Sorry to be a little late to the party!! These are very good questions.
You are quite correct that in a fully ‘properly’ designed system we would almost certainly tease out aspects like problem lists, lab results etc into different templated compositions.
I was the primary author of the Heart Failure summary template and its primary purpose was to model the overall content requirements for a research app dataset as part of an EU academic project, modelled on a real-world registry/research application. So it was built of a vey specific purpose, and much simpler use-case than you are imagining but you might consider it to be a ‘copy’ of an outpatient letter, so might make sense as snapshot of an outgoing message.
The other NCD template you were looking at is/was based on some early work in Jamaica, really as a training exercise. I am actually working with the team in Jamaica to take this towards a real deployment and we are discussing exactly those issues that you raise - what should be split out into different compositions. I’m sure they will be no objection to sharing the outcome of the discussions. So very much work in progress.
Whether to reference or clone/copy data that originates e.g in an Encounter can be tricky - in a perfect world I would always want to reference but this can be harder to implement and manage over time.
I guess part of the issue here is that are often trying to take our customers/users on a journey from a form-based view of the world where e.g medication lists are replicated on every form, but also have to recognise that some of these lists are not truly longitudinal/holistic but may need to be maintained per patient pathway / condition.
Why does medication list or problem list need to be updated in the separate COMPOSITION despite there are medication order and diagnosis/problem sections in the Encounter template? It seems for me to cause data redundancy and reduce data integrity.
So yes, in theory I agree but sometimes we make compromises for training purposes or because the ‘customer’ is not quite ready to jump into that level of sophistication.