Validation Results for CCDA

Generated Thu Dec 19 01:05:57 UTC 2024, FHIR version 5.0.0 for hl7.cda.us.ccda#4.0.0-ballot (canonical = http://hl7.org/cda/us/ccda (history)). See Full QA Report

Quality Checks
Publisher Version:	IG Publisher Version: v1.8.3
Publication Code:	n/a . PackageId = hl7.cda.us.ccda, Canonical = http://hl7.org/cda/us/ccda
Realm Check for n/a:	n/a
Language Info:	This IG has no language information
Publication Request:	package-id hl7.cda.us.ccda version 4.0.0-ballot path http://hl7.org/cda/us/ccda/2025Jan Pub-Mode working release status ballot Release-Label STU4 Ballot Sequence (Group) CCDA 4.0 (current: 'CCDA 3.0', others = 'CCDA 2.1') desc First balloted version of C-CDA 4.0. This release enables exchange of USCDI v5. Proposed path for this publication should usually be the canonical with the version or sequence appended and then some kind of label (typically '-snapshot')
Supressed Messages:	113 Suppressed Issues
Dependency Checks:	Package Version FHIR Canonical Web Base Comment hl7.cda.us.ccda 4.0.0-ballot R5 http://hl7.org/cda/us/ccda hl7.terminology.r5 6.1.0 M R5 http://terminology.hl7.org http://terminology.hl7.org/6.1.0 hl7.fhir.uv.extensions.r5 5.1.0 M R5 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.1.0 hl7.cda.uv.core 2.0.1-sd M R5 http://hl7.org/cda/stds/core http://hl7.org/cda/stds/core/2.0.1-sd hl7.fhir.uv.extensions.r5 5.1.0 M R5 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.1.0 see above hl7.terminology 5.2.0 O R4 http://terminology.hl7.org http://terminology.hl7.org/5.2.0 FHIR Version Mismatch. Latest Release is 6.1.0 hl7.fhir.uv.extensions.r4 1.0.0 O R4 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/1.0.0 FHIR Version Mismatch. Latest Release is 5.1.0 us.nlm.vsac 0.21.0 M R4 http://fhir.org/packages/us.nlm.vsac http://fhir.org/packages/us.nlm.vsac FHIR Version Mismatch us.cdc.phinvads 0.12.0 M R4 http://fhir.org/packages/us.cdc.phinvads http://fhir.org/packages/us.cdc.phinvads FHIR Version Mismatch hl7.fhir.us.core 8.0.0-ballot I R4 http://hl7.org/fhir/us/core http://hl7.org/fhir/us/core/2025Jan FHIR Version Mismatch hl7.terminology.r4 6.1.0 M R4 http://terminology.hl7.org http://terminology.hl7.org/6.1.0 FHIR Version Mismatch hl7.fhir.uv.smart-app-launch 2.0.0 O R4 http://hl7.org/fhir/smart-app-launch http://hl7.org/fhir/smart-app-launch/STU2 FHIR Version Mismatch. Latest Release is 2.2.0 us.nlm.vsac 0.21.0 M R4 http://fhir.org/packages/us.nlm.vsac http://fhir.org/packages/us.nlm.vsac see above hl7.fhir.uv.sdc 3.0.0 M R4 http://hl7.org/fhir/uv/sdc http://hl7.org/fhir/uv/sdc/STU3 FHIR Version Mismatch hl7.fhir.r4.examples 4.0.1 O R4 http://hl7.org/fhir http://hl7.org/fhir/R4 FHIR Version Mismatch. Latest Release is 5.0.0 us.cdc.phinvads 0.12.0 M R4 http://fhir.org/packages/us.cdc.phinvads http://fhir.org/packages/us.cdc.phinvads see above hl7.fhir.uv.extensions.r4 5.1.0 M R4 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.1.0 FHIR Version Mismatch Templates: hl7.cda.template#current -> hl7.base.template#current -> fhir.base.template#current. Tools: 0.3.0
Dependent IGs:	no references
Global Profiles:	(none declared)
Terminology Server(s):	http://tx.fhir.org/r5 (details)
HTA Analysis:	All OK
R5 Dependencies:	(none)
Draft Dependencies:	hl7.cda.uv.core#2.0.1-sd: CDANullFlavor (5183 uses), CDAActMood (144 uses), CDACompressionAlgorithm (141 uses), BinaryDataEncoding (141 uses), CDAActClassObservation (90 uses), CDASetOperator (73 uses), CDAObservationInterpretation (88 uses), CDAActRelationshipType (107 uses), CDAParticipationType (173 uses), CDAContextControl (129 uses), CDARoleClassRoot (17 uses), CDAEntityCode (23 uses), CDARoleCode (54 uses), CDAActClass (77 uses), CDAPostalAddressUse (14 uses), CDAInformationRecipientRole (13 uses), CDASignatureCode (26 uses), CDARoleClassAssociative (10 uses), CDAActMoodIntent (13 uses), CDAActSubstanceAdministrationCode (5 uses), CDAEntityNameUse (3 uses), CDARoleClassMutualRelationship (1 uses) hl7.fhir.r5.core#5.0.0: GuideParameterCode (15 uses), FHIRDocumentTypeCodes (7 uses), MedicationDispenseStatusCodes (2 uses), DiagnosticServiceSectionCodes (2 uses) hl7.fhir.uv.extensions.r5#5.1.0: DefaultType (141 uses) hl7.fhir.uv.tools.r5#0.3.0: ResourceSortExt (487 uses), LogicalTarget (226 uses), XmlElementName (2203 uses), LogicalContainer (226 uses) hl7.terminology.r4#6.1.0: ManufacturerModelNameExample (14 uses), SoftwareNameExample (14 uses)
Modifier Extensions:	(none)
Previous Version Comparison:	Comparison with version 3.0.0
IPA Comparison:	n/a
IPS Comparison:	n/a
Validation Flags:	On: autoLoad; Off: hintAboutNonMustSupport, anyExtensionsAllowed, checkAggregation, showReferenceMessages, noExperimentalContent, displayWarnings
Summary:	errors = 30, warn = 0, info = 0, broken links = 0

