Merge pull request #56 from HL7/mlt-qa-cleanup

qa cleanup; plain language summary; fixed narrative

Author: mlterryMitre1

input/fsh/examples/Role-OT-JenCadbury.fsh

@@ -2,7 +2,7 @@ Instance: Role-OT-JenCadbury
 InstanceOf: $USCorePractitionerRole
 Usage: #example
 Title: "Example: Role of Dr. Jen Cadbury"
-Description: "Dr. Jen Cadbury is a fictional Internal Medicine Physician at Neuro Care Inc."
+Description: "Dr. Jen Cadbury is a fictional Occupational Therapist at Happy Nursing Facility."
 
 * meta.profile = Canonical(us-core-practitionerrole|8.0.1)
 * active = true

input/ignoreWarnings.txt

@@ -5,9 +5,7 @@
 # See https://github.com/FHIR/sample-ig/blob/master/input/ignoreWarnings.txt for examples
 
 # These warnings are for dependency IGs, which we do not have direct control over
-# %Reference to draft CodeSystem http://hl7.org/fhir/narrative-status|4.0.1%
-# %Reference to draft ValueSet http://hl7.org/fhir/ValueSet/servicerequest-category|4.0.1%
-# %The extension http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet|5.2.0 is deprecated%
+
 INFORMATION: Bundle/Example-Smith-Johnson-TOCBundle: Bundle.entry[28].resource/*CarePlan/BSJ-SNFDischargeCarePlan*/.text.status: Reference to draft CodeSystem http://hl7.org/fhir/narrative-status|4.0.1
 INFORMATION: Bundle/Example-Smith-Johnson-TOCBundle: Bundle.entry[34].resource/*ServiceRequest/BSJ-SNFDischargeLabOrderBMP*/.category[0]: Reference to draft ValueSet http://hl7.org/fhir/ValueSet/servicerequest-category|4.0.1
 INFORMATION: Bundle/Example-Smith-Johnson-TOCBundle: Bundle.entry[35].resource/*ServiceRequest/BSJ-SNFDischargeLabOrderCBC*/.category[0]: Reference to draft ValueSet http://hl7.org/fhir/ValueSet/servicerequest-category|4.0.1
@@ -89,17 +87,11 @@ WARNING: 5: The HTML fragment 'expansion-params.xhtml' is not included anywhere
 # There is no hl7.fhir.us.ccda#1.8.0 listed in the CCDA IG. The most current version listed is 1.2.0: https://hl7.org/fhir/us/ccda/history.html
 WARNING: ImplementationGuide/hl7.fhir.us.pacio-toc: ImplementationGuide.dependsOn[9]: The ImplementationGuide uses package hl7.fhir.us.ccda#1.2.0 released on 2024-03-12, but the most recent appropriate version is 1.8.0. This reference is getting old and the more recent version should be considered
 
-# MedicationStatement and List resources are valid unsliced entries in the TOC Bundle (open slicing).
-# These types have no US Core 8.0.1 profiles, so they cannot be used with the #profile discriminator
-# without creating ambiguous multi-slice matches. Open slicing allows them as valid unsliced entries.
-
-# %This element does not match any known slice defined in the profile http://hl7.org/fhir/us/pacio-toc/StructureDefinition/TOC-Bundle%
-
 # PACIO PFE observations include an ICF domain category (category[PFEDomain]) that is required
 # by the pfe-observation-single profile. This category uses codes from http://hl7.org/fhir/sid/icf,
 # which are not in the us-core-simple-observation-category value set. US Core uses open slicing on
 # category, so this extra category is valid. The INFORMATION message is expected and safe to suppress.
-# %This element does not match any known slice defined in the profile http://hl7.org/fhir/us/core/StructureDefinition/us-core-simple-observation%
+
 INFORMATION: Bundle/Example-Smith-Johnson-TOCBundle: Bundle.entry[21]: This element does not match any known slice defined in the profile http://hl7.org/fhir/us/pacio-toc/StructureDefinition/TOC-Bundle|1.0.0 (this may not be a problem, but you should check that it's not intended to match a slice)
 INFORMATION: Bundle/Example-Smith-Johnson-TOCBundle: Bundle.entry[22]: This element does not match any known slice defined in the profile http://hl7.org/fhir/us/pacio-toc/StructureDefinition/TOC-Bundle|1.0.0 (this may not be a problem, but you should check that it's not intended to match a slice)
 INFORMATION: Bundle/Example-Smith-Johnson-TOCBundle: Bundle.entry[23]: This element does not match any known slice defined in the profile http://hl7.org/fhir/us/pacio-toc/StructureDefinition/TOC-Bundle|1.0.0 (this may not be a problem, but you should check that it's not intended to match a slice)

input/pagecontent/disciplines.md

@@ -2,7 +2,7 @@ The Centers for Medicare & Medicaid Services (CMS) Data Element Library (DEL) is
 
 ### Standardized Data for Continuity of Care ###
 
-The DEL ensures that PAC providers use standardized data elements, which are mapped to health IT standards such as Logical Observation Identifiers Names and Codes (LOINC) and Systematized Medical Nomenclature for Medicine–Clinical Terminology (SNOMED CT). This standardization allows for seamless communication and data exchange between different care settings, reducing the risk of errors or omissions during transitions of care.
+The DEL ensures that PAC providers use standardized data elements, which are mapped to health IT standards such as Logical Observation Identifiers Names and Codes (LOINC) and Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT). This standardization allows for seamless communication and data exchange between different care settings, reducing the risk of errors or omissions during transitions of care.
 
