1. State CDA Pilot Projects Delaware’s Journey

2. State CDA Pilot Projects • Two Projects Not One • What is CDA • Template Development • Execution • Conclusion

3. Two Projects Not One • Template Development Project • Execute Data Exchange Project

4. Two Projects Not One • Project Teams Make-Up • Project Executive Team • State Pilot Team • State Personnel • Vendors • Template Team • Modelers

5. Two Projects Not one • Delaware was unique • There were participants on both Template Development and the State Pilot teams • Other participating jurisdictions only had representation on the state pilot team • As a dual participant there were approximately 12 additional hours of conference calls added to our calendars each month

6. WHAT is CDA? • CDA(Clinical Document Architecture) by definition is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange. (fancy webpage)

7. Author Raw CDA XML

8. Author Rendered CDA

9. Template development • Reportable Conditions • Determine reportable conditions • Who are they reportable to? • Reportable to the State Health Offices • Reportable to the CDC • Reportable to both • Do you share this data with other states?

10. Template development Gather reportable condition forms from multiple sources LA-County, New York City, Massachusetts ,Michigan • Similarities • Naming conventions • Formats • Medication recommendations • Treatment recommendations • Demographics • Differences • Naming conventions • Formats • Medication recommendations • Treatment recommendations • Demographics

11. Template development • Implementation guidelines • If published guidelines exists then you can follow the guidelines • If there are no published guidelines then you have to look at developing vocabulary and submitting to PHIN VADS(PHIN Vocabulary Access & Distribution System)

12. Learning Model Driven health Tool(MDHT) • What is MDHT • MDHT is a JAVA based application, built on the open source application Eclipse maintained by The Eclipse Foundation • Who do you need? • CDA Expert • Templates / Constraints • Background • Understand both business and technical sides of project • Does not need to be technical but it helps • There is technical language that may get mixed in

13. Place Holder for MDHT screenshot MDHT Screen Shot

14. Learning Model Driven health Tool(MDHT) MDHT was the most time consuming part of the project • Learn a new tool • Technical issues • Network issues • Firewalls • Permission issues • Time constraints • Competing priorities

15. Learning Model Driven health Tool(MDHT) • Learning a new tool • Different than other development tools • Even with a technical background the learning curve proved difficult at times because there were a lot of manual steps that could have been automated.

16. Near the end of Modeling • Weekly conference calls • Conference calls 2x a week • Extra Conference calls a week when needed Modeling DONE

17. Execute the model • State Pilot Project Team • Business Analysts • EMR, DERSS (NEDDS based system), and DPHL(Lab) • Vendors • Core Solutions, Labware, Orion Systems

18. Execute the model • Delaware’s initial CDA execution plan Lab Instruments Lab Request LIMS Lab Result EMR/EHR CDA Lab Result Set Lab Request Lab Request Rhapsody CDA Lab Result Set DERSS DHIN EMR

19. Execute the model • Delaware’s actual CDA execution plan DHIN Rhapsody EMR/EHR CDA Result Set CDA Result Set DERSS

20. Execute the model • Why change the execution plan? • Time • Vendor Business Model was not flexible enough to dynamically deliver resources in 30 days or less • LIMS vendor could not perform the work needed in the required time frame

21. Conclusion • Resource intensive project • States participating at all levels will need additional resources • Template development is time consuming and public private partnership is worth considering • Forces you to think about your entire data sharing model • Opens up new opportunities for collaboration • Allows you to better plan your funding for data integration

22. Participants Template Team • Anna Orlova, PHDSC • Maiko Minami, PHDSC • Alla Fridman, PHDSC • Lisa Nelson, PHDSC • Sarah Quaynor, PHDSC • Kendall Patterson, Delaware • Sondra Renly, IBM Research • Lori Reed-Fourquet, eHealthSign • NikolayLipskiy, CDC Pilot Participants • Marcy Parykaza, Delaware • Jean Collison, Delaware • Patricia Burke, Delaware • Barry Borden, Delaware • Andrew Rentschler, Delaware • Kendall Patterson, Delaware • Core Solutions(EMR Vendor)