Id2.16.840.1.113883.3.1937.777.11.10.103Effective Date2020‑10‑07 08:20:31
Statusactive ActiveVersion Label
NameeHDSIAuthorPrescriberDisplay NameeHDSI Author Prescriber
Description

A CDA document shall have at least one author. Authors could be either human (ClinicalDocument/author/assignedAuthor/assignedPerson) either devices (ClinicalDocument/author/assignedAuthor/assignedAuthoringDevice).

For definition “The author element represents the creator of the clinical document. If the role of the actor is the entry of information from his or her own knowledge or application of skills, that actor is the author. If one actor provides information to another actor who filters, reasons, or algorithmically creates new information, then that second actor is also an author, having created information from his or her own knowledge or skills. [From Implementation Guide for CDA Release 2: Imaging Integration – UV Realm, March 2009].

According to this definition, not any device that generates the electronic document has to be considered as an author:

  • a spider collecting and filtering information from different repositories, according to defined rules and policies, for the scope of creating a Patient Summary is definitely a document author (and maybe the only one for this document);
  • an application that transforms a prescription record into an eHDSI eP CDA may not be an author instead;
  • The NCP that modifies the concepts conveyed, should appear as one of the authors.
  • The author of the parent document is often also an author of the document generated through a transformation process (in that case also the author time should be the same).

Further to this, is therefore possible to determine the Nature of Patient Summary as follows [Excluding the NCPs as authors]:

  • if there is a person author only, there the Patient Summary is the result of a practitioner clinical act;
  • if there is a device author only, the summary was automatically generated according to well defined rules defined by the responsible organization;
  • if there are both a person and a device as authors, the summary was created via a mixed approach.

The CDA provides a mechanism to better specify who authored what within the document, allowing the specification of authorship at the whole document level, at the section level and finally at the entry level. In any case is not required to repeat this information for each level, taking advantage of the context conduction propriety. In fact “context that is specified on an outer tag holds true for all nested tags, unless overridden on a nested tag. Context specified on a tag within the CDA body always overrides context propagated from an outer tag. For instance, the specification of authorship at a document section level overrides all authorship propagated from outer tags.” (HL7 CDA R2 Standard).

/ClinicalDocument/author/assignedAuthor
/ClinicalDocument/documentationOf/serviceEvent/performer (this applies to the prescriber and the dispenser).

The template ID referenced here refers to HP information in the /ClinicalDocument/documentationOf/serviceEvent/performer structure. In this document, the same requirements apply to the person author of the document (if there is one), and to the prescriber and dispenser (see body).

When there is no HP but we have the method of assembly of data by a device, such as the “spider” method, we have the following expression; ClinicalDocument/author/assignedAuthor/assignedAuthoringDevice.

When the data is collected from different sources & pre-existing documents that are part of a bigger system. In that case the organization responsible of that collection “signed” the PS as responsible.

