There is a Composition.confidentiality element, this element should be removed.

It is duplicate functionality to the security tags found in Composition.meta. duplicate ways to carry the same information is not helpful wout an explaination of why there is duplication, how this is different, why this should be used rather than meta?

Please remove the Composition.confidentiality element.

You could remind your reader that the Composition.meta element exists for the same functionality found in CDA confideniality code...