Skip to content
Pesquise para saber mais sobre produtos e soluções da InterSystems, oportunidades de carreira e muito mais. Os resultados incluem conteúdos da nossa comunidade de desenvolvedores, documentação de produtos e sites de educação, além de InterSystems.com.

Advisory: Order Status Values are Inappropriately Mapped in Some Circumstances

This problem affects the following products:

  • HealthShare Unified Care Record, all versions
  • HealthShare Health Connect, all versions
  • InterSystems IRIS for Health, all versions

In InterSystems SDA data model, orders are captured in the following streamlet types:

  • Medication
  • Vaccination
  • LabOrder
  • RadOrder
  • OtherOrder

Each of these orders may contain a Status property.

  • Inbound data transformations map values from source data into the SDA Status property for each type of order.
  • Outbound data transformations map the SDA Status property to target data standards.
  • Clinical Viewer and Personal Community apply additional transformations to the SDA Status property when displaying the data for use in those systems.

InterSystems has identified the following issue with these transformations:
Inappropriate or missing mappings may result in inaccurate or ambiguous information regarding the status of the order.

This has been identified as a clinical safety risk as this information may be used in clinical decision making. The details regarding the impacted transformations are detailed in this advisory.

  • All HealthShare solution customers are affected by this issue.
  • Health Connect and InterSystems IRIS for Health customers are affected by this issue if they store Medication, Vaccination, LabOrder, RadOrder, or OtherOrder data in SDA.

A fix is not yet available for this issue. InterSystems recommends that customers notify their users and recipients of outbound data that order status information should not be relied upon for clinical decision making.

Additional Information

The values from each source format are mapped to values within SDA and then may be further transformed upon ingestion into downstream systems or for outbound data standards. For example, a value of “HD” from HL7v2 is stored as “H” in SDA and displays as “On Hold” in Clinical Viewer and Personal Community. This is an example of an appropriate mapping where the meaning of the source value is retained.

There are a very large number of mappings between source and target values across all of InterSystem's data transformations. Each mapping was reviewed by the InterSystem's clinical safety team using a standardized process to determine which values were appropriately and inappropriately mapped.

In each of the following tables only the inappropriate mappings are listed. If a source value or target format/system and value is not listed here, the mapping has been assessed to be appropriate. For example:

  • The HL7v2 value of “ER” is appropriately retained in SDA as “ER” and appropriately displayed in Personal Community as “ER”
  • The value is inappropriately displayed in Clinical Viewer as “Verified” and inappropriately mapped in outbound CDA/C-CDA and FHIR data

The following tables will list only the “ER” mappings for Clinical Viewer, CDA/C-CDA, and FHIR, but not for SDA and Personal Community.

Medication Status

Source Properties Populating the Medication Status Property:

Source FormatSource Property
HL7v2
ORC-5 (Order Status Field)
CDA C32, C-CDA 1.1, and C-CDA 2.1

·  If supply moodCode (/entry/substanceAdministration/entryRelationship/supply/@moodCode) ='EVN' then Status='E'

·  If CDA status entryRelationship code (entryRelationship[@typeCode='REFR']/observation[code/@code='33999-4']/value/@code) ='421139008' then SDA Status='H'.

·  If CDA status entryRelationship code (entryRelationship[@typeCode='REFR']/observation[code/@code='33999-4']/value/@code) ='55561003' then SDA Status='IP'.

·  Otherwise SDA Status='I'.

FHIR STU3 MedicationDispense
status
FHIR STU3 MedicationRequest
status
FHIR R4 MedicationStatement
status

Source FormatSource Property
HL7v2
ORC-5 (Order Status Field)
CDA C32, C-CDA 1.1, and C-CDA 2.1

·  If supply moodCode (/entry/substanceAdministration/entryRelationship/supply/@moodCode) ='EVN' then Status='E'

·  If CDA status entryRelationship code (entryRelationship[@typeCode='REFR']/observation[code/@code='33999-4']/value/@code) ='421139008' then SDA Status='H'.

·  If CDA status entryRelationship code (entryRelationship[@typeCode='REFR']/observation[code/@code='33999-4']/value/@code) ='55561003' then SDA Status='IP'.

·  Otherwise SDA Status='I'.

FHIR STU3 MedicationDispense
status
FHIR STU3 MedicationRequest
status
FHIR R4 MedicationStatement
status

Inappropriate Mappings of Source to Target Values for Medications:

Source FormatSource ValueTarget Format/SystemTarget Value
HL7v2
ER
Clinical Viewer
Verified
HL7v2
ER 
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Current Med?" column as "Yes"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 73425007 (Inactive)

HL7v2
ER
FHIR STU3 MedicationDispense, MedicationRequest
·  stopped
HL7v2
ER
FHIR R4 MedicationDispense, MedicationStatement, MedicationRequest
stopped
HL7v2 
(null)
SDA
V
HL7v2
(null)
Clinical Viewer
Verified
HL7v2 
(null)
Personal Community
Verified
HL7v2 
(null)
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Current Med?" column as "Yes"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 73425007 (Inactive)