 Supporting Reference: CMS emphasizes that the DEL supports interoperability by aligning data elements with standards required for electronic health records (EHRs) under the 21st Century Cures Act. This alignment ensures that data can be shared across systems without loss of meaning or accuracy. (Centers for Medicare & Medicaid Services, 2023)
 

input/pagecontent/formal_specification.md

@@ -24,6 +24,6 @@ The following rules apply to all Transitions of Care Profile elements marked as
 - Data Consumer Systems **SHALL** be capable of displaying the data elements for human use.
 - Data Consumer Systems **SHOULD** be capable of storing the data elements for other uses (such as record keeping of data used for clinical use).
 - Data Consumer Systems **SHALL** be capable of processing resource instances containing the data element without generating an error or causing the application to fail.
-- Data Consumer Systems **SHALL** interpret missing data elements within resources instances as not being present on the Data Sources system’s or as being withheld for privacy or business reasons.
+- Data Consumer Systems **SHALL** interpret missing data elements within resource instances as not being present on the Data Source systems or as being withheld for privacy or business reasons.
 
 Profiles used by this IG, but defined in other IGs, inherit the definition of Must Support from their respective guides.

input/pagecontent/guidance.md

@@ -48,7 +48,7 @@ Social determinants such as transportation, housing, and access to food can impa
 
 #### Use of Technology and Telehealth ####
 
-Technology, such as electronic health records (EHRs) and telehealth, facilitates communication and monitoring during transitions, especially for patients in remote or underserved areas. Critically important technology and the impetus for this IG is human and machine readable interoperability form endpoint to endpoint across a national framework of networks such as TEFCA and the QHINs.
+Technology, such as electronic health records (EHRs) and telehealth, facilitates communication and monitoring during transitions, especially for patients in remote or underserved areas. Critically important technology and the impetus for this IG is human and machine readable interoperability from endpoint to endpoint across a national framework of networks such as TEFCA and the QHINs.
 
 * Evidence: A study by Lin et al. (2020) found that telehealth interventions during care transitions improved patient satisfaction and reduced hospital readmissions. (Lin MH, Yuan WL, Huang TC, et al. J Med Internet Res. 2020;22(10):e19099.)
 
@@ -58,9 +58,9 @@ Ongoing evaluation of transition processes, including patient outcomes and satis
 
 * Evidence: The National Transitions of Care Coalition (NTCC) emphasizes the importance of monitoring key metrics, such as readmission rates and patient satisfaction, to improve care transitions. (NTCC. Improving Transitions of Care: Findings and Considerations of the "Vision of the National Transitions of Care Coalition." 2008.)
 
-Effective post-acute care transitions requires interoperability across a national framework of networks, such as TEFCA, facilitating aa multidisciplinary approach that emphasizes communication (requiring human and machine readable interoperability), patient education, medication safety, follow-up care, and addressing social determinants. Evidence-based models and interventions, such as the Transitional Care Model and Care Transitions Intervention, have demonstrated their ability to improve outcomes and reduce rehospitalizations.
+Effective post-acute care transitions requires interoperability across a national framework of networks, such as TEFCA, facilitating a multidisciplinary approach that emphasizes communication (requiring human and machine readable interoperability), patient education, medication safety, follow-up care, and addressing social determinants. Evidence-based models and interventions, such as the Transitional Care Model and Care Transitions Intervention, have demonstrated their ability to improve outcomes and reduce rehospitalizations.
 
-By defining a standard of human and machine readable interoperable documentation for post-acute care transitions this IG facilitates focusing on these key aspects, healthcare providers to ensure smoother transitions, better patient outcomes, and reduced healthcare costs.
+By defining a standard of human and machine readable interoperable documentation for post-acute care transitions this IG enables healthcare providers to ensure smoother transitions, better patient outcomes, and reduced healthcare costs.
 
 ### Transitions of Care Document Structure
 
@@ -78,24 +78,24 @@ The Transition of Care composition defines the following sections:
 Declarations by individuals made in advance of a situation in which they may be unable to decide about or articulate their wishes for their own care, stating their treatment preferences and limitations on treatment. Examples include Personal Advance Care Plans, Portable Medical Orders, Mental Health Advance Directives, Episodic Advance Directives, POLST/MOLST forms.
 
