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CDA-based content integration profiles

CDA-based content integration profiles. Philippe Lagouarde, Cegedim Co-chair Vendor, IHE-France. plan. CDA ? CDA Release 1 CDA Release 2 Integration-content profiles Conclusion. CDA : Clinical Document Architecture. CDA is an international standard ANSI/HL7 CDA R1.0-2000

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CDA-based content integration profiles

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  1. CDA-based content integration profiles Philippe Lagouarde, Cegedim Co-chair Vendor, IHE-France

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

  3. 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

  4. 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

  5. Application

  6. Readable Human Rendering

  7. 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.

  8. Header Body Diagnosis: Asthma Generiic stylesheet <section> <caption>Diagnosis</caption> <content>Asthma</content> </section> Structure of a CDA document • Document context • Clinical information • XML encoding • Human readable… • …and by computers

  9. plan • CDA ? • CDA Release 1 • CDA Release 2 • Integration-content profiles • Conclusion

  10. CDA R1 First HL7 standard based on the RIM Header Body Body : some structured clinical data for automatic processing

  11. 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

  12. CDA R1 - Example of Body <section> <caption> <captionCode V="11496-7" S=“LOINC"/> Allergies and Adverse Reactions </caption> <list> <item><content ID=“A1”>Penicillin - Hives</content></item> <item><content>Aspirin - Wheezing</content></item> <item> <content>Codeine – Itching and nausea</content> </item> </list> <coded_entry> <coded_entry.value ORIGTXT=“A1” V="DF-10074" S=“SNOMED“ DN=“Allergy to Penicillin”/> </coded_entry> </section> Narrative Computable

  13. plan • CDA ? • CDA Release 1 • CDA Release 2 • Integration-content profiles • Conclusion

  14. CDA R2 HL7 V3 Framework Development RIM  … XML Schema Header Body Observation Substance administration Narrative block Procedure Entry Encounter Observation Media …

  15. CDA R2 – Example of Body Narrative … <text> <list> <item><content ID="A1">Penicillin – Hives … </list> </text> <entry> <observation classCode="OBS" moodCode="EVN"> <code code="84100007" codeSystem="2.16.840.1.113883.6.96“ codeSystemName="SNOMED CT" displayName="History taking"/> <value xsi:type="CD" code="247472004" codeSystem="2.16.840.1.113883.6.96" displayName="Hives"> <originalText><reference value="#A1"/></originalText> </value> <entryRelationship typeCode="MFST"> <observation classCode="OBS" moodCode="EVN"> <code code="84100007" codeSystem="2.16.840.1.113883.6.96" displayName="History taking"/> <value xsi:type="CD" code="91936005“ CodeSystem="2.16.84…" displayName=“PCN Allergy"/> … Computable

  16. 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

  17. 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

  18. 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)

  19. Example - CRS

  20. Example of the Sciphox Project

  21. 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”

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

  23. 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

  24. IHE-XDS – Actors/Transactions • Extension of Clinical Content Profile also with XDM and XDR integration profiles

  25. 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

  26. XDS-MS – Example of guides

  27. Evolution of PCC

  28. Extension to other IHE domains • Laboratory domain : Example of a use case from the 2007 Sharing Laboratory Reports (XD - LAB)

  29. 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. • … • …

  30. XDS-MS Actors Share content Content creator Content consumer

  31. XDS-MS Options

  32. 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

  33. Thank you! IHE Europe web site: www.ihe-europe.org

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