Encoding problems have been noticed in the following cases:
CDA document:
<city>Z&#xFC;rich</city>
<family>Wegm&#xFC;ller</family>
<th>Pr&#xE4;partename</th>

FHIR document:
<family value="Wegm&#xFC;ller"/>
<city value="Z&#xFC;rich"/>

see ahdis/ch-emed-pmp#13

Wenn ein "individuelles" CodeSystem kommt, wird es nicht gemappt.

(Spec: Snomed CT FHIR: extensible, CDA: SHALL)

Medication.ingredient

"ingredient": [{
                                "itemCodeableConcept": {
                                    "coding": [{
                                            "system": "http://chmed16af.emediplan.ch/fhir/CodeSystem/chmed16af-codesystem-substance",
                                            "code": "205432",
                                            "display": "Metoprolol tartrat"
                                        }
                                    ],
                                    "text": "Metoprolol tartrat"
                                },

<pharm:ingredient classCode="MMAT" determinerCode="KIND">
<pharm:code code="205432" displayName="Metoprolol tartrat"/>

Request

@host = https://test.ahdis.ch/r4

POST {{host}}/StructureMap/$transform?source=http://fhir.ch/ig/cda-fhir-maps/StructureMap/BundleToCdaCh
Accept: application/fhir+xml;fhirVersion=4.0
Content-Type: application/fhir+xml;fhirVersion=4.0

< ./input/ch-core/1-ZuweisungZurRadiologischenDiagnostik.xml

Response

HTTP/1.1 406 Not Acceptable
X-Powered-By: HAPI FHIR 5.3.0-SNAPSHOT REST Server (FHIR Server; FHIR 4.0.1/R4)
X-Request-ID: ReQu4ZygqFQ6ThUm
Cache-Control: must-revalidate,no-cache,no-store
Date: Thu, 03 Dec 2020 14:29:42 GMT
Via: 1.1 google
Transfer-Encoding: chunked
Alt-Svc: clear
Connection: close

Source MTP (Composition.section):

        "section": [
          {
            "title": "Plan de traitement médicamenteux",
            "code": {
              "coding": [
                {
                  "system": "http://loinc.org",
                  "code": "77604-7",
                  "display": "Medication treatment plan.brief"
                }
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p id=\"refpdf\">Temesta Expidet cpr orodisp 1 mg, 0-0-0-1, durant 3 jours, raison: pour dormir</p></div>"
            },
            "entry": [
              {
                "reference": "MedicationStatement/1-3-MedStatTemesta"
              }
            ]
          },
          {
            "title": "Commentaire",
            "code": {
              "coding": [
                {
                  "system": "http://loinc.org",
                  "code": "48767-8",
                  "display": "Annotation comment"
                }
              ]
            },
            "text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">si aucune amélioration au bout de 3 jours, reprendre contact avec le médecin</div>"
            }
          }
        ]

Transformed CDA:

     <component>
        <section>
          <templateId root="2.16.756.5.30.1.1.10.3.2"/>
          <id root="4137D4F8-E966-425B-B383-E4933A80C8CE"/>
          <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>
          <title>Commentaire</title>
          <text>si aucune amélioration au bout de 3 jours, reprendre contact avec le médecin</text>
          <entry>
            <act classCode="ACT" moodCode="EVN">
              <templateId root="2.16.756.5.30.1.1.10.4.2"/>
              <templateId root="2.16.840.1.113883.10.20.1.40"/>
              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.2"/>
              <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>
              <text>
                <reference value="#&lt;div xmlns="/>
              </text>
              <statusCode code="completed"/>
            </act>
          </entry>
        </section>
      </component>

Map BundleToCdaChEmed (Line 43)

Validation is not converting correctly:

