Linking+Narrative+to+Entries

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** __NOTE__: The SDWG decided on 3/24 that the narrative-entry link is a SHOULD.**

=__Initial Discussion__= IHE requires entry text to be linked to the narrative block.

See [|IHE PCC 6.3.4.2] Linking Narrative and Coded Entries

Also see figure to the right.

During the 2/22 the Harmonization work group discussed relaxing this constraint, but decided against until further input from IHE PCC was provided.

On the 3/1 Harmonization work group, the discussion continued without a decision on this constraint.

Below is a summary of the conversation from 3/1.


 * SHALL include narrative-entry link:**
 * Various entries need to incorporate text that is available in the narrative; duplicating text in both places is potential for errors
 * Discussed in SDWG and is allowed in CCD
 * Application pointers are straight forward and easy to implement
 * Link guarantees what physician sees in narrative is what they are signing
 * In case where narrative is not DeRIVed from entries, there is no other method to associate the narrative with the specific entry
 * Relax narrative-entry link**
 * Discussed in SDWG and agreed to not require in CCD
 * All of these pointers are a significant barrier to implementation
 * Recommendation – remove pointers (nationwide)
 * Every implementer faces a significant challenge (cost)
 * Implementers are adding pointers, without valid reference, to pass validation
 * Additional comments**
 * Implementer request for more guidance on narrative text structure
 * Validity of link pointing to text can be validated, proper content cannot
 * If narrative block is a derived relationship from entries, no linking is required

=Consensus Round on Scope Determination= //** Scope Determination **// //If option C, please provide specific scenario For SHALL vs SHOULD//
 * Background:** The Consolidation Work group discussed the requirement to link Coded Entries to Narrative Block and various proposals to modify that requirement. Linking Narrative and Coded Entries is a US Realm requirement drawn from [|IHE PCC 6.3.4.2], adopted by HITSP, and included in the C32 'stack' via C83.
 * Question:** Should the link from narrative to entry be relaxed from SHALL to SHOULD?
 * Options:**
 * A. Yes - Update relevant requirements to SHOULD
 * B. No - Keep link as SHALL
 * C. Depends

