IPS implementationguide 1

Document Information

This document contains: Implementation Guide International Patient Summary (0.50). The text materials belong to category cdaips.

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HL7 International Patient Summary
based on Clinical Document Architecture Release 2

International Patient Summary

Implementation Guide

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Terminology	Owner/Contact
Current Procedures Terminology (CPT) code set	American Medical Association https://www.ama-assn.org/practice-management/cpt-licensing
SNOMED CT©	SNOMED CT® International http://www.snomed.org/snomed-ct/get-snomed-ct or info@ihtsdo.org
Logical Observation Identifiers Names & Codes (LOINC©)	Regenstrief Institute, Inc.
International Classification of Diseases (ICD) codes	World Health Organization (WHO)
NUCC Health Care Provider Taxonomy code set	American Medical Association. Please see www.nucc.org. AMA licensing contact: 312-464-5022 (AMA IP services)

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CPT content is copyrighted by the American Medical Association and CPT is a registered trademark of the AMA.

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User acknowledge that User's development and commercialization of CPT-informed works developed with reference to Licensed Products may only be implemented in the Territory.

User is prohibited from making CPT content publicly available, creating derivative works (including translating), transferring, selling, leasing, licensing, or otherwise making available to any unauthorized party the CPT content, or a copy or portion of CPT content to any unauthorized party, including a subsidiary, affiliate, or other legal entity, however designated, for any purpose whatsoever except as expressly permitted under a separate agreement.

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User expressly consents to the release of its name to the AMA.

Authors and Contributors

Introduction

Relationships with other projects and guides

• Connection with CEN IPS ?
• epSOS/eHDSI; C-CDA; IHE-PCC

Principles and background

Identifiers

• (OID,...)

Terminologies

• Focus on Value Sets

Design conventions and principles

Principle on negations and data known absent

• Usage of negations
• The choice for negation it is not that of using negation indicator @negationInd but rely on the terminologies to do this
• To do: add a description in the introduction
• @negationInd in CDA has been superseded in V3 later by two other negation indicators: actNegationInd valueNegationInd
• Alignment with FHIR

General implementation guidance

How to populates IDs, where I can get IDs

Standards used

SNOMED-CT, ...

Legend

Description of formalisms used, symbols, icons, how to read ART-DECOR tables

Conformance clause

Different conformance levels (to be explored)

Functional requirements and high-level use cases

• Add a reference to the CEN prEN. (to be analyzed)
• PSS
• Add a reference to the data set included in the html package
• Include in the functional area that no assumption on transport has been made…
• PS comes from one source, and covers different cases.
• Specify, how the provenance could be managed without going into details) to be included in next versions.
• To be further discussed, in any case add a paragraph in which explain the problem and how it might be faced.