• patientRole.id missing
• check maybe section order
• missing id on the representedCustodianOrganization
• missing references for narrative text
• timing events

https://ehealthsuisse.ihe-europe.net/EVSClient//detailedResult.seam?type=FHIR&oid=1.3.6.1.4.1.12559.11.25.1.13.47855

https://ehealthsuisse.ihe-europe.net/EVSClient//detailedResult.seam?type=CDA&oid=1.3.6.1.4.1.12559.11.25.1.13.47845

FHIR: source file

• Composition.author
  • Practitioner/AuthorDocument: mapping done
  • Organization/AuthorDocumentOrganization: mapping done
• Composition.section.author
  • Practitioner/AuthorSection
  • Organization/AuthorSectionOrganization
• MedicationStatement.extension:ch-emed-ext-documentauthor
  • Practitioner/AuthorOriginalDocument
  • Organization/AuthorOriginalDocumentOrganization
• MedicationStatement.informationSource
  • .extension:ch-emed-ext-representedorganization: Organization/AuthorMedicalDecisionOrganization
  • Practitioner/AuthorMedicalDecision

for mapping details see here

Generate xmlns:xsi & xsi:type

CDA: entry.substanceAdministration.consumable.manufacturedProduct.manufacturedMaterial.pharm:ingredient

• target state after mapping from FHIR to CDA

<pharm:ingredient classCode="ACTI">
	<pharm:quantity>
		<numerator unit="mg" value="10" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="PQ"/>
		<denominator value="1" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="PQ"/>
	</pharm:quantity>

• actual state after mapping from FHIR to CDA

<pharm:ingredient classCode="ACTI">
         <pharm:quantity>
                   <numerator unit="mg" value="10"/>
                   <denominator value="1"/>
         </pharm:quantity>

Original FHIR

"text": {
              "status": "generated",
              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n<span id=\"co1\">\nKommentar zu Medication Treatment\n</span>\n</div>"
            }

Transformed CDA

          <text>
            <content ID="co1">
                  Kommentar zu Medication Treatment
              </content>
          </text>

          <text>
                <reference value="#co1"/>
          </text>

Generated JSON

"text": {
                            "status": "generated",
                            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Kommentar zu Medication Treatment</div>"
                        }

Transformed CDA

<text>Kommentar zu Medication Treatment</text>

              <text>
                <reference value="#&lt;div xmlns="/>
              </text>

Transformation of the FHIR-Document

<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.1"/> is missing in the transformed cda document for the marcoumar section

Source CDA:
entry.observation.effectiveTime -> Type: IVL_TS
<effectiveTime value="20120204140000+0100" />

Target FHIR:
Observation.effective[x] -> Type: dateTime
<effectiveDateTime value="2012-02-04T14:00:00+01:00"/>

To be mapped in group PharmaceuticalAdviceItemEntryContentModule in Map CdaChEmedToBundle

CDA requires the Timestamp of the authorship (author.time), see spec.

The mapping doesn't work for this example:

• PADV-CANCEL.json
  • https://ehealthsuisse.ihe-europe.net/EVSClient/detailedResult.seam?type=CDA&oid=1.3.6.1.4.1.12559.11.25.1.1352548

CDA requires the author.assignedAuthor, see spec.

Required elements for assignedAuthor are:

• hl7:id (The specification of GS1 GLN is REQUIRED. If it is not (yet) known, this MUST be declared using nullFlavor.)
• Elements to choose from:
  • hl7:assignedPerson
  • hl7:assignedAuthoringDevice

In the FHIR source these elements aren't required.

Note:
If there is a reference to a PractitionerRole from Composition.author the mapping doesn't work.

