WHY DEAL WITH A CDA INCARNATION OF X73? Or, do we really need more problems… Hint: perhaps we do

The “usual” use case for device data is streaming

But what about inclusion in encapsulated record of clinical happenings? Key feature is boundedness Who wants it? First use case from anesthesiologists: anesthesia record (use case detail) Fair to say it is a gap even though groups involved are hard at work elsewhere (? -> discussion topic)

Things fly apart (with apologies to Yeats and Chinua Achebe) Centripetal Forces in Play Stop the world, I want to stay on

Desirability of pulling together Lots of disparate: Goals Organizations/groups People Ideas Involved. Current project is another instance of an opportunity to diverge – we don’t want to do that

Building Blocks Nomenclature Domain Information Model (DIM) Document architectures Clinical Document Architecture (CDA) Continuity of Care Document (CCD) Implementation Guide for CDA Release 2.0 Personal Healthcare Monitoring Report (PHMR) Implementation Guide for CDA Release 2.0 Personal Healthcare Monitoring Report (PHMR)

Personal Healthcare Monitoring Report (PHMR) Intended Use: Remote monitoring Stimulus from Continua Alliance Status: expired Draft Standard for Trial Use (resuscitation underway?)

Previous work Martin Hurrell Alan Nicol Devised a schema incorporating concepts and models; went through an iteration with HL7 Structured Documents group Current work relies on this

Current work (Hardly deserves the name of work – mea culpa. John Rhoads is working on modeling and schema – John Walsh is offering clinical guidance and support)

Basic CCD Very general – can be (and has been) used or extended for very many kinds of medical events and sequences Framework for inclusion of minimum needed information on what happened and who it happened to

What PHMR added to CCD Inherits general form and may constraints from CCD Structural adds to CCD: device details RIM Observation object: device supplements

PHMR as is Required sections: Medical Equipment Vital Signs Results

PHMR as is, contd. Optional sections: Purpose Medications Functional Status

PHMR as is, contd. Medication administration Supports inclusion of waveforms Limited (PHD) nomenclature and examples Glucose meter Thermometer

PHMR, contd. Constraints section General Clinical Statement Constraints Device Definition Organizer PHMR Product Instance PHMR Product Instance Reference Sampling Frequency Observation Device Resolution Observation Device Accuracy Observation Numeric Observation Waveform Series Observation Waveform Sample Period Observation Waveform Observation Event Observation

Semantic fidelity challenges We tend to funnel device data through HL7 V2, for example, with the IHE PCD Device Enterprise Communications profile Since HL7 V2 was really not purpose-built for this, certain contortions occur to meet challenges of: Supplementary backup measurement information Provenance / traceability

What more would be useful to add Provenance (promotes traceability Medical Device Systems MDC Virtual Medical Device VMD Channel Metric Supplementary measurement and device information

CCD HL7 quasi-UML, in part

Alan Nicols model proposal

As embodied in XML

To do Work in additional DIM material as required Identify nomenclature to use Document Work through process

You too can be part of this magnificent effort Fortunately we have a CDA expert who has actually volunteered and others we can dragoon, that is, politely call on expertise wanted – in any case you will be solicited