International Healthcare Interoperability Conference CDA Around the World August 25, 2006 International Healthcare Interoperability Conference Cologne, Germany Liora Alschuler

All about us Consultant, Alschuler Associates, LLC Co-editor, CDA Military Health System, Northrup-Grumann “Documents, Files, Images” (DFI) project Subcontractor, HITSP Standards Harmonization Subcontractor, HISPC Security & Confidentiality Center for Disease Control & Prevention (CDC) Commercial software developers implementing standards-based solutions Co-editor, CDA Co-chair HL7 Structured Documents TC Co-author, CDA & CRS Quick Start Guides Member, HL7 Board of Directors HL7 IHE Liaison past Chair, KEG & XML SIG & HL7 Marketing Committee Author ABCD... SGML: A Managers Guide to Structured Information, 1995 liora@alschulerassociates.com, www.alschulerassociates.com 2

The World & CDA What? Where? How? Why? What next? 3

CDA: Clinical Document Architecture What? ANSI/HL7 CDA R1.0-2000 ANSI/HL7 CDA R2.0-2005 Created & maintained by HL7 Structured Documents Technical Committee (SDTC) A specification for document exchange using XML, the HL7 Reference Information Model (RIM) and vocabulary (SNOMED, ICD, local,…) XML is the wire format, the RIM is “behind the scenes” Differences between R1 and R2 ---------------------------------------------- The R1 header was derived from the RIM, but the body was hand crafted. This was intentional, because they wanted to limit the scope until they really figured out what they wanted to do. R2 has coded entries in the body that derive from the RIM. 4

HL7’s CDA What? eDocuments for Interoperability Everyone uses documents All types of clinical documents Many documents comprise an individual medical record Indexed by the the CDA header EMR compatible, no EMR required Consult Discharge Radiology Animation Can hold very primitive (scanned docs) or highly structured documents. Does not require physicians to purchase EMR systems or spend a lot of time recoding their records. Lets people start playing today, while providing for much richer data in the future. Path CCD CDA Health chart 5

Sample CDA What? Header Body Readable: required Computable: optional 6 Animation The CDA XML and how it is rendered. Maybe launch the actual CDA sample in a browser (with/without stylesheets). Open one in FireFox and one in IE. 6

CDA: A Document Exchange Specification What? CDA: A Document Exchange Specification This is a CDA and this Animation Anything that would go in a patient’s chart. Legally attestable Has a custodian (i.e. the entity holding the record at the time of creation). 7

In the world? Where? CDA: fundamental to national/regional exchange Germany SCIPHOX Finland Aluetietojärjestelmä Greece HYGEIAnet/WebOnColl Japan MERIT-9 (MML) Canada e-MS France Dossier Médical  Personnel Italy TeleMed Escape US CHI, HITSP, IHE Argentina Hosp. Italiano de Buenos Aires 8

In the world? Where? and where else? Major pilots, experimental work Korea Mexico Israel New Zealand Australia Estonia Wales England and where else? 9

Where? 10

CDA Italian Style Where? 11

CDA personal health record How? CDA personal health record All transform to CDA Complete view of record No loss in computable semantics PHR EMR web HL7|^v2 data PM-paper CDA CDA ? CDA HL7|^v2 text CDA What is available? How do I get it? Can I read it? Can I import it into my EMR/PHR/CDR...? text CDA CDA ? HL7|^v2 chart CDA CDA EHR V-EHR PHR Patient Portal Physician Portal Health Record Bank LIS CDA text DICOM paper NCPDP RIS/dictation eRx/paper 12

SpringHIE: PHR Bank How? Health Record Bank puts the patient in control Patients view records, grant viewing priviledges Payer views records with permission HRB Providers view records with permission Registry accesses records with permission 13

How? do I use my CDA? 14

Record Locator Service How? do I use my CDA? Aluetietojärjestelmä Record Locator Service Markle CfH Prototype 15

How? do I use my CDA? Aluetietojärjestelmä CDA Health chart 16

How? do I use my CDA? Aluetietojärjestelmä 17

How? do I use my CDA? Aluetietojärjestelmä 18

do I use my CDA? How? p2p RLS CEN/LDAP national spine PHR/HRB CDA is adaptable across multiple exchange architectures RLS Aluetietojärjestelmä CEN/LDAP national spine PHR/HRB 19

CDA ? Why? Ease of rendering Fidelity to authenticated content Single standard or custom stylesheet Fidelity to authenticated content Medical-legal record Full record All types of content Optimize level of semantic interoperability Only code where it pays off Works across disparate, evolving architectures Central or distributed; any discovery, access method 20

Seven Challenges for CDA What next? Seven Challenges for CDA CDA vs. EHR/EMR Narrative documents are not necessary evil, they are essential CDA vs. MyCode Proprietary “works”: short term CDA vs. OtherStandards Other standards are not the challenge (see above) CDA vs. IHE IHE is cool but it’s only one way to do things Re-packaging should not obscure the brand CDA vs. HL7 CDA is not the ugly step-child of V3 messaging CDA is the vanguard of RIM-based interoperability HL7 needs a cohesive architecture for interoperability CDA vs. CDA Release 3 How much, how soon? CDA vs. CDA What are the limits of semantic interoperability? 21

The World & CDA What? Where? How? Why? Questions? What next? 22 alschulerassociates.com