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

2. 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 2

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

4. CDA: Clinical Document Architecture
What?
ANSI/HL7 CDA R
ANSI/HL7 CDA R
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

5. 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

6. 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

7. 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

8. 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

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

10. Where? 10

11. CDA Italian Style
Where? 11

12. 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

13. 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

14. How?
do I use my CDA? 14

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

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

17. How?
do I use my CDA?
Aluetietojärjestelmä 17

18. How?
do I use my CDA?
Aluetietojärjestelmä 18

19. 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

20. 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

21. 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

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