Convert your FHIR JSON -> XML and back here. The CDA Book is sometimes listed for Kindle here and it is also SHIPPING from Amazon! See here for Errata.

Ask me a Question

This page was inspired by Grahame Grieve.  Simply post a comment with your question or topic suggestion below.  I'll either answer it in a followup comment, or write a post on it.

[Note: Due to increases in spamming on other pages, your comment may not be published immediately.  Don't worry, I'll accept all comments so long as they aren't spam, and if I cannot answer it, I'll let you know.  One benefit of this new approach is that it should encourage me to answer your questions sooner!]

The rules are simple:
  1. Topics I'll cover include anything in the Tag cloud to the right...
    (Please do not ask me questions about my employer's products.  While I may sometimes be the right person to answer these, this blog is not related to my employment, and isn't the proper channel to ask or respond to those questions.  If uncertain, you can always contact me directly).
    (Also don't ask me questions about Meaningful Use certification (e.g., how to pass a test).  I'm not an authority there, and while I can tell you what is correct in the standard, I don't want to give bad advice about certification).
  2. All questions and suggestions posted are subject to this Blog's Policies.  
  3. If I don't know or cannot otherwise answer your question, I'll let you know.  
  4. Questions are not necessarily answered or addressed in the order received.  Note, the SLA here is when I can get to it, which is probably not what you are looking for.  However, I do encourage other readers to answer when possible.
Answers and Questions from 2011 have been Archived.
Answers and Questions from 2012 have been Archived.
Answers and Questions from 2013 have been Archived.
Answers and Questions from 2014 have been Archived.
Answers and Questions from 2015-2016 have been Archived.
Answers and Questions from 2017 have been Archived.


  1. After reading Grahame's book, where he describes that in a CCD all information to authorize, bill, contact and collect from a payer should be in the payer section: would the medicare identifier for a hospital go in there, or be in the provider organization under clinicaldocument?

  2. Dear Kieth, in you blog post from March ( you mentioned the issue of e1 containing a diagnostic image report in the body of the document. I've encountered this issue and was wondering if you'd found a resolution, or could point me to someone who may help resolve this? Thanks!

  3. Hello Kieth,

    I am struggling in understanding the differences between XDR/XDM and XDS(.b). All I know is below:

    XDR: SOAP based post over HTTPS. This will be under HISP Direct protocol.
    XDM: SOAP based post over SMTP. This will be under HISP Direct protocol.
    XDS: SOAP based post over HTTPS using SAML as and Mutual TLS for encryption.

    In healthcare industry, What approach is more acceptable? XDS.b or XDR?

    1. XDR and XDM are used for messaging, and supported by the Direct protocol. Most every EHR in the US supports the Direct protocol in some way, most often through XDM and SMTP (though XDR is also used to some extent). NOTE: XDM is NOT SOAP based.

      XDS.b is widely used with HIE systems, and is likely the preferred approach for HIE connections.

      All are widely acceptable, the question is, what is your specific use case, and then you can get a better answer.

  4. Hello,
    On the Fhir coverage resource, what type indicates "Medicare" and what type indicates "Medicaid"? Also is there an easy way of identifying if the payor is a private party like "Aetna"?

    1. Codes used to identify coverage vary according to jurisdiction, but most are commonly based on Federal claims standards to identify type of payer.

      May payers (like Aetna) act in both public and private interactions (e.g., they handle some kinds of Medicare processing), so there isn't an easy way to distinguish between them.

  5. Please explain how SNOMED can provide hierarchy and ontology coding

  6. Using a Google search, I came across your blog post for 04/27/2010 concerning Advance Directives in a CCD. You mentioned the advance directive content should not be included in a CCD, and indeed, the Advance Directive Observation Template (2.16.840.1.113883. did not allow for a value element. However, there has since been a 2015-08-01 update to this template requires a value element. I've seen many sample CCD's, including in HL7 documentation, that have a value element here describing the advance directive content. Is your old blog post now obsolete, and advance directive content can and should be summarized in the value element?

    1. Summarized as to type, perhaps, but not in more detail. The challenge is that an advance directive can be VERY specific, but the summary not. For example, a no intubation order may be for a specific time period, but that would not be captured in a summary, and thus anything more than the type of content contains can result in a misapplication of the patient's intent.