Examples:

• PADV-CANCEL.json
  • https://ehealthsuisse.ihe-europe.net/EVSClient/detailedResult.seam?type=CDA&oid=1.3.6.1.4.1.12559.11.25.1.1352548
• PADV-CHANGE.json
  • https://ehealthsuisse.ihe-europe.net/EVSClient/detailedResult.seam?type=CDA&oid=1.3.6.1.4.1.12559.11.25.1.1352549

siehe Issue: ahdis/ch-emed-pmp#1

The element hl7:observation.hl7:entryRelationship is not mapped with these examples (spec):

• PADV-CANCEL.json
  • https://ehealthsuisse.ihe-europe.net/EVSClient/detailedResult.seam?type=CDA&oid=1.3.6.1.4.1.12559.11.25.1.1352548
• PADV-CHANGE.json
  • https://ehealthsuisse.ihe-europe.net/EVSClient/detailedResult.seam?type=CDA&oid=1.3.6.1.4.1.12559.11.25.1.1352549

Error:
(PharmaceuticalAdviceItemEntryContentModule): choice (hl7:entryRelationship[@typecode='REFR' and hl7:substanceAdministration[hl7:templateId[@root='2.16.756.5.30.1.1.10.4.45']]] or hl7:entryRelationship[@typecode='REFR' and hl7:supply[hl7:templateId[@root='2.16.756.5.30.1.1.10.4.46']]] or hl7:entryRelationship[@typecode='REFR' and hl7:substanceAdministration[hl7:templateId[@root='2.16.756.5.30.1.1.10.4.47']]]) does not contain enough elements [min 1x]

CDA:
manufacturedMaterial.code 1..1
see spec:
The element SHALL be present and describes the code of the medication (GTIN). If it as magistral preparation/compound medicin nullFlavor SHALL be NA

FHIR Source file
only Medication.code.text is required

TBD for Transformation
Generating this part for CDA:
<code code="7680460380107" codeSystem="2.51.1.1" codeSystemName="Global Trade Item Number" displayName="NA"/>

Medication List (CDA)

   <reference typeCode="XCRPT">
      <externalDocument>
          <id root="363BCBFD-9192-47FA-BB16-878253FBC973"/>
      </externalDocument>
  </reference>

mapping to FHIR in these extensions:

• http://fhir.ch/ig/ch-emed/StructureDefinition/ch-emed-ext-treatmentplan
• http://fhir.ch/ig/ch-emed/StructureDefinition/ch-emed-ext-dispense
• http://fhir.ch/ig/ch-emed/StructureDefinition/ch-emed-ext-prescription
• http://fhir.ch/ig/ch-emed/StructureDefinition/ch-emed-ext-pharmaceuticaladvice

extension:id -> id of the medication entry (e.g. MedicationStatement)
extension:externalDocumentId -> the CDA element above

Change in CH Core:
EPRDataEnterer: valueReference only to Practitioner (not Person) #85

CDA-FHIR-Maps -> Change Reference from Person to Practitioner

• CDA to FHIR: input\maps\CdaChToBundle.map
  • Line 138: group ChExtEprDataEnterer
  • Line 173: call of this rule
• FHIR to CDA: input\maps\BundleToCdaCh.map
  • Line 168: rule dataEnterer

templateId root="1.3.6.1.4.1.19376.1.9.1.3.6"
IHE PHARM Dosage Instructions

this is missing when mapping a pre from fhir to cda,
e.g. http://fhir.ch/ig/ch-emed/Bundle-2-6-MedicationPrescription.xml.html

FHIR.zip

The CDA and FHIR example are in the zip folder

Anwendungsinstruktion (Instruction au patient) → MedicationStatement.note and back

according to discussion in ch-emed-pmp

Please add a nullFlavor if the country is missing:

<addr>
   <country nullFlavor="NI"/>
   <city>Zürich</city>
   <postalCode>8003</postalCode>
   <streetAddressLine>Wiesenstr. 12</streetAddressLine>
</addr>

Element hl7:addr
(https://art-decor.org/art-decor/decor-templates--cdachemed-?section=templates&id=2.16.756.5.30.1.1.10.9.35&effectiveDate=2018-04-18T00:00:00&language=en-US)

Extension setID has been removed during STU2 Ballot. Composition.identifier should be mapped to ClinicalDocument.set and back. See hl7ch/ch-core#97 for additional information.