n/a Show Validation Information

input/examples/basic-industry-observation-example.xml Show Validation Information (2)

input/examples/basic-occupation-observation-example.xml Show Validation Information (2)

input/examples/care-plan-complete-example.xml Show Validation Information (25)

input/examples/ccd-header-example.xml Show Validation Information (134)

input/examples/consultation-note-complete-example.xml Show Validation Information (209)

input/examples/discharge-summary-header-example.xml Show Validation Information (225)

input/examples/encounter-activity-example.xml Show Validation Information (1)

input/examples/history-and-physical-header-example.xml Show Validation Information (317)

input/examples/operative-note-header-example.xml Show Validation Information (145)

input/examples/patient-generated-document-informationrecipient.xml Show Validation Information (6)

input/examples/procedure-note-header-example.xml Show Validation Information (154)

input/examples/progress-note-header-example.xml Show Validation Information (56)

input/examples/referral-note-header-example.xml Show Validation Information (250)

input/examples/transfer-summary-header-example.xml Show Validation Information (271)

input/examples/us-realm-address-example.xml Show Validation Information (0)

input/examples/us-realm-date-and-time-example.xml Show Validation Information (0)

input/examples/us-realm-date-and-time-ivl-example.xml Show Validation Information (0)

input/examples/us-realm-header-example.xml Show Validation Information (3)

input/hl7.cda.us.ccda.xml Show Validation Information (1)

Suppressed Messages (Warnings, hints, broken links)

01 CDA Schematron generation parameters that are noted as unknown by the IG publisher

• Unknown Parameters: [value-set-limit=1000, parent-template-id=2.16.840.1.113883.10.20.22] (1 uses)

02 Deliberate decision around fixed/pattern which results in warnings

• http://hl7.org/fhir/StructureDefinition/ElementDefinition#eld-20 (86 uses)
• http://hl7.org/fhir/StructureDefinition/ElementDefinition#eld-24 (6283 uses)

03 IG Publisher issue - Grahame to fix: https://chat.fhir.org/#narrow/stream/198221-cda.2Fpublish/topic/Invariant.20expression.20error

• http://hl7.org/fhir/StructureDefinition/ElementDefinition#eld-21 (18 uses)

04 Inherent collections where collection is limited to a single value so the warning is fine

• %The left side is inherently a collection, and so the expression 'item.country.xmlText% (8 uses)
• %The left side is inherently a collection, and so the expression 'value.code% (1 uses)
• %The left side is inherently a collection, and so the expression 'value.unit% (8 uses)

05 Deprecated value set that is used by CDA and inherited by C-CDA

• Reference to deprecated ValueSet http://hl7.org/fhir/ValueSet/jurisdiction|5.0.0 (228 uses)

06 xsi:type information - firing on templates with constrained type, but still required in CDA

• xsi:type is unnecessary at this point (66 uses)

07 Unavailable code system in tx.fhir.org

• Error from http://tx.fhir.org/r5: Unable to provide support for code system https://www.nubc.org/CodeSystem/PatDischargeStatus (1 uses)

08 Each slice is optional, so the maximum still applies

• The slice definition for Observation.value has a maximum of 1 but the slices add up to a maximum of 2. Check that this is what is intended (3 uses)

09 Slice does not match due to an error in a VSAC value set definition (see CPT value set error)

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/EncountersSection|4.0.0-ballot (this may not be a problem, but you should check that it's not intended to match a slice) (1 uses)

10 CPT valueset from VSAC that tx.fhir.org can't expand at this time

• Error from http://tx.fhir.org/r5: The filter "concept is-a 1013625" from the value set http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.80.32|20240711 was not understood in the context of http://www.ama-assn.org/go/cpt (1 uses)

11 These are template IDs that are embedded in other templates and are not an individual template. The validator can not find these templates and warns us about them.

