OP note, this is currently not required. Device name, type and ID will be important to require. ||
 * Emma Jones || Allscripts || Yes, with comments || 1. Care Team members - Need clearer directions on how to define care team members that would cross documents - e.g. In a cardiologist system, the PCP will need to be listed as one of the care team members. However, the abiltiy to do this using HL7 Participation Type need to be clearly explained.

2. Analysis work should have taken into consideration the MU test data. For example, family members are defined as one of the care team members. Need further guidance on how to define this.

3. Need clearer guidance the data that is used for testing capability versus what is needed functionally ( especially data that is provided to a patient at the end of each office visit - less is more).

4. Document contains a lot of copy and paste from Consolidation CDA guide. Would have been good to have more explanations as to why somethings are constructed the way they are and include realistic examples - e.g. the various Procedure activity entry templates used in Plan of Care section.

5. "Date last updated" was discussed in previous calls and have not been addressed in the consensus version of the document. ||
 * Les Keepper || Shape Hitech ||  ||   ||
 * Sri Koka || Techsant Technologies || Yes ||  ||
 * Thom Kuhn || American College of Physicians ||  ||   ||
 * Russell Leftwich, MD || State of Tennessee Office of eHealth || Yes || Where CDA documents are referenced on page 9, would insert a reference to table 1 on page 15 that lists those documents.

Where HITSP C32 and CCD 1.1 are first mentioned on page 10, insert definition war footnote for these previously undefined concepts.

The first paragraph in section 2.2 seems mostly redundant, since the same statements are repeated in subsequent paragraphs.

Would bold the words "document template" at the end of page 12, since this sentence defines the term.

On page 12 would give an example of an entry level template, analogous to the examples given for section level templates on that page.

The paragraph below figure 2 repeats the requirement for human readability which was already stated.

The principles and practice box on page 13 seems out of place, since it's content is not discussed in the adjacent text.

Section 2.4.2 describes CCD on discharge but does not mention why the discharge summary template is not used. Some statement should be made that the template chosen is not the one named "discharge summary", otherwise it appears to be a typo.

The principle and practice box on page 18 seems a poor example, since there would be no logical reason to include a medication list in the operative report or the diagnostic imaging report.

Section 2.4.3 should include an entry-level novel flavor example, such as no known allergy for the allergy list.

Section 3.1.1: the differences in the summaries is. In apparent and a short definition of each summary type should be included.

Leave the discussion of shared team member within a theft from an example or a pointer to an example.

Section 3.5.1 RxNorm is a value set for medications which might cause an allergic reaction, it is not a value set for allergic reactions. The medication allergy list would actually be a list of SNOMED terms with reference to the medication. MU 2 does refer to the Medication Allergy List as a list of medications, but that is not consistent with Consolidated CDA.

Chief complaint is an element of documentation, but not of a summary document and is not synonymous with reason for hospitalization or reason for visit.

Section 5.5 refers to LOI NC version 2.27 or higher, but MU2 specifies version 2.40. This document should not allow for using previous versions.

Section 6.2.6 in discussing MU2 Vocabularies should include a table of the versions of each vocabulary for value set specified in the final rule. And to be most accurate I believe they are SCC 2014 vocabularies, not MU2. || in order to change No to Yes. After reviewing draft 4 and the resolution spreadsheet, I am changing my vote to Yes. ||
 * Ophir Lotan || bMotion Ltd. ||  ||   ||
 * Michael J. McCoy, MD || IHE PCC, ACOG, Catholic Health East || Yes ||  ||
 * Holly Miller, MD || MedAllies || Yes || Agree that David Tao's comments need to be resolved ||
 * Bebet Navia || NJ Health Information Technology Extension Center || Yes || The Companion Guide was very well written and organized in a way that I am able to follow the flow of information and most especially understand the concepts being conveyed. ||
 * Terry O'Malley, MD || Partners Healthcare ||  ||   ||
 * Sandra Robinson || Tennessee Association for Home Care ||  ||   ||
 * Sandy Stuart || Kaiser Permanente ||  ||   ||
 * David Tao || Siemens (thru 9/30/2012; now unaffiliated) || Yes || I suggest the **bold** comments in this link be resolved
 * Cyndalynn Tilley || Intermountain Healthcare/GE Healthcare ||  ||   ||
 * Dante Ventresca || OhioHealth Information Services || Yes ||  ||