If no value is entered in the element note in the CDA document (source), no text element is generated in the FHIR document (target). But in FHIR the Element note.text is required.

TBD in following maps:

• input\maps\CdaChEmedMedicationCardDocumentToBundle.map
• input\maps\CdaChEmedMedicationDispenseDocumentToBundle.map
• input\maps\CdaChEmedMedicationPrescriptionDocumentToBundle.map

Example: 1-2-MedicationDispense
Input (CDA):

<td ID="dis.1.note"></td>

Actual Output (FHIR):

<note>
   <extension url="http://hl7.org/fhir/StructureDefinition/narrativeLink">
      <valueUrl value="#dis.1.note"/>
   </extension>
</note>

Target Output (FHIR):

<note>
   <extension url="http://hl7.org/fhir/StructureDefinition/narrativeLink">
      <valueUrl value="#dis.1.note"/>
   </extension>
   <text value="-"/>
</note>

Comment: An empty text element in FHIR is not valid. (Error from IG-Publisher: Primitive types must have a value that is not empty)

actual mapping section:

// source: https://art-decor.org/art-decor/decor-templates--cdachemed-?section=templates&id=2.16.756.5.30.1.1.10.4.2
// target: Annotation note (e.g. http://build.fhir.org/ig/hl7ch/ch-emed/branches/master/StructureDefinition-ch-emed-medicationdispense.html)
group AnnotationComment(source section: Section, source act: Act, target note: Annotation) {
  act -> note.text =  (%section.text.substring(%section.text.indexOf(%act.text.reference.value.substring(1))).substring(%section.text.substring(%section.text.indexOf(%act.text.reference.value.substring(1))).indexOf('>')+1, %section.text.substring(%section.text.indexOf(%act.text.reference.value.substring(1))).indexOf('<')-%section.text.substring(%section.text.indexOf(%act.text.reference.value.substring(1))).indexOf('>')-1)) "idRef"; 
  act.text as text then {
    text.reference as reference then {
      reference.value as value -> note.extension as ext then NarrativeLink(value, ext) "narrativeLink";
    } "reference";
  } "text";
}

• CDA author.assignePerson.name.prefix is required to have an AC qualifier

Source: CDA File
<name>Préparation magistrale</name>

CDA element name should be transformed in FHIR element Medication.code.text, currently missing

ch.fhir.ig.cda-fhir-maps#0.2.0 /

test

from fhir to cda the practitioner.address and telecom is not assigned to the assignedAuthor

see ahdis/ch-emed-pmp#16

Das Mapping des PADV Kommentars ist folgendermassen definiert:

• CDA: section.entry.observation.text.reference -> Bsp: value="#padv.1"
  • (siehe Art-Decor)
• FHIR: Observation.note

Der Wert, der bei FHIR Observation.note erwartet wird ist folgender:
<td ID="padv.1.note">Abgesetzt aufgrund UAW trockener Husten</td>
(Bsp. 2-2-PharmaceuticalAdvice)

Das Mapping von CDA->FHIR und FHIR->CDA ist noch offen. Wie kann das richtige Element aus dem Text evaluiert werden?

see ahdis/ch-emed-pmp#17

Examples:

MedicationStatement.dosage.sequence:
<sequence v3:value="1"/>
(e.g. input\generated-files\ch-emed-2-3-MedicationTreatmentPlan.xml,
input\generated-files\ch-emed-2-7-MedicationCard.xml)

MedicationDispense.dosageInstruction.sequence:
<sequence v3:value="1"/>
(e.g. input\generated-files\ch-emed-2-4-MedicationDispense.xml)

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed:
<numberOfRepeatsAllowed v3:value="2"/>
(e.g. input\generated-files\ch-emed-2-6-MedicationPrescription.xml)