• The CDA Template 2.16.840.1.113883.10.20.1.58 is not known (2 uses)
• The CDA Template 2.16.840.1.113883.10.20.21.3.1 is not known (2 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.87 is not known (3 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.88 is not known (1 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.89 is not known (3 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.90 is not known (1 uses)

12 Our examples may not enforce the text references

• Constraint failed: should-sdtctext-ref-value: 'SHOULD contain text/reference/@value'% (5 uses)
• Constraint failed: should-text-ref-value: 'SHOULD contain text/reference/@value'% (88 uses)

13 Our examples will not always contain an author

• Constraint failed: should-author: 'SHOULD contain author'% (54 uses)

14 Multiple template IDs are required so the validator throws a warning on the slices

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ProblemObservation% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/SocialHistoryObservation% (3 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/SubstanceOrDeviceAllergyIntoleranceObservation% (3 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/USRealmHeader% (13 uses)

15 In the example the OID matches two different code systems - nothing we can do about this in the guide itself.

• The OID '2.16.840.1.113883.6.101' matches multiple resources (http://nucc.org/provider-taxonomy|4.0.0(active), http://terminology.hl7.org/CodeSystem/v3-nuccProviderCodes|3.0.1(active)); http://nucc.org/provider-taxonomy was chosen as the most appropriate (74 uses)

16 Assigned Author slices that are detected multiple times

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ContinuityofCareDocumentCCD% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/DischargeSummary% (1 uses)

17 An extra element not specified by the template

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/GoalObservation% (3 uses)

18 Note Activity is not a defined slice in the template but can be included

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection% (1 uses)

19 Goal Observation is not a defined slice in the template but can be included

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/OutcomeObservation% (1 uses)

20 Template requires a retired code

• The code '421927004' is valid but is not active (1 uses)
• The code 'NP' is valid but is retired (11 uses)

21 Unknown code systems used in examples

• The OID '2.16.840.1.113883.1.11.19563' is not known, so the code can't be validated (7 uses)
• The OID '2.16.840.1.113883.12.112' is not known, so the code can't be validated (1 uses)
• The OID '2.16.840.1.113883.6.255.1336' is not known, so the code can't be validated (1 uses)

22 PHINVADS code systems that have no codes so can not be validated

• A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/PHOccupationalDataForHealthODH' could not be found, so the code cannot be validated% (2 uses)
• A definition for CodeSystem 'https://www.nubc.org/CodeSystem/PatDischargeStatus' could not be found, so the code cannot be validated% (1 uses)
• A definition for CodeSystem 'urn:oid:2.16.840.1.113883.12.112' could not be found, so the code cannot be validated (1 uses)
• None of the codings provided are in the value set 'Industry NAICS Detail (ODH)' (http://phinvads.cdc.gov/fhir/ValueSet/2.16.840.1.114222.4.11.7900|1), and a coding from this value set is required% (1 uses)
• None of the codings provided are in the value set 'Occupation ONETSOC Detail (ODH)' (http://phinvads.cdc.gov/fhir/ValueSet/2.16.840.1.114222.4.11.7901|1), and a coding from this value set is required% (1 uses)

23 SHOULD constraints that we are intentionally not including

• %1098-7513% (3 uses)
• %4537-10007% (1 uses)
• %should-addr% (3 uses)
• %should-assignedPerson% (1 uses)
• %should-care-team-org% (1 uses)
• %should-effectiveTime% (2 uses)
• %should-entry% (1 uses)
• %should-health-status-obs% (1 uses)
• %should-id-npi% (2 uses)
• %should-legalAuthenticator% (1 uses)
• %should-maritalStatusCode% (1 uses)
• %should-npi% (7 uses)
• %should-nutritional-status-obs% (2 uses)
• %should-otext-ref-value% (2 uses)
• %should-performer% (2 uses)
• %should-post-procedure-dx% (1 uses)
• %should-preop-dx% (1 uses)
• %should-procedure-act-procedure% (1 uses)
• %should-proficiencyLevelCode% (1 uses)
• %should-relatedParticipant% (7 uses)
• %should-responsibleParty% (6 uses)
• %should-routeCode% (1 uses)
• %should-section-advance-directives% (1 uses)
• %should-section-discharge-dx% (1 uses)
• %should-section-functional-status% (1 uses)
• %should-section-hpi% (1 uses)
• %should-section-mental-status% (1 uses)
• %should-section-nutrition% (1 uses)
• %should-section-plan-of-treatment% (1 uses)
• %should-section-procedures% (2 uses)
• %should-smoking-status% (3 uses)
• %should-targetSiteCode% (2 uses)
• %should-telecom% (3 uses)
• %should-time% (1 uses)
• %should-us-code% (2 uses)
• %should-use% (3 uses)
• %should-value% (11 uses)
• %ts-should-minute% (7 uses)