 **Usage Notes:**
-
+No additional guidance beyond the description above.
 
 #### Allergies and Adverse Reactions
 
 **Section Code**: [LOINC 48765-2](https://loinc.org/48765-2/) Allergies and adverse reactions Document
 
 **Description:**
-List of any responses to medication, food, and topical. ingested or inhaled agent occurring with normal use that are unintended, potentially harmful, and unwanted by the individual. Allergic reactions involve the activation of the immune system in the response. Examples of adverse reactions include low blood pressure from opiates, confusion and dry mouth from anticholinergics. Examples of allergic reactions include hives, rash, and anaphylaxis.
+List of any responses to medication, food, and topical, ingested or inhaled agent occurring with normal use that are unintended, potentially harmful, and unwanted by the individual. Allergic reactions involve the activation of the immune system in the response. Examples of adverse reactions include low blood pressure from opiates, confusion and dry mouth from anticholinergics. Examples of allergic reactions include hives, rash, and anaphylaxis.
 
 **Usage Notes:**
-
+No additional guidance beyond the description above.
 
 #### Behavioral Health
 
 **Section Code**: local code: Behavioral Health Summary 
 
 **Description:**
-Observations, assessments, and interventions regarding the impact of behaviors on mental and physical well being. Examples of behaviors include reactions to stress, habits, substance use disorders, eating disorders, as well as mental health conditions such as anxiety, depression, psychosis, and personality disorders. Interventions include education, counseling, pharmacological and non-pharmalogical treatments. Impacts on physical and mental health include legal, social, and occupational issues, as well as physical impacts from behaviors such as sedentary lifestyles.
+Observations, assessments, and interventions regarding the impact of behaviors on mental and physical well being. Examples of behaviors include reactions to stress, habits, substance use disorders, eating disorders, as well as mental health conditions such as anxiety, depression, psychosis, and personality disorders. Interventions include education, counseling, pharmacological and non-pharmacological treatments. Impacts on physical and mental health include legal, social, and occupational issues, as well as physical impacts from behaviors such as sedentary lifestyles.
 
 **Usage Notes:**
 This section should not include diagnoses or medications. Diagnoses should all be in the TOC `Problems` section. Medications should all be included in the TOC `Medications` section. Ideally, Medications should be linked to the problem for which they are indicated. The diagnosis “Depression” is listed in the US Core Plan, but should not be included here.
@@ -108,7 +108,7 @@ This section should not include diagnoses or medications. Diagnoses should all b
 Observation, assessments, and interventions regarding basic physical and cognitive activities and their impact on mental and physical well being. Examples of observations and assessments include those of mental status, mobility, activities of daily living, speech, and swallowing. Examples of interventions include devices, therapy, and modification of the environment including personal assistance.
 
 **Usage Notes:**
-This section should not include diagnoses or medications. Diagnoses should all be in the TOC `Problems` section. Medications should all be included in the TOC `Medications` section” Ideally, Medications should be linked to the problem for which they are indicated. Within the US Core Procedure several diagnoses are listed, “Delirium, Depression, Psychosis and should not be included.
+This section should not include diagnoses or medications. Diagnoses should all be in the TOC `Problems` section. Medications should all be included in the TOC `Medications` section. Ideally, Medications should be linked to the problem for which they are indicated. Within the US Core Procedure, several diagnoses are listed — Delirium, Depression, and Psychosis — and should not be included.
 
 
 #### Immunizations
@@ -119,7 +119,7 @@ This section should not include diagnoses or medications. Diagnoses should all b
 List of immunizations an individual has received and when. May also include a schedule for future immunizations.
 
 **Usage Notes:**
-
+No additional guidance beyond the description above.
 
 #### Discharge Instructions
 
@@ -140,7 +140,7 @@ Education/instructions provided at discharge should be included.
 List of equipment the individual uses for prevention, diagnosis, monitoring, or treatment of conditions or functional impairment (disability). Examples included implanted pumps, lines, tubes and drains as well external devices including splints, mobility aides, and ventilators.
 
 **Usage Notes:**
-
+No additional guidance beyond the description above.
 
 #### Medications
 
@@ -178,7 +178,7 @@ Health concerns or symptoms that have been diagnosed using ICD 10 or SNOMED, as
 **Section Code**: [LOINC 47519-4](https://loinc.org/47519-4/) History of Procedures Document
 
 **Description:**
-List of interventions undergone by the indivdual that required informed consent. Examples include surgery, exposure to radiation, experimental interventions.
+List of interventions undergone by the individual that required informed consent. Examples include surgery, exposure to radiation, experimental interventions.
 
 **Usage Notes:**
 There may be additional procedures that have been documented for which informed consent was not obtained.
@@ -191,7 +191,7 @@ There may be additional procedures that have been documented for which informed
 Purpose to be served by moving the individual to a new site of care. Examples include continued rehabilitation or treatment, treatment unavailable at the current site, preference of individual or substituted decision maker.
 
 **Usage Notes:**
-
+No additional guidance beyond the description above.
 
 #### Clinical Results
 
@@ -243,7 +243,7 @@ We are evaluating the following sections for a future release and welcome feedba
     </tr>
     <tr>
         <td>Competency</td>
-        <td>Observations and assessments of the ability to understand the nature and effect of the act in which the individual is engaged in particular the ability to consent to treatment. (See also: Substitued Judgement)</td>
+        <td>Observations and assessments of the ability to understand the nature and effect of the act in which the individual is engaged in particular the ability to consent to treatment. (See also: Substituted Judgement)</td>
         <td />
     </tr>
     <tr>