Route from CCDA to FHIR by Grahame Grieve

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CCDA to FHIR

Grahame Grieve

FHIR Developer Days

November 26, 2014


CDA vs FHIR

I am CDA subject matter expert for the

Australian national program

I was co-chair of Structured Documents WG,

which owns the CDA standard

I am the lead for FHIR


CDA vs FHIR

Through 2010/2011, it became clear that:

CDA was too hard to construct and read

Documents not good for granular data exchange

CDA used for exchanging data because the

alternatives were worse

CDA getting pushback from implementers

The SD committee was about to double down

These strategic frustrations were part of why FHIR

was invented

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CDA vs FHIR

The design of FHIR was strongly influenced

by CDA:

Narrative/Data in every resource

Need to a document package

Use of “must understand” ( isModifier)

CDA content model a first point of reference

Green CDA simplification

CDA usage guided our resource priority

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CDA vs FHIR

CDA community was focused on their task

Mostly didn’t even pay attention to FHIR

Common Questions to us:

Why does FHIR have “documents”?

What is the relationship between CDA and FHIR?

What does Lantana think about FHIR?

Do you have a transform from (C)CDA to FHIR?

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CDA vs FHIR

Joint Position Statement from leaders in the

FHIR and CDA community

Focus: The future of CDA and FHIR

This statement is not official policy

https://www.lantanagroup.com/wp-content/uploads/Lantana-Position-Statement-CDA-FHIR.pdf

https://www.lantanagroup.com/wp-content/uploads/Lantana-Position-Statement-CDA-FHIR.pdf


CDA vs FHIR

Position:

CDA addresses interoperability for clinical

documents, mixing narrative and structured

data. FHIR provides granular access to data,

a contemporary, streamlined approach to

interoperability, and is easy to implement.

FHIR can be the future of CDA, but it is not

there yet7


Documents vs APIs

“The medical record is not data. It contains data, as do many

forms of writing, but it is not data, nor is it simply a repository

into which data are poured. Although its raw material is

information—some of which, importantly, can only be

expressed with words and not with numbers—a finished

medical record is information that has been transformed by

the knowledge, skill, and experience of the physician,

motivated by the healing impulse, into an understanding of

human experience that makes the care of the patient

possible.”

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Documents vs APIs

This dual nature of a medical record—the

combination of data and narrative—runs

deeply through the clinical process and,

consequently, through the clinical record

Why CDA is narrative based

Why FHIR resources have narrative

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Documents vs APIs

Packaged Access

Trust from document

context & obligations

Independent of

system integration

Import data from

documents

Granular Access

System-based trust

framework

Tightly integrated IT

and business systems

Export data from APIs

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Documents vs APIs

Documents are the correct way to exchange

information between clinicians in disparate

parts of the healthcare system

APIs will integrate access to the data

between applications where the context is

unambiguous.

Both the document and API should

seamlessly use the same syntax and

semantics and Narrative approach11


Call to Action (1)

Recognize the duality and interdependence

of data and narrative in clinical information

Understand the gaps in support for clinical

documents in the current FHIR Draft

Standard for Trial Use (DSTU)

Ensure that FHIR 2.0 addresses clinical

document requirements

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Call to Action (2)

Establish, publish, and test CDA/FHIR,

FHIR/CDA mapping

Define, document, and promote a future

where clinical documents and Application

Programming Interfaces (APIs) share a

common syntax and set of resources

Establish, in technical and regulatory policy,

a smooth roadmap to the future of clinical

document exchange13


CDA -> FHIR project

Map CDA header to FHIR

Resolve issues around sections in FHIR

Map basic CDA entries to FHIR (general)

Map CCDA sections & entries to FHIR

(specific)

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CDA -> FHIR Project

Work is in a google spreadsheet

Ongoing calls on a weekly basis

Up to step #3

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https://docs.google.com/spreadsheets/d/1KctdexG3oB2QBiBQNH1Rbt2uJ6Dx

QFROyIFKo5q95WU/edit#gid=1223244219

https://docs.google.com/spreadsheets/d/1KctdexG3oB2QBiBQNH1Rbt2uJ6DxQFROyIFKo5q95WU/edit#gid=1223244219


Working Spreadsheet

Basic Information from CDA

Element

Cardinality

Mandatory

Conformance

Type

Domain

Extensible

Notes16


Working Spreadsheet

FHIR Specification Mapping – where it goes

in FHIR

Base Card – what the FHIR cardinality is

Profile Card – what the CDA-on-FHIR

cardinality will be

Type – what the FHIR type is

Notes / CDA on FHIR call decisions –

discussion of issues

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CDA FHIR outcomes

The mapping spreadsheet itself

A series of change proposals to the base

FHIR specification

Corollary: CDA -> FHIR requires DSTU2

A formal “Clinical Document” profile which

will be part of the FHIR specification

CCDA section/entry mappings and profiles

Conversion Libraries?

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CDA Profile in FHIR

http://hl7-fhir.github.io/cda.html

Profiles and Extensions

Very incomplete

This will develop as the project goes on

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http://hl7-fhir.github.io/cda.html


CCDA

“Consolidated CDA”

Harmonised several US and IHE CDA

implementation guide

In service of “Meaningful Use Minimal Data

Set” though it includes more

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CCDA FHIR

The project is not up to this

Some work has been done by a variety of

individuals and groups

CCDA is hard to understand, and there is

much variance in it’s use

It’s unclear at what level this needs to be

useful

..Demonstration

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From CCDA to FHIR

This is an active area of investigation

DSTU 2 will be “Clinical Document” ready

DSTU 2 will include a base Meaningful Use

Profile

A formal CCDA profile will follow in due

course

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Route from CCDA to FHIR by Grahame Grieve

Healthcare

Transcript of Route from CCDA to FHIR by Grahame Grieve