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AttributeSchema Type or Enumeration ValuesUsageDefinitionBusiness Rules
ItemOIDoidrefRequiredReference to an ItemDef in the MetaDataVersion identified in the ClinicalData element.
TransactionType(Insert | Update | Remove | Upsert | Context)ConditionalRecords the TransactionType for this ItemData instance in the source system.The TransactionType attribute must be provided on the ItemData or one of it's anscestor elements  its ancestor elements when the ODM/@FileType has the value 'Transactional'.  
IsNull(Yes)ConditonalConditional

IsNull is a flag to signify that an item's value is to be set to null. If the Value attribute is set, IsNull must not be set. If IsNull is set, the Value attribute msut must not be present.

In the interest of creating non-verbose XML instances, one should not use ItemData elements with IsNull set to "Yes" to indicate uncollected data. The better practice is to transmit only collected data.

It is not necessary to provide an ItemData element with IsNull set to "Yes" in cases where the source system would not created create a record.

For use cases where data traceability is important,  providing ItemData elements wiht with IsNull="Yes" maybe be useful.