Sistema y plan de ventas (administración)

component — The "component" Act Relationship is used to nest a Section within a Section. Context

propagates to nested sections (see CDA Context (§ 2.3.4 )).

Table 86: Value set for component.typeCode (CNE)

Code Definition

COMP (component) [default] The nested section is a component of the outer section.

entry — The relationship between the Section's narrative (Section.text) and its entries is encoded in the

intervening "entry" Act Relationship.

The narrative of each Section, together with the multimedia content referenced in the narrative, comprises the complete authenticated content of the Section. This multimedia content consists of ObservationMedia and RegionOfInterest entries referenced by <renderMultimedia> tags in the Section.text (see CDA Entry Acts (§ 2.3.3.6 )). This is the only case where the entries contain authenticated content that must be rendered with the narrative.

In terms of the relationship between Entries and narrative, CDA defines one specific and one general case: Specific Entry/Narrative relationship:

Derived from (DRIV): Narrative fully derived from CDA Entries. When a report consisting entirely of structured data is transformed into CDA, the encoding application must ensure that the authenticated content (narrative plus multimedia) is a faithful and complete rendering of the clinical content of the structured source data. This ensures that the narrative plus multimedia represents, as in all CDA

documents, the complete authenticated content of the Section. In this case, narrative plus multimedia does not contain any clinical content that is not present in the Entries. An example of this case is a DICOM

Structured Reporting document of obstetrical measurements made by ultrasound, rendered into a tabular report by a program converting it to CDA narrative block.

The typeCode of the ActRelationship linking these Entries to the Section should be "DRIV" (is derived from). This indicates to a receiving application: 1) the source of the narrative block is the Entries; 2) the contents of the two are equivalent.

There is no linking of any parts of the Section narrative to particular Entries; the set of all Entries with

ActRelationship of typeCode="DRIV" is linked to the Section. The method of derivation may be identified via participants sourced from those Entries.

General Entry/narrative relationship:

Component (COMP): The narrative is the original content. The CDA entries are derived from the narrative, such as coding added by a natural language processing system or a human coder or structured entry tools that output both Entries and a text report. The method of extraction may be indicated by the participants identifying the algorithm or person generating the Entries. This relationship carries no assertion on the equivalence of the Entries and narrative. The typeCode of the ActRelationship linking these Entries to the Section must be "COMP" (component).

A section may also have no narrative content in the case where the entries represent information that is not part of the clinical content of the document. A report may embed information referencing evidence data, reagents, calibration or other information that may be used for later processing but is not part of the clinical content. Such entries are also linked to the Section with ActRelationships possessing typeCode="COMP"

The Entries sourced from a Section may have a mix of ActRelationship typeCodes. For example, a single section may be rendered from a set of Entries (all with ActRelationship typeCode="DRIV") in such a way that the rendering process produced graphical ObservationMedia Entries (all with ActRelationship

typeCode="DRIV"), and from the narrative a set of coded Entries (all with ActRelationship typeCode="COMP") was extracted using a natural language processing algorithm.

The value set for the Section-to-Entry ActRelationship typeCode is defined in the following table.

Table 87: Value set for entry.typeCode (CNE)

Code Definition

COMP (component)

[default] The associated CDA Entry is a component of the section.

DRIV (is derived from) The narrative was rendered from the CDA Entries, and contains _{no clinical content not derived from the entries.}

XML ID/IDREFS Pointers — CDA entries can point in to the <content> element of the CDA Narrative

Block, and the <renderMultiMedia> element of the CDA Narrative Block can point out to CDA entries. The <content> element (see CDA Section Narrative Block (§ 2.3.3.5 )) contains an optional local identifier (represented as an XML ID attribute), serving as the target of a reference. The originalText component of a RIM attribute present in any CDA entry can make explicit reference to the identifier, thereby indicating the original text associated with the attribute in the CDA entry.

Example 5: Referencing into the CDA Narrative Block

<title>Past Medical History</title> <text>

There is a history of <content ID="a1">Asthma</content> </text> <entry> <Observation> <code code="84100007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"

displayName="history taking (procedure)"/> <value xsi:type="CD" code="195967001"

codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Asthma"> <originalText> <reference value="#a1"/> </originalText> </value> </Observation> </entry> </section>

There is no requirement that CDA entries must reference into the CDA Narrative Block. The referencing mechanism can be used where it is important to represent the original text component of a coded CDA entry.

The <renderMultiMedia> element (see CDA Section Narrative Block (§ 2.3.3.5 )) contains a required

referencedObject attribute (represented as an XML IDREFS attribute), the values of which must equal XML ID values of one ObservationMedia or one or more RegionOfInterest CDA entries within the same document. An XML attribute "MMID" (multimedia identifier), of type XML ID, is added to ObservationMedia and

Example 6: Referencing out of the CDA Narrative Block

Erythematous rash, palmar surface, left index finger. <renderMultiMedia referencedObject="MM1"/> </text> <entry> <ObservationMedia MMID="MM1"> <id root="10.23.4567.345"/> <value xsi:type="ED" mediaType="image/jpeg"> <reference value="left_hand_image.jpeg"/> </value> </ObservationMedia> </entry> </section>

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