Transcript Oracle experiences from eHealth projects across Europe

The Basics of HL7 CDA
Krzysztof Kulesza, Business Development Director – Healthcare
Oracle Polska
Ożarów Mazowiecki, 16.02.2012
Agenda
• Introduction – what is HL7 CDA
• HL7 CDA Document Paradigm and Methodology
Overview
• GreenCDA
• Examples from real world
• Conclusion
*some slides with courtesy of Rene Spronk, Liora
Alschuler, and many other HL7 experts
Introduction
• Why Document Standard?
• Documents are usually the most
standard way of conveying
health information and status in
service provisioning
• Practitioners are used
to communicate in
terms of “notes” or
“clinical documents”
• All Healthcare Records
(paper and electronic)
are comprised by sets
of documents
HL7 CDA
Clinical Document Architecture
• HL7 CDA - XML-based markup standard intended to specify the
encoding, structure and semantics of clinical documents for
exchange
• HL7 CDA is all about interoperability
• Human interoperability – matching what is existing today in paper format
• SW application interoperability – enable storage and management of clinical
data, reusability, etc
• Based on HL7v3 methodology and RIM – the fundamental part of
HL7 CDA document specification
• ISO/HL7 27932:2008
• It does NOT define how the document is transferred from A to B
HL7 CDA
Clinical Document Architecture
• HL7 CDA provides you with
• Goals – persistance, stewardship, context preservation, wholeness
• Static information vs. Information flows – CDA enables persistency of
both clinical data and the context
• Supports binary objects, large number of implementations (prescriptions,
discharge letters, etc)
• One XML schema for all documents – easy to use to start with, but lacks
rich semantics
• Widely implemented
• Continuity of Care Document (USA)
• epSOS project – Patient Summaries and ePrescriptions
• Number of projects across the world (DE, FI, CA, FR,
IT, JP, ...)
• Basis fo IHE PCC (Point of Care Coordination)
Some of the HL7 CDA Use Cases
• Access, transfer and exchange of various types of clinical
documents (discharge letters, referrals, observations,
medical histories, ...)
• Operations such as queries - locate by patient, provider, practitioner,
point of care, encounter, date
• Enables access to distributed information through common metadata
• Document management
• Integration Layer
• Transcription systems in hospital settings
• Regional and national EHR networks
• Reuse of Data
• Reporting
• Decision Support
Structure of CDA Document
• Document context
• Identification
• Confidentiality, security,
authorizations
• Entities and actors involved
• Body – Clinical document
• Structured – XML based
• Non-XML – binary objects
*courtesy of Rene Spronk, Ringholm
Structure of CDA Document
Header
Body
Clinical Document
Clinical Information
Patient
Provider
Body Structures
Contextual Information
Body Entires (Clinical Statements)
Medical History
Prescription
Medical History
HL7 CDA RMIM
Header
CDA Body
Structures
CDA Body
Entries
HL7 CDA Release 2
Levels of Specification
HL7 CDA R2 – Level 1
• Narrative Text with additional Formating
Level 1
<component>
<!– History -->
<section>
<title>29.08.2005: History</title>
<text>Onset of asthma in his teens. He was
hospitalized twice last year, and already
twice this year.
</text>
</section>
</component>
HL7 CDA R2 – Level 2
• Section level coding for additional processing rules
Level 2
<component>
<!– History -->
<section>
<code code="10164-2“ codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"/>
<title>29.08.2005: History</title>
<text>Onset of asthma in his teens. He was
hospitalized twice last year, and already
twice this year.
</text>
</section>
</component>
HL7 CDA R2 – Level 3
• Keywords coding with
CDA sections for
addtional comupter
processing
Level 3
<component>
<section>
<code code="10164-2" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1“ />
<title>29.08.2005: History</title>
<text>Onset of <content ID="a1">asthma</content> in his
teens. He was hospitalized twice last year, and already twice this
year. </text>
<entry typeCode="COMP">
<observation>
<code code="195967001“
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Asthma">
<originalText>
<reference value="#a1"/>
</originalText>
</code>
</observation>
</entry>
</section>
</component>
Green CDA
• The issue with current CDA specification
• Overly compex data model
• One (huge!) schema for all CDA documents results in the
need for simplified approach in implementation scenarios
• The result – greenCDA
• A project that developed a pragmatic methodology for creating
simplified schemas that can be transformed directly to or from
normative CDA.
• GreenCDA is both a document that describes a
process how to create the compliant document,
as well as XML schema that can be transformed to a
compliant CDA
• Simplifies the development of CDA compliant systems
HL7 Messaging and Documents
Message
Document
Results In
•Conveys the data in a certain
point of the process
• Transient information
•Summary data of the (complex)
clinical process
•Finalized process, preserving data
in the context
Level of co-existance – every HL7 CDA document can be encapsulated as
MIME-encoded payload in HL7 Message
However, what is a prescription? Or radiology/lab report?
Visit http://www.ringholm.de/docs/04200_en.htm
*courtesy of Rene Spronk, Ringholm
HL7 – How To Get Involved
• HL7 Affiliate
• Represents its members at HL7 International and within its Territory on HL7 matters
• Participates in HL7 International’s standards development processes
• Promotes the relevance and fitness of the HL7 Protocol Specifications, HL7 Educational
Material and Other HL7 Material for the Affiliate's Territory’s purposes
• Distributes, translates and localizes the HL7 Protocol Specifications as appropriate
• Administers and proctors HL7 Certification tests in the Affiliate’s Territory when suitable
and authorized
• Promotes HL7 standards, educates, informs and supports current and potential users
within the Territory to promote consistent and widespread usage of the standards
• Individual or Organizational Membership in HL7 Inc
• In cases where there is no affiliate in a give country
• Rights to vote on a given standard, participation on education seminars and WGM
meetings
Example from practice
epSOS Project
• Goal for the epSOS eHealth Project:
• To develop a practical eHealth
framework and ICT infrastructure
[based on existing national
infrastructures] that will enable secure
access to patient health information,
particularly with respect to a basic
patient summary and ePrescription,
between European health care systems
• Layers of Interoperability
•
•
•
•
Legal Interoperability
Organisational Interoperability
Semantic Interoperability
Technical Interoperability
• Standards of Choice
• HL7 CDAR2
• IHE Profiles for communication
and interoperability
23 Participating Nations
(20 MS plus Turkey, Norway and Switzerland)
References
• HL7 Structured Documents TC
• http://www.hl7.org/Special/committees/structure/index.cfm
• CDA Wiki
• http://hl7book.net/index.php?title=CDA
• GreenCDA
• http://wiki.hl7.org/index.php?title=GreenCDA_Project
• HL7 CDA, Documents vs. Messaging WhitePapers
• http://www.ringholm.de
• Validation Tools
• http://www.cdatools.org/
• http://hit-testing.nist.gov/cda-validation/
Thank You for Your Attention!
Email: [email protected]