HL7v2 
(null)
FHIR STU3 MedicationDispense, MedicationRequest
completed
HL7v2
(null)
FHIR R4 MedicationDispense, MedicationStatement, MedicationRequest
completed
HL7v2
Non-null value other than A, CA, DC, CM, ER, HD, I, IP, P, PO, Q, RP, S, U
Clinical Viewer
Verified
HL7v2
Non-null value other than A, CA, DC, CM, ER, HD, I, IP, P, PO, Q, RP, S, U
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Current Med?" column as "Yes"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 73425007 (Inactive)

CDA C32, C-CDA 1.1, C-CDA 2.1.
Medication status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
SDA
I
CDA C32, C-CDA 1.1, C-CDA 2.1 
Medication status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
Clinical Viewer
Inactive
CDA C32, C-CDA 1.1, C-CDA 2.1 
Medication status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
Personal Community
Inactive
CDA C32, C-CDA 1.1, C-CDA 2.1
Medication status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Current Med?" column as "No"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 73425007 (Inactive)

CDA C32, C-CDA 1.1, C-CDA 2.1
Medication status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
FHIR STU3 MedicationDispense, MedicationRequest
entered-in-error
CDA C32, C-CDA 1.1, C-CDA 2.1
Medication status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
FHIR R4 MedicationDispense, MedicationStatement, MedicationRequest
entered-in-error
FHIR STU3 MedicationRequest
unknown or draft
Clinical Viewer
Verified
FHIR STU3 MedicationRequest
unknown or draft
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Current Med?" column as "Yes"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 73425007 (Inactive)

FHIR STU3 MedicationRequest
unknown or draft
FHIR STU3 MedicationRequest, MedicationDispense
null
FHIR R4 MedicationStatement
unknown
Clinical Viewer
Verified
FHIR R4 MedicationStatement
unknown
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Current Med?" column as "Yes"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 73425007 (Inactive)

FHIR R4 MedicationStatement
unknown
FHIR STU3 MedicationRequest, MedicationDispense
null
FHIR R4 MedicationStatement
intended or not-taken
Clinical Viewer
Verified
FHIR R4 MedicationStatement
intended or not-taken
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Current Med?" column as "Yes"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 73425007 (Inactive)

FHIR R4 MedicationStatement
intended or not-taken
FHIR STU3 MedicationRequest, MedicationDispense
null
FHIR R4 MedicationStatement
intended or not-taken
FHIR R4 MedicationDispense, MedicationStatement, MedicationRequest
unknown

Vaccination Status

Source Properties Populating the Vaccination Status Property:

Source FormatSource Property
HL7v2
ORC-5 (Order Status Field)
CDA C32, C-CDA 1.1, and C-CDA 2.1

·  If supply moodCode (/entry/substanceAdministration/entryRelationship/supply/@moodCode) ='EVN' then Status='E'

·  If CDA status entryRelationship code (entryRelationship[@typeCode='REFR']/observation[code/@code='33999-4']/value/@code) ='421139008' then SDA Status='H'.

·  If CDA status entryRelationship code (entryRelationship[@typeCode='REFR']/observation[code/@code='33999-4']/value/@code) ='55561003' then SDA Status='IP'.

·  Otherwise SDA Status='I'.

FHIR STU3 Immunization
status
FHIR R4 Immunization
status

Inappropriate Mappings of Source to Target Values for Vaccinations:

Source FormatSource ValueTarget Format/SystemTarget Value
HL7v2
ER
Clinical Viewer
Verified
HL7v2
ER 
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Status" column as "Completed"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 55561003 (Active)

HL7v2
ER 
FHIR STU3 Immunization
Results in an invalid resource due to empty status property
HL7v2
ER 
FHIR R4 Immunization
Results in an invalid resource due to empty status property
HL7v2
null
SDA
V
HL7v2
null
Clinical Viewer
Verified
HL7v2
null
Personal Community
Verified
HL7v2
null
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Status" column as "Completed"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 55561003 (Active)

HL7v2
null
FHIR STU3 Immunization
Results in an invalid resource due to empty status property
HL7v2
null
FHIR R4 Immunization
Results in an invalid resource due to empty status property
HL7v2
Non-null value other than A, CA, DC, CM, ER, HD, I, IP, P, PO, Q, RP, S, U
Clinical Viewer
Verified
HL7v2
Non-null value other than A, CA, DC, CM, ER, HD, I, IP, P, PO, Q, RP, S, U
CDA C32, C-CDA 1.1, C-CDA 2.1

·  HTML table displays value in "Status" column as "Completed"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 55561003 (Active)