//** Consensus Votes **// Center for Healthcare Information Research and Policy (CHIRP) ||=  ||   || See comment on parent page || Prevention and Health Promotion ||=  ||   || (SEMHIE) and Henry Ford Health System ||=  ||   ||
 * __**Name**__ || __**Organization**__ ||< __**Choice**__ || __**Comments**__ ||
 * John Quinn || Accenture ||=  ||   ||
 * Robin Barnes || AHRQ/USHIK ||=  ||   ||
 * Emma Jones || Allscripts ||=  ||   ||
 * Thomson Kuhn || American College of Physicians (ACP) ||= A ||  ||
 * Seonho Kim || ApeniMED (formerly MEDNET) ||=  ||   ||
 * Greg Chittim || Arcadia Solutions ||=  ||   ||
 * Jack Corley || ATI ||= A || Yes - Update to SHOULD. ||
 * Lin Wan || Axolotl Corp. ||=  ||   ||
 * Coletta Dorado || AZZLY ||=  ||   ||
 * Bob Beckley || Beth Israel Deaconess Medical Center ||= A || Yes - Update relevant requirements to SHOULD. ||
 * Jim McKinley || Blue Cross and Blue Shield of Alabama ||=  ||   ||
 * Durwin Day || Blue Cross and Blue Shield of Illinois ||=  ||   ||
 * Carl Ahmed || CA (Carl Ahmed) Associates ||=  ||   ||
 * Landen Bain || CDISC ||=  ||   ||
 * Gaby Jewell || Cerner ||=  ||   ||
 * Greg Turner || CGI Federal ||=  ||   ||
 * John Paganini || Cleveland Clinic ||=  ||   ||
 * Justin Austin || Clopton Clinic ||=  ||   ||
 * Dr. Thomas Stevenson || Covisint ||=  ||   ||
 * David Parker, MD || Department of Defense/Evolvent Technologies ||=  ||   ||
 * Tom Dawson || Dispersive Medical ||=  ||   ||
 * Dave Parker || DoD/Evolvent ||=  ||   ||
 * Stephen Hufnagel || DoD Military Health System ||=  ||   ||
 * Elliot B. Sloane, PhD || Drexel University /
 * Vassil Peytchev || Epic ||= C || SHALL for DRIV narrative, and for others (on section by section basis). For example, medication entries need to have a SHALL requirement, regardless of DRIV or COMP relationship between narrative and entries. ||
 * Chirag Bhatt || FEI Systems on behalf of SAMHSA ||=  ||   ||
 * Tony Calice || FEI Systems on behalf of SAMHSA ||=  ||   ||
 * Sarah Sugarman || First Insight Corporation ||=  ||   ||
 * John B. Williams || Garden State Health Systems Inc / Health-ISP.com ||=  ||   ||
 * Harry Solomon || GE Healthcare ||= C || SHALL for DRIV narrative, SHOULD otherwise
 * Rob Allen || Gensa Corporation ||=  ||   ||
 * Johnathan Samples || Greenway ||=  ||   ||
 * Susan Johnston || GSI Health ||=  ||   ||
 * Anil Luthra || Guidewire Architecture ||=  ||   ||
 * Larry Sampson || Health Partners ||=  ||   ||
 * Lindsey Hoggle || Health Project Partners, LLC ||=  ||   ||
 * Leslie Kelly Hall || Healthwise ||=  ||   ||
 * Anna Poker || HHS/HRSA ||=  ||   ||
 * Louise V. Fryer, RN, MS, PMP || Highmark Blue Cross Blue Shield ||=  ||   ||
 * Penny Probst || Highmark Blue Cross Blue Shield ||=  ||   ||
 * Andy Spooner || HL7 Child Health Workgroup ||=  ||   ||
 * Noam Arzt || HLN Consulting ||=  ||   ||
 * Keith W. Boone || IHE PCC ||= B ||  ||
 * Michael J. McCoy, MD || IHE PCC, ACOG, Catholic Health East ||=  ||   ||
 * John Donnelly || IntePro Solutions ||= A ||  ||
 * Srinivas Velamuri || Iowa Foundation for Medical Care (IFMC) ||=  ||   ||
 * Sandra Stuart || Kaiser Permanente ||=  ||   ||
 * Scott Robinson || Kaiser Permanente ||=  ||   ||
 * Sajid Ahmed || L.A. Care Health Plan -- HITEC-LA ||=  ||   ||
 * Lisa Nelson || LOTS, LLC ||= B || I believe the CDA *core principle* of *Potential to be authenticated* would be violated without this requirement as a SHALL. ||
 * Al Manint || Louisiana Health Care Quality Forum ||= A ||  ||
 * Corey Spears || McKesson ||=  ||   ||
 * David Heaney || McKesson ||=  ||   ||
 * Vasu Iyengar || MedAZ.net, LLC ||=  ||   ||
 * Laura Bryan || MedEDocs ||=  ||   ||
 * Eric Heflin || Medicity ||=  ||   ||
 * V. Juggy Jagannathan || MedQuist, Inc ||=  ||   ||
 * Fred Buhr || Metasteward LLC ||=  ||   ||
 * Paul Edge || Microsoft Corp ||=  ||   ||
 * Stanley Nachimson || Nachimson Advisors, LLC ||=  ||   ||
 * Akaki Lekiachvili || National Center for Chronic Disease
 * Tom Foley || NextEnt, LLC ||=  ||   ||
 * Laura Bright || NexJ Systems ||=  ||   ||
 * Nathalie Hartert || Office of eHealth Initiatives, State of Tennessee ||=  ||   ||
 * K. D. Pool, MD || OZ Systems, Inc. ||=  ||   ||
 * Brock Morris || Pediatric Associates Inc. P.S. ||=  ||   ||
 * Chris Melo || Philips Healthcare ||=  ||   ||
 * Thomas McMennamin || Practice Fusion ||=  ||   ||
 * Teresa M. Mota, BSN, RN, CALA || Quality Partners of Rhode Island ||=  ||   ||
 * Ken McCaslin || QuestDiagnostics, Inc. ||=  ||   ||
 * Freida Hall || QuestDiagnostics, Inc. ||=  ||   ||
 * Chris Carr || Radiological Society of North America (RSNA) ||=  ||   ||
 * Gary Christensen || Rhode Island Quality Institute ||=  ||   ||
 * Charles Hewitt || Rhode Island Quality Institute ||=  ||   ||
 * Paula Mossaides || SAIC ||=  ||   ||
 * Wendy Scharber || Registry Widgets, Inc. ||= A ||  ||
 * Lester Keeper Jr. || Secure Hitech LLC ||=  ||   ||
 * Ernest Grove || Secure Hitech LLC ||=  ||   ||
 * Sherry Selover || Selover Company ||=  ||   ||
 * Didi Davis || Serendipity Health, LLC ||=  ||   ||
 * Lawrence McKnight || Siemens Healthcare ||= C || 'SHALL if the entry relationship is "COMP".' (No explicit linkage required if entry relationship is 'DRIV') (see section 4.3.4.2 of CDAr2) ||
 * Tom Davidson || Social Security Administration ||=  ||   ||
 * Marty Prahl || Social Security Administration ||=  ||   ||
 * Dave Katz || Social Security Administration ||=  ||   ||
 * Michael Tyburski || Social Security Administration ||=  ||   ||
 * Mike Lomangino || Social Security Administration ||=  ||   ||
 * Helen Hill || South East Michigan Health Information Exchange
 * Mick Talley || Southeast Michigan HIE ||=  ||   ||
 * Kris Hardy || Sypherlink ||= A ||  ||
 * Mark T. Palen, PMP, CPHIMS || System Administrative Services, L.L.C. ||=  ||   ||
 * Camilo Barcenas || The Barcenas Group, Inc ||=  ||   ||
 * Tory Berger || TJB Consulting ||=  ||   ||
 * Philip DePalo || Towson University ||=  ||   ||
 * Yeong-Tae Song || Towson University ||=  ||   ||
 * Arturo Sanchez || U. of North Florida - School of Computing ||=  ||   ||
 * Marie Swall || VA ||=  ||   ||
 * Dave Carlson || VA ||=  ||   ||
 * Peter Gilbert || Wayne State University Physician Group ||=  ||   ||
 * Theresa (Terry) M. Hearn || WellPoint ||=  ||   ||
 * Michael Meyer || WellPoint ||=  ||   ||
 * Rick Geimer || Lantana Consulting Group ||= A ||  ||
 * Bob Dolin || Lantana Consulting Group ||= A ||  ||