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 Format | Source 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 Format | Source 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 Format | Source Value | Target Format/System | Target 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 Format | Source 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 Format | Source Value | Target Format/System | Target 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 Format | Source 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 Format | Source Value | Target Format/System | Target 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).