ClinicalDocument/author/assignedAuthor/representedOrganization

ClassificationCDA Header Level Template
Open/ClosedOpen (other than defined elements are allowed)
Associated with
Associated with 14 concepts
IdNameData Set
ehdsi-dataelement-234draft HP Identifier draft eHDSI Data Set
ehdsi-dataelement-232draft Given Name draft eHDSI Data Set
ehdsi-dataelement-231draft Family Name/Surname draft eHDSI Data Set
ehdsi-dataelement-227draft Medical Specialty draft eHDSI Data Set
ehdsi-dataelement-229draft Profession draft eHDSI Data Set
ehdsi-dataelement-224draft Street Address draft eHDSI Data Set
ehdsi-dataelement-223draft City draft eHDSI Data Set
ehdsi-dataelement-222draft Zip or Postal Code draft eHDSI Data Set
ehdsi-dataelement-221draft State or Province draft eHDSI Data Set
ehdsi-dataelement-220draft Country draft eHDSI Data Set
ehdsi-dataelement-219draft Telephone draft eHDSI Data Set
ehdsi-dataelement-218draft E-mail draft eHDSI Data Set
ehdsi-dataelement-216draft Organization Name draft eHDSI Data Set
ehdsi-dataelement-215draft Organization Identifier draft eHDSI Data Set
Used by / Uses
Used by 2 transactions and 43 templates, Uses 1 template
Used by as NameVersion
2.16.840.1.113883.3.1937.777.11.4.19Transactiondraft Return eP from country A2013‑11‑02
2.16.840.1.113883.3.1937.777.11.4.32Transactiondraft Return eP (PDF embedded) from country A2017‑11‑21 10:26:49
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeretired epSOS-ePrescription2013‑12‑20
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeretired epSOS-ePrescription2018‑11‑14 10:49:44
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeretired eHDSI ePrescription2020‑04‑16 10:42:14
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeretired eHDSI ePrescription2020‑06‑17 09:25:30
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeretired eHDSI ePrescription2020‑09‑09 12:19:36
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeretired eHDSI ePrescription2020‑09‑09 12:22:47
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeretired eHDSI ePrescription2022‑09‑12 13:39:27
1.3.6.1.4.1.12559.11.10.1.3.1.1.1Includeactive eHDSI ePrescription2024‑04‑19 09:57:14
1.3.6.1.4.1.12559.11.10.1.3.1.1.6Includeretired eHDSI-ePrescription PDF embedded2017‑03‑11 22:32:59
1.3.6.1.4.1.12559.11.10.1.3.1.1.6Includeretired eHDSI-ePrescription PDF embedded2018‑11‑14 09:01:05
1.3.6.1.4.1.12559.11.10.1.3.1.1.6Includeretired eHDSI ePrescription PDF embedded2020‑04‑16 10:39:54
1.3.6.1.4.1.12559.11.10.1.3.1.1.6Includeretired eHDSI ePrescription PDF embedded2020‑06‑17 09:27:29
1.3.6.1.4.1.12559.11.10.1.3.1.1.6Includeretired eHDSI ePrescription PDF embedded2020‑09‑09 12:25:17
1.3.6.1.4.1.12559.11.10.1.3.1.1.6Includeretired eHDSI ePrescription PDF embedded2022‑09‑12 13:39:56
1.3.6.1.4.1.12559.11.10.1.3.1.1.6Includeactive eHDSI ePrescription PDF embedded2024‑04‑19 09:58:04
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired epSOS CDA substanceAdministration2013‑12‑20
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired epSOS CDA substanceAdministration2019‑03‑21 13:51:15
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired epSOS CDA substanceAdministration2019‑11‑07 16:15:52
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired epSOS CDA substanceAdministration2020‑03‑30 13:06:06
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2020‑04‑14 14:55:37
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2020‑07‑02 13:56:15
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2020‑09‑03 12:24:41
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includecancelled eHDSI Substance Administration2021‑12‑23 14:16:45
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2021‑12‑23 14:25:03
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2022‑07‑06 13:39:09
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2022‑08‑26 10:04:41
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2022‑12‑13 14:35:52
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2022‑12‑13 14:36:14
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2022‑12‑13 14:44:56
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeretired eHDSI Substance Administration2023‑04‑20 15:20:58
1.3.6.1.4.1.12559.11.10.1.3.1.3.2Includeactive eHDSI Substance Administration2023‑07‑03 13:52:39
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired Medication Item2013‑12‑20
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired Medication Item2019‑04‑08 12:46:30
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired Medication Item2019‑12‑03 08:26:05
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired Medication Item2020‑03‑24 15:58:29
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired eHDSI Medication Item2020‑04‑15 15:15:45
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired eHDSI Medication Item2020‑09‑03 12:38:20
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired eHDSI Medication Item2022‑03‑08 11:02:28
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired eHDSI Medication Item2022‑07‑06 13:37:25
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired eHDSI Medication Item2022‑09‑12 13:52:42
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired eHDSI Medication Item2022‑12‑08 16:19:08
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeretired eHDSI Medication Item2023‑07‑03 13:55:12
1.3.6.1.4.1.12559.11.10.1.3.1.3.4Includeactive eHDSI Medication Item2024‑01‑25 13:59:32
Uses as NameVersion
2.16.840.1.113883.3.1937.777.11.10.111Containmentactive eHDSI OrganizationDYNAMIC
RelationshipSpecialization: template 2.16.840.1.113883.10.12.102 CDA author (2005‑09‑07)
ref
ad1bbr-
Example
Example
<author>
  <time value="20121229"/>  <assignedAuthor>
    <id root="2.16.840.1.113883.2.9.4.3.2" extension="RSSMRA00A01F205F" assigningAuthorityName="Ministero Economia e Finanze"/>    <addr>
      <streetAddressLine>Viale della Cristallina 3</streetAddressLine>      <city>Bologna</city>      <state>BO</state>      <postalCode>40121</postalCode>      <country>IT</country>    </addr>
    <telecom use="WP" value="tel:(+39)051-34343434"/>    <assignedPerson>
      <name>
        <given>Paolo</given>        <family>Rossi</family>      </name>
    </assignedPerson>
  </assignedAuthor>
</author>
ItemDTCardConfDescriptionLabel
hl7:author
1 … *ReHDSdotsiber
@typeCode
cs0 … 1FAUT
@contextControlCode
cs0 … 1FOP
hl7:functionCode
CE.EPSOS1 … 1MR1.10.6
 