Map: CdaChEmedToBundle

group DosageInstructionsEntryDosageChange

entry.sequenceNumber as sequenceNumber -> dosage.sequence = sequenceNumber "sequenceNumber";

group PrescriptionItemEntryContentModule

src.repeatNumber as repeatNumber -> medicationRequest.dispenseRequest as dispenseRequest then {
    repeatNumber -> dispenseRequest.numberOfRepeatsAllowed = repeatNumber "repeatNumber";
} "repeats";

In the element Medication.ingredient a wrong URL is generated as CodeSystem

• OID: 2.16.840.1.113883.6.73
• wrong: <system value="http://hl7.org/fhir/sid/atc"/>
• correct: <system value="http://www.whocc.no/atc"/>

FHIR CodeSystem (external)

<itemCodeableConcept>
    <coding>
      <system value="http://hl7.org/fhir/sid/atc"/>
      <code value="C08CA01"/>
      <display value="amlodipine"/>
   </coding>
   <text value="amlodipine"/>
</itemCodeableConcept>

See ahdis/chmed#13

Transformation from CDA to FHIR

actual mapping:
<doseQuantity value="40" unit="mg"/>

"doseAndRate": [{
       "doseQuantity": {
                "value": 40,
                 "code": "mg"
          }
      }
]

Validation error: qty-3: If a code for the unit is present, the system SHALL also be present [code.empty() or system.exists()]

target mapping:

"doseQuantity": {
      "value": 40,
      "unit": "mg",
      "system": "http://unitsofmeasure.org",
      "code": "mg"
},

This element on entry level is not yet mapped.

CDA:
component.section.entry.substanceAdministration.author

                            <author>
                                <templateId root="2.16.756.5.30.1.1.10.9.23"/>
                                <time value="20190227110000+0100"/>
                                <assignedAuthor>
                                    <id root="2.51.1.3" extension="7601000234322"/>
                                    <assignedPerson>
                                        <name>
                                            <family>Hôpital</family>
                                            <given>Docteur</given>
                                        </name>
                                    </assignedPerson>
                                </assignedAuthor>
                            </author>

FHIR:
MedicationStatement.informationSource
details see here in column D/E

CDA and FHIR example from actual mapping here: 3-1-List-Cetirizine.zip

CodeableConcept.text element is generated without value=

<code>     
   <coding>      
      <system value="urn:oid:2.51.1.1"/>
      <code value="7680500440334"/>
      <display value="NORVASC Tabl 10 mg"/>
   </coding>
   <text>NORVASC Tabl 10 mg</text>
</code>

input\maps\CdaChEmedMedicationPrescriptionDocumentToBundle.map

• Line 94: initial variant without text element (uncomment)
• Line 95: variant with text element

FHIR datatype CodeableConcept

For example for PADV, but also concerns the other eMedication exchange formats.

FHIR PADV:
Composition.type requires only the SCT code, see spec

CDA PADV:
But in the element hl7:code both the SCT and the LOINC code are required, see spec

CDA:
author.assignedAuthor.assignedAuthoringDevice

FHIR:
ACTUAL = Composition.author -> Practitioner
TARGET = Composition.author -> Device

CDA and FHIR example from actual mapping here: 3-1-List-Cetirizine.zip
Device from CDA example:

    <author>
        <templateId root="2.16.756.5.30.1.1.10.9.23"/>
        <functionCode code="COMPOSER" codeSystem="2.16.840.1.113883.5.88" codeSystemName="Participation Function" displayName="composer software"/>
        <time value="20220810072849+0000"/>
        <assignedAuthor>
            <id root="2.51.1.3" extension="7601002860123"/>
            <assignedAuthoringDevice>
                <manufacturerModelName>CARA's PMP</manufacturerModelName>
                <softwareName>PMP CARA v0.1</softwareName>
            </assignedAuthoringDevice>
        </assignedAuthor>
    </author>

If no fullUrl on entries is existing, the IG publisher aborts the process with the following error message:
e.g. No fullUrl on entry 1 in Bundle 2-6-MedicationPrescription-FHIR

Quentin:

Please use the annotation comment to express the reason for the action in PADV OK, CHANGE, SUSPEND, CANCEL, REFUSE. For PADV COMMENT, the comment goes in the hl7:text element. I’ve updated the integration guide. It’ll be aggregated in the next version.

