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![Page 1: September, 2005What IHE Delivers 1 CDA-based content integration profiles Philippe Lagouarde, Cegedim Co-chair Vendor, IHE-France.](https://reader034.fdocuments.us/reader034/viewer/2022051613/551491ad550346ea6e8b5236/html5/thumbnails/1.jpg)
1September, 2005 What IHE Delivers
CDA-based content integration CDA-based content integration profilesprofiles
Philippe Lagouarde, CegedimPhilippe Lagouarde, Cegedim
Co-chair Vendor, IHE-FranceCo-chair Vendor, IHE-France
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planplan
CDA ?
CDA Release 1
CDA Release 2
Integration-content profiles
Conclusion
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CDA : Clinical Document ArchitectureCDA : 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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InteroperabilityInteroperability
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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ApplicationApplication
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Readable Human RenderingReadable Human Rendering
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Characteristic of a CDA documentCharacteristic 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 documentStructure of a CDA document
Document context
Clinical information
HeaderHeader
BodyBody
XML encoding Human readable…
…and by computers
Diagnosis:
Asthma
<section>
<caption>Diagnosis</caption>
<content>Asthma</content>
</section>
<section>
<caption>Diagnosis</caption>
<content>Asthma</content>
</section>
Generiic stylesheet
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planplan
CDA ?
CDA Release 1
CDA Release 2
Integration-content profiles
Conclusion
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CDA R1CDA R1
First HL7 standard based on the RIM
HeaderHeader
BodyBody
Body : some structured clinical data for automatic processing
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CDA HeaderCDA HeaderDocument 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 BodyCDA 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>
Nar
rativ
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Com
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planplan
CDA ?
CDA Release 1
CDA Release 2
Integration-content profiles
Conclusion
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CDA R2CDA R2HL7 V3 Framework Development
HeaderHeaderRIM … XML Schema
BodyBody
Narrative blockNarrative block
EntryEntry
ObservationObservation
Substance administrationSubstance administration
ProcedureProcedure
EncounterEncounter
Observation MediaObservation Media
……
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CDA R2 – Example of BodyCDA R2 – Example of Body…
<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"/> …
Nar
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blee
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Benefits of CDA R2Benefits of CDA R2Non 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 documentsFor all type of documentsCommunication 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 guidesCDA 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 - CRSExample - CRS
Section Title CODE LOINC Card
Advance Directives
X‑ADVDIR ADVANCED DIRECTIVES
0..1
Functional Status
10158‑4 HISTORY OF FUNCTIONAL STATUS
0..1
Conditions X‑COND CONDITIONS 1..1
Active 11450‑4 PROBLEM LIST 1..1
…
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Example of the Sciphox ProjectExample of the Sciphox Project
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Important developmentImportant 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-XDSIHE-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/TransactionsIHE-XDS – Actors/Transactions
Extension of Clinical Content Profile also with XDM and XDR integration profiles
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XDS-MSXDS-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 guidesXDS-MS – Example of guides
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Evolution of PCCEvolution of PCC
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Extension to other IHE domainsExtension 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 constraintsLAB 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 ActorsXDS-MS Actors
ContentContentcreatorcreator
ContentContentconsumerconsumer
Share contentShare content
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XDS-MS OptionsXDS-MS Options
Actor Options
Content Consumer View Option
Document Import Option
Section Import Option
Discrete Data Import Option
Content Creator Referral Option
Discharge Summary Option
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ConclusionConclusion
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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33September, 2005 What IHE Delivers
Thank you!Thank you!
IHE Europe web site: IHE Europe web site: www.ihe-europe.orgwww.ihe-europe.org