target
ehdsi-dataelement-229draft Profession draft eHDSI Data Set
 CONF
The value of @code shall be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.1 eHDSIHealthcareProfessionalRole (DYNAMIC)
hl7:time
TS.EPSOS.TZ1 … 1RThe author/time element represents the start time of the author’s participation in the creation of the clinical document. The author/time element SHALL be present.eHDSdotsiber
hl7:assignedAuthor
1 … 1ReHDSdotsiber
@classCode
cs0 … 1FASSIGNED
 Schematron assertrolered error 
 test@nullFlavor or hl7:assignedPerson or hl7:assignedAuthoringDevice 
 MessageAt least an assignedPerson or an assignedAuthoringDevice has to be provided, otherwise a nullFlavor shall be present. 
hl7:id
II.EPSOS1 … *RIdentification of the Healthcare Practitioner that is the author of this document.
R1.10.5
 
target
ehdsi-dataelement-234draft HP Identifier draft eHDSI Data Set
@nullFlavor
cs0 … 1FNA
hl7:code
CE.EPSOS0 … 1RHP SpecialtyR1.10.7
 
target
ehdsi-dataelement-227draft Medical Specialty draft eHDSI Data Set
hl7:addr
AD.EPSOS1 … *RIHE PCC
 
target
ehdsi-dataelement-224draft Street Address draft eHDSI Data Set
ehdsi-dataelement-223draft City draft eHDSI Data Set
ehdsi-dataelement-222draft Zip or Postal Code draft eHDSI Data Set
ehdsi-dataelement-221draft State or Province draft eHDSI Data Set
ehdsi-dataelement-220draft Country draft eHDSI Data Set
hl7:telecom
TEL.EPSOS1 … *RThis telephone or e-mail <telecom> element is required.

If there is no information, the nullFlavor attribute shall have a value of 'NI' and the "value" and "use" attributes shall be omitted, otherwise the nullFlavor attribute shall not be present, and the "value" and "use" attributes shall be present.

Attribute @value SHALL contain a URI if element telecom is used. The URI scheme SHALL be one of URLScheme.
IHE PCC / R1.10.8 / R1.10.8.1 / R1.10.8.2
 
target
ehdsi-dataelement-219draft Telephone draft eHDSI Data Set
ehdsi-dataelement-218draft E-mail draft eHDSI Data Set
@use
set_cs0 … 1 
 CONF
The value of @use shall be drawn from value set 1.3.6.1.4.1.12559.11.10.1.3.1.42.40 eHDSITelecomAddress (DYNAMIC)
hl7:assignedPerson
1 … 1MeHDSdotsiber
@classCode
cs0 … 1FPSN
@determinerCode
cs0 … 1FINSTANCE
hl7:name
PN1 … 1RHP NameIHE PCC
 Example<name>
  <given>John</given>  <family>Español Smith</family></name>
hl7:family
1 … *RHP Family Name/SurnameR1.10.1
 
target
ehdsi-dataelement-231draft Family Name/Surname draft eHDSI Data Set
hl7:given
1 … *RHP Given NameR1.10.2
 
target
ehdsi-dataelement-232draft Given Name draft eHDSI Data Set
hl7:prefix
0 … *RHP PrefixR1.10.3
hl7:suffix
0 … *RHP SuffixR1.10.4
hl7:representedOrganization
1 … 1RContains 2.16.840.1.113883.3.1937.777.11.10.111 eHDSI Organization (DYNAMIC)R1.10.9
 
target
ehdsi-dataelement-216draft Organization Name draft eHDSI Data Set
ehdsi-dataelement-215draft Organization Identifier draft eHDSI Data Set