HL7v2
Non-null value other than A, CA, DC, CM, ER, HD, I, IP, P, PO, Q, RP, S, U
FHIR STU3 Immunization
Results in an invalid resource due to empty status property
HL7v2
Non-null value other than A, CA, DC, CM, ER, HD, I, IP, P, PO, Q, RP, S, U
FHIR R4 Immunization
Results in an invalid resource due to empty status property
CDA C32, C-CDA 1.1, C-CDA 2.1.
Immunization status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
SDA
I
CDA C32, C-CDA 1.1, C-CDA 2.1 
Immunization status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
Clinical Viewer
Inactive
CDA C32, C-CDA 1.1, C-CDA 2.1 
Immunization status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
Personal Community
Inactive
CDA C32, C-CDA 1.1, C-CDA 2.1 
Immunization status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
CDA C32, C-CDA 1.1, C-CDA 2.1 

·  HTML table displays value in "Status" column as "Completed"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 55561003 (Active)

CDA C32, C-CDA 1.1, C-CDA 2.1 
Immunization status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
FHIR STU3 Immunization
entered-in-error
CDA C32, C-CDA 1.1, C-CDA 2.1 
Immunization status entryRelationship is absent or does not contain SNOMED codes 55561003 (Active) or 421139008 (On Hold)
FHIR R4 Immunization
entered-in-error
FHIR R4 Immunization
not-done
Clinical Viewer
Verified
FHIR R4 Immunization
not-done
CDA C32, C-CDA 1.1, C-CDA 2.1 

·  HTML table displays value in "Status" column as "Completed"

·  substanceAdministration statusCode = completed

·  status entryRelationship = 55561003 (Active)

FHIR R4 Immunization
not-done
FHIR STU3 Immunization
Results in an invalid resource due to empty status property
FHIR R4 Immunization
not-done
FHIR R4 Immunization
Results in an invalid resource due to empty status property

LabOrder, RadOrder, OtherOrder

Source Properties Populating the LabOrder, RadOrder, OtherOrder Status Property:

Source FormatSource Property
HL7v2
ORC-5 (Order Status Field)
FHIR STU3 DiagnosticReport
status
FHIR STU3 ProcedureRequest
status
FHIR R4 Diagnostic Report
status
FHIR R4 ServiceRequest
status

Inappropriate mappings of source to target values for LabOrder, RadOrder, and OtherOrder:

These streamlets may be associated with results. If results are present, the Status will be updated to “E” or “Executed”, regardless of the original value.

If results are not present, the source status values may be transformed. The inappropriate mappings are listed below.

Source FormatSource ValueTarget Format/SystemTarget Value
HL7v2
ER
Clinical Viewer
Verified
HL7v2
ER 
FHIR STU3 ProcedureRequest
cancelled
HL7v2
ER 
FHIR R4 ServiceRequest
revoked
HL7v2
null
SDA
V
HL7v2
null
Clinical Viewer
Verified
HL7v2
null
Personal Community
Verified
HL7v2
null
FHIR STU3 ProcedureRequest
active
HL7v2
null
FHIR R4 ServiceRequest
active
HL7v2
Non-null value other than A, CA, DC, CM, ER, HD, I, IP, P, PO, Q, RP, S, U
Clinical Viewer
Verified
FHIR R4 DiagnosticReport
unknown
Clinical Viewer
Verified
FHIR R4 DiagnosticReport
entered-in-error
SDA
R
FHIR R4 DiagnosticReport
entered-in-error
Clinical Viewer
Replaced
FHIR R4 DiagnosticReport
entered-in-error
Personal Community
Replaced
FHIR R4 DiagnosticReport
amended, appended, corrected
SDA
K
FHIR R4 DiagnosticReport
amended, appended, corrected
Clinical Viewer
Verified
FHIR R4 DiagnosticReport
amended, appended, corrected
Personal Community
K
FHIR STU3 ProcedureRequest
unknown
Clinical Viewer
Verified
FHIR STU3 ProcedureRequest
completed
FHIR STU3 ProcedureRequest
unknown
FHIR STU3 ProcedureRequest
completed
FHIR R4 ServiceRequest
unknown
FHIR STU3 ProcedureRequest
draft
FHIR STU3 ProcedureRequest
active
FHIR STU3 ProcedureRequest
draft
FHIR R4 ServiceRequest
active
FHIR STU3 ProcedureRequest
entered-in-error
SDA
R
FHIR STU3 ProcedureRequest
entered-in-error
Clinical Viewer
Replaced
FHIR STU3 ProcedureRequest
entered-in-error
Personal Community
Replaced
FHIR R4 ServiceRequest
unknown
Clinical Viewer
Verified
FHIR R4 ServiceRequest
completed
FHIR STU3 ProcedureRequest
unknown
FHIR R4 ServiceRequest
completed
FHIR R4 ServiceRequest
unknown
FHIR R4 ServiceRequest
draft
FHIR STU3 ProcedureRequest
active
FHIR R4 ServiceRequest
draft
FHIR R4 ServiceRequest
active
FHIR R4 ServiceRequest
entered-in-error
SDA
R
FHIR R4 ServiceRequest
entered-in-error
Clinical Viewer
Replaced
FHIR R4 ServiceRequest
entered-in-error
Personal Community
Replaced

Reference Information

This issue is identified as HSIEC-6741. If you have any questions regarding this alert, please contact the Worldwide Response Center (WRC).