1. Clinical Documentation Architecture (CDA) S&I Framework One-Pager Series, Side 1 Background CDA is an XML-based standard prescribed by HL7 that specifies the encoding, structure, and semantics for the exchange of clinical document information. There are several source Implementation Guides (IG) that are covered by the CDA standard: Eight Health Story IGs HITSP/C32 HITSP/C83 HL7 and IHE Templates HITSP/C48 Challenge The healthcare community faces implementation challenges regarding navigation of the source IGs. Source CDA IGs contain multiple layers of references to other documents rather than including section level content in one document. The resulting occurrence forces developers to follow a reference trail in order to implement standards. S&I Framework: ONC brought together providers, health IT vendors, states, federal partners, government agencies, the standards community and the research community to examine how to improve the exchange of clinical information among providers, patients and other authorized entities electronically in support of meaningful use and IOM-identified needs for improvement in the quality of care. 2 Solution The CDA project consolidates existing disparate IGs through a harmonization process that eliminates current implementation challenges - unclear documentation, lack of technical guidance, and a general overlap of standards – that EHR implementers face. CDA uses model-driven tools development that enables the reusability of templates to republish IGs for future initiatives. 1 3 CDA Overview CDA Objectives and Progress There were several charter objectives identified during the launch of the CDA Consolidation project, under the S&I Framework, focusing on the rapid development of a Consolidated CDA Implementation Guide: Objective 1 Consolidate the HL7/Health Story clinical document type IGs and HITSP/C32, and HL7 and IHE templates into a single library of CDA Templates using model- driven tools to re-publish them from this library Objective 2 Rapid demonstration of templated CDA for health information exchange, according to PCAST recommendations Provide a real world demonstration of model-driven standards development using MDHT and the CDC/NCI Template Database (Tdb) Objective 3 Objective 4 Resolve the ‘peel the onion’ problem: deliver a single, implementation-ready, implementer-friendly package, which includes both textual and computable Development of a testing solution to enable implementers to validate their output Objective 5

2. Clinical Documentation Architecture (CDA) S&I Framework One-Pager Series, Side 2 1 CDA Tooling Process CDA Adoption Approach The approach for CDA consolidation is a three step process that begins by identifying the source CDA standards to be consolidated, consolidates the identified guides, and generates critical published outputs to provide to implementers. The Consolidated CDA IG is expressed in two ways: The document submitted through HL7 ballot and the outputs generated through Model-Driven Health Tools (MDHT) and Tdb. MDHT serves as the tool used to enable consolidation and can be used to generate Java API, validation tools, and sample code to reference in support of implementation. Step 1: Identify Current Standards Used by an organization to determine the level of fit and gaps between their current state and the Consolidated CDA IG. Step 2: Define Constrained CDA by recommending optional and required data fields that organizations need to be supported. Step 3: Adopt Constrained CDA to provide an incremental milestone towards transitioning to the full CDA standard. Vendors should be engaged to support the implementation of constrained CDA. Step 4: Transition to Consolidated CDA IG by identifying the gaps that need to be bridged between the current state and full standard. Vendors will need to expand their involvement to also support the implementation of the Consolidated CDA IG. The CDA project utilizes the following approach to enable an organization to transition to the Consolidated CDA Standard. The project considers the following stakeholders: State HIE, Beacon Communities, LTPAC, VLER, the ToC Initiative, and healthcare vendors: Key Links 2 3 4 5 S&I Framework Wiki http://wiki.siframework.org CDA Wiki Overview http://wiki.siframework.or g/CDA+Consolidation+P roject+Charter http://www.healthstory. com/standards/standar ds.htm Health Story IGs Health Level 7 (HL7) www.HL7.org ONC Website healthit.hhs.gov/portal