CDAbased content integration profiles

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CDA-based content integration profiles

• Philippe Lagouarde, Cegedim
• Co-chair Vendor, IHE-France

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plan

• CDA ?
• CDA Release 1
• CDA Release 2
• Integration-content profiles
• Conclusion

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CDA Clinical Document Architecture

• CDA is an international standard
• ANSI/HL7 CDA R1.0-2000
• ANSI/HL7 CDA R2.0-2005
• CDA is an XML-based format for clinical document

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Interoperability

• CDA proposes two levels of interoperability
• Human
• CDA describes traditional structure of a document
• CDA does not required sophisticated tools to be
  directly read by Healthcare professionals or
  patients
• Application interoperability
• multimedia content
• data

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Application
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Readable Human Rendering
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Characteristic of a CDA document

• Persistence
• Stewardship
• Potential for authentication
• Context
• Wholeness
• Human readability
• A CDA document is a defined and complete
  information object that can include text, images,
  sounds, and other multimedia content.

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Structure of a CDA document

• Document context
• Clinical information

• XML encoding
• Human readable
• and by computers

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plan

• CDA ?
• CDA Release 1
• CDA Release 2
• Integration-content profiles
• Conclusion

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CDA R1

• First HL7 standard based on the RIM

Header
Body
Body some structured clinical data for
automatic processing
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CDA Header

• Document Identification (ID, code, title, date )
  
• Confidentiality, language, authorisations
• Authenticator(s), including legal authenticator
• recipient(s) du contenu
• Author(s), Data enterer
• Patient
• Informants
• Related Document(s)
• Service Event(s), Participant(s), Encounter

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CDA R1 - Example of Body
ltsectiongt ltcaptiongt ltcaptionCode
V"11496-7" SLOINC"/gt Allergies and
Adverse Reactions lt/captiongt ltlistgt
ltitemgtltcontent IDA1gtPenicillin -
Hiveslt/contentgtlt/itemgt ltitemgtltcontentgtAspirin
- Wheezinglt/contentgtlt/itemgt ltitemgt
ltcontentgtCodeine Itching and nausealt/contentgt
lt/itemgt lt/listgt ltcoded_entrygt
ltcoded_entry.value ORIGTXTA1
V"DF-10074" SSNOMED DNAllergy to
Penicillin/gt lt/coded_entrygt lt/sectiongt
Narrative
Computable
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plan

• CDA ?
• CDA Release 1
• CDA Release 2
• Integration-content profiles
• Conclusion

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CDA R2

• HL7 V3 Framework Development

RIM ? ? XML Schema
Header
Body
Observation
Substance administration
Narrative block
Procedure
Entry
Encounter
Observation Media

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CDA R2 Example of Body
Narrative
lttextgt ltlistgt ltitemgtltcontent
ID"A1"gtPenicillin Hives lt/listgt
lt/textgt ltentrygt ltobservation
classCode"OBS" moodCode"EVN"gt ltcode
code"84100007" codeSystem"2.16.840.1.113883.6.96
codeSystemName"SNOMED CT"
displayName"History taking"/gt ltvalue
xsitype"CD" code"247472004"
codeSystem"2.16.840.1.113883.6.96"
displayName"Hives"gt ltoriginalTextgtltrefere
nce value"A1"/gtlt/originalTextgt lt/valuegt
ltentryRelationship typeCode"MFST"gt
ltobservation classCode"OBS" moodCode"EVN"gt
ltcode code"84100007" codeSystem"2.16.840.1.
113883.6.96" displayName"History
taking"/gt ltvalue xsitype"CD"
code"91936005 CodeSystem"2.16.84"
displayNamePCN Allergy"/gt
Computable
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Benefits of CDA R2

• Non limited Vocabularies (SNOMED, LOINC, national
  vocabularies)
• Structured data coherent with the HL7 RIM
• Modification of Confidentiality code, language,
  auteurs, within a section
• Internal and external links
• An observation (eczema) ? a substance
  administration (penicillin)
• An observation (fracture) ? une image (radiology)
  
• Current document (Discharge letter) ? another
  document (referral)
• A unique schema an a generic XSL stylesheet

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For all type of documents

• Communication Admission evaluation
• Transfer of care referral Pre-operative
  evaluation and management
• Evaluation and management Subsequent
  evaluation
• Conference Summarization of episode
• Case conference Transfer summarization
• Consult Discharge summarization
• Confirmatory consultation Summary of death
• Counseling Transfer of care referral
• Group counseling Supervisory direction
• Education Telephone encounter
• History and Physical Interventional
  Procedure
• Admission history and physical Operative
• Comprehensive history and physical Pathology
  Procedure
• Targeted history and physical Autopsy
• Initial evaluation Admission evaluation
• Admission evaluation Pre-operative
  evaluation and management

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CDA Implementation guides

• The objective is to give a common table of
  contents to all document of a specific type
• Additional constraints to the generic CDA
  standard
• First initiatives for CDA medical summaries
• e-MS (British Columbia)
• Clinical Record Summary (HL7/ASTM US)

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Example - CRS
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Example of the Sciphox Project
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Important development

• International
• Germany SCIPHOX (medical summary)
• Finland ( 100 CDA guidelines)
• France Volet Médical (medical summary)
• New Zeland Health Information Summaries
• Italy TeleMed Escape
• UK (NHS, South Staffordshire)
• Japan MERIT-9
• Greece HYGEIAnet/WebOnColl
• IHE
• IHE Transactions profiles are extended by IHE
  integration content profile

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• CDA ?
• CDA Release 1
• CDA Release 2
• Integration-content profiles
• Conclusion

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IHE-XDS

• Cross Document Sharing integration profile
• Neutral from format
• RTF, PDF, DICOM, JPEG and CDA
• Neutral from type of CDA document
• Metadata used for management of the document
  inherits from the CDA header

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IHE-XDS Actors/Transactions

• Extension of Clinical Content Profile also with
  XDM and XDR integration profiles

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XDS-MS

• 2006 PCC a new IHE domain PCC (Patient Care
  Coordination)
• First focus To leverage IHE-XDS for Medical
  Summary Documents
• A class of clinical documents that contain the
  most relevant portions of information about the
  patient intended for a specific provider or a
  broad range of potential providers in different
  settings.
• Content Profiles define how the content used in a
  transaction is structured.
• Implementation guides for types of CDA document

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XDS-MS Example of guides
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Evolution of PCC
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Extension to other IHE domains

• Laboratory domain Example of a use case from
  the 2007 Sharing Laboratory Reports (XD - LAB)

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LAB CDA report constraints

• A clinical laboratory report SHALL have a
  structuredBody.
• This body is organized as a tree of up to two
  levels of sections.
• Top level sections represent laboratory
  specialties.

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XDS-MS Actors
Share content
Content creator
Content consumer
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XDS-MS Options
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Conclusion

• CDA R2 a flexible tool to manage electronic
  document
• Ready to use
• Implementation guides to constraint CDA document
  types
• New localisation possibilities for national IHE
• Rapid development
• International initiatives outside IHE context
• IHE Content profiles

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Thank you!

• IHE Europe web site www.ihe-europe.org