For CH EMED is it for all PADV in observation.note.text, we will map it according to the type to the correct CDA part.

Mapping defined in : https://docs.google.com/spreadsheets/d/17c6p-67TPhWcZz3a-GwvCugrg9LSm606tLR8QarL9Hw/edit?usp=sharing

FHIR:

CDA:

If there is no Composition.author.ch-ext-epr-time (FHIR 0..1), then the CDA author.time (1..1) should be generated with the information from Composition.date (1..1)

Map:

• input\maps\CdaChEmedMedicationDispenseDocumentToBundle.map
• input\maps\CdaChEmedMedicationPrescriptionDocumentToBundle.map

Mapping MedicationDispense as example

// quantity value (number of packages)
  source.quantity as quantity -> medicationDispense.quantity as medDispQuantity then {
    // IHE-DIS: If the product-element contains package information, the unit attribute is not be present
    quantity.value as value -> medDispQuantity.value = value "value";

    // IHE-DIS: If the product-element does not contain package information, the unit attribut is present and the value SHALL be out of the UCUM code system
    quantity.unit as unit then {
      unit -> medDispQuantity.unit = unit "unit";
      unit -> medDispQuantity.system = 'http://unitsofmeasure.org' "ucum";
      unit -> medDispQuantity.code = unit "code";
    } "unit";
  } "quantity";

Input (CDA, e.g. 1-2-MedicationDispense):

<quantity value="20" unit="mg"/>

Output (FHIR) -> element value in wrong order:

<quantity>
    <unit value="mg"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg"/>
    <value value="20"/>
</quantity>

Target Output (FHIR):

<quantity>
    <value value="20"/>
    <unit value="mg"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg"/>     
</quantity>

View this comment in following Maps:
// FIXME: add fullUrl reference rule which for urn:uuid

• BundleToCdaChEmedMedicationCardDocument
• BundleToCdaChEmedMedicationDispenseDocument
• BundleToCdaChEmedMedicationPrescriptionDocument
• BundleToCdaChEmedPharmaceuticalAdviceDocument

The ConceptMap http://hl7.org/fhir/R4/cm-administrative-gender-v3.html which is used in the transform is only an example instance. It is not provided in the core conformance package and we don't want to upload all examples on the transformation service.

http://hl7.org/fhir/R4/cm-administrative-gender-v3.html

FHIR -> CDA:
If there is no Medication.amount there should be a nullFlavor for pharm:capacityQuantity

<pharm:capacityQuantity nullFlavor="NP"/>

see Spec

source File FHIR
Composition.section:Medikamentenliste

no substanceAdministration.text.reference is generated for cda

if the package amount is not specified pharm:asContent should not be generated (otherwise it gives a schematron error)
vice versa the gtin should be taken from manufacturedMaterial.code

Mapping from FHIR to CDA:
If no section id is included in the fhir bundle, a uuid for the cda document will be generated. Because uuid() is not a fhir path expression, upper() cannot be used.

// create section id if there is none in the fhir bundle (mapping source)
section as section where $this.extension.where(url='http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-epr-sectionid').exists()=false 
    -> cdasection.id as id then { 
      section -> id.root = uuid() "section id";
    } "extension";

Concerned are all Maps for the Medication Documents:
input\maps\BundleToCdaChEmedMedication...Document.map

• Generate a FHIR-Extension for ClinicalDocument.authorization
  - Reference: http://hl7.org/fhir/us/ccda/2016Sep/StructureDefinition-ccda-authorization-extension.html
• Add the Mapping for this Element in both directions
• CDA-Example with this Element: input\cda-ch\1-Zuweisung zur Radiologischen Diagnostik.xml