OMQ^O57 Acknowledgment Choreography

It should be noted that, unless orders are communicated at the granular, fully decomposed test/medication/procedure/etc. level, state management can only happen at the group level, i.e., equal to all elements in the document. It also should be noted that identification of individual elements can only be achieved if the CDA document contains appropriate identification while the order numbers in ORC effectively act as a group number.