24 ERROR - our examples use an element that makes sense but does not match the actual datatype name

• The QName 'urn:hl7-org:v3::addr' does not match the expected QName 'urn:hl7-org:v3::AD' (1 uses)
• The QName 'urn:hl7-org:v3::effectiveTime' does not match the expected QName 'urn:hl7-org:v3::IVL_TS' (1 uses)
• The QName 'urn:hl7-org:v3::time' does not match the expected QName 'urn:hl7-org:v3::TS' (1 uses)

25 ERROR the full document examples are there and do get validated but the validator is unable to resolve reference

• Unable to resolve resource with reference 'Binary/care-plan-complete-example' (1 uses)
• Unable to resolve resource with reference 'Binary/ccd-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/consultation-note-complete-example' (1 uses)
• Unable to resolve resource with reference 'Binary/discharge-summary-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/history-and-physical-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/operative-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/patient-generated-document-informationrecipient' (1 uses)
• Unable to resolve resource with reference 'Binary/procedure-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/progress-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/referral-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/transfer-summary-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/us-realm-header-example' (1 uses)

26 ERROR the language value set is not able to be expanded by the validator so validation can not occur

• Binding http://hl7.org/fhir/us/core/ValueSet/simple-language could not be expanded (2 uses)
• The value provided ('en') was not found in the value set 'Language codes with language and optionally a region modifier' (http://hl7.org/fhir/us/core/ValueSet/simple-language|8.0.0-ballot), and a code is required from this value set% (11 uses)
• The value provided ('fr-CN') was not found in the value set 'Language codes with language and optionally a region modifier' (http://hl7.org/fhir/us/core/ValueSet/simple-language|8.0.0-ballot), and a code is required from this value set% (1 uses)

27 Duplicate anchor ids produced by publisher - see if this can be fixed in a future release of the template

• The html source has duplicate anchor Ids:% (226 uses)

28 Experimental value sets in THO

• The definition for the element 'ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.manufacturerModelName' binds to the value set 'http://terminology.hl7.org/ValueSet/v3-ManufacturerModelNameExample' which is experimental, but this structure is not labeled as experimental (13 uses)
• The definition for the element 'ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.softwareName' binds to the value set 'http://terminology.hl7.org/ValueSet/v3-SoftwareNameExample' which is experimental, but this structure is not labeled as experimental (13 uses)
• The definition for the element 'Organizer.sdtcCategory' binds to the value set 'http://hl7.org/fhir/ValueSet/diagnostic-service-sections' which is experimental, but this structure is not labeled as experimental (2 uses)
• The definition for the element 'ParticipantRole.playingDevice.manufacturerModelName' binds to the value set 'http://terminology.hl7.org/ValueSet/v3-ManufacturerModelNameExample' which is experimental, but this structure is not labeled as experimental (1 uses)
• The definition for the element 'ParticipantRole.playingDevice.softwareName' binds to the value set 'http://terminology.hl7.org/ValueSet/v3-SoftwareNameExample' which is experimental, but this structure is not labeled as experimental (1 uses)

29 Deprecated templates that are still referenced in section templates

• The profile http://hl7.org/cda/us/ccda/StructureDefinition/SmokingStatusMeaningfulUse|4.0.0-ballot is retired (1 uses)
• The profile http://hl7.org/cda/us/ccda/StructureDefinition/TobaccoUse|4.0.0-ballot is retired (1 uses)

30 This is a guide that uses FHIR v5 that references guides that are FHIR v4

• This IG is for FHIR version 5.0.0, while the package 'hl7.terminology#5.2.0' is for FHIR version 4.0.1 (0 uses)
• This IG is version 5.0.0, while the IG 'hl7.fhir.us.core' is from version 4.0.1 (0 uses)
• This IG is version 5.0.0, while the IG 'us.cdc.phinvads' is from version 4.0.1 (0 uses)
• This IG is version 5.0.0, while the IG 'us.nlm.vsac' is from version 4.0.1 (0 uses)

31 ERROR in retrieving ActCode from tx.fhir.org is affecting slicing

• Error from http://tx.fhir.org/r5: Error reading E:\fhir-server\fhir-server\hl7.terminology.r4#6.1.0\package\CodeSystem-v3-ActCode.json% (0 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ProblemSection% (0 uses)

Errors sorted by type

Reference_REF_CantResolve

Terminology_TX_NoValid_16

Terminology_TX_NoValid_1_CC