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HINZ Conference 2012 Paper Presentation 8 November 2012

Clinical Document Architecture Implementations - Lessons Learnt To Date…. Peter Jordan Primary Care Information Architect. HINZ Conference 2012 Paper Presentation 8 November 2012. Introduction. HISO 10040 Health Information Exchange. 10040.1 R-CDRs XDS. 10040.2 CCR SNOMED CT

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HINZ Conference 2012 Paper Presentation 8 November 2012

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  1. Clinical Document Architecture Implementations - Lessons Learnt To Date… Peter Jordan Primary Care Information Architect HINZ Conference 2012 Paper Presentation 8 November 2012

  2. Introduction HISO 10040 Health Information Exchange 10040.1 R-CDRs XDS 10040.2 CCR SNOMED CT Archetypes 10040.3 Documents CDA • Challenges- encountered in early CDA implementations • Solutions – common Data Models & NZ CDA Toolkit • Lessons - learnt in the process

  3. CDA Implementations • The overarching goal…using CDA to facilitate semantic interoperability between diverse EHRs. • International standard – flexible, but diverse interpretations. • How to implement in NZ? BroadChallenges • Data Modelling– PMS/Relational to RIM/XML • Data Typing – Codes, Identifiers, nullFlavor • Validation– XSD, Tools, IGs and Templates • NZ-specific requirements – e.g. multiple ethnicities • Presentation– which Style Sheet? • Transport– sending and receiving a CDA

  4. ProjectSolutions • ImplementationTypes • GP2GP– Continuity of Care • E-Discharge Summaries – Connected Care • Community E-Prescribing – Order Filling Service • SharedComponents • Common Data Model – Semantic Integration • Client Software Adapter – NZ CDA Toolkit

  5. Shared Data Model C1: Bridge the logical data model in Business Requirements and the vendor’s physical data models - via the CCR/CCD standard (Sections/Entries). Highest or lowest common denominator? “Don’t exclude anything that any one of us has.” • Mandatory Sections – none in GP2GP • Required Elements – only patient & record identifiers • Extensible– Name-Value Pairs • Linking Entries – to Encounters • External Documents – linked to any Entry • Project variances – e-Prescribing ordering elements

  6. NZ CDA Toolkit Client-side adapter; a class library facilitating the creation, validation, packing and consumption of CDAs. • C2: Data Typing – translates Data Model to CDA • Which Act class – act or observation? • Constants for identifiers e.g. 2.16.840.1.113883.6.96 = SNOMED • Single NULL • C3: Validation • Encapsulates Schema (structure), adds business level (content) • Removes some pain points (UCUM) – but not all (Schema mandates) • C4: NZ-Specific Requirements – Additional Demographics • C5: Presentation – GP2GP version of standard CDA Style Sheet • C6: Transport Packaging –Project-specific • GP2GP & e-Discharge: MIME package within HL7 v2.4 message • E-Prescribing: CDATA section in NZePS XML message

  7. Practical Discussion Have the challenges been overcome? • Data Model – Would GP2GP be possible without one? • Vendor willingness to co-operate • Business Requirements imprecise; Implementation Guide, highly complex • Toolkit Development – Common ownership: • Shared Source and Test Harness application • Co-operative development; teleconferences, workshops • Reusability– Accumulate lessons learnt, not revisit • Validation– More granularity via XML Schematron • GP2GP Review –Vendor Issues in 1st Year • Validation (legacy data) • User-Defined Codes containing spaces • Large message files (> 5Mb)

  8. Summary Conclusions • Successes • Technical and practical: resource duplication minimised • Project outcomes: two delivered and one nearing trial • Going Forward • Data Modelling: openEHR Archetypes (ISO 13606) • CDA: Templates and Schematron (HISO 10043 standards) • Acknowledgements • David Hay, Peter Sergent, Andre Bredenkamp & Andrew Terris. • The Vendors! “If you want to be incrementally better, be competitive, if you want to be exponentially better, be collaborative.”

  9. Reference Sources • Boone KW. The CDA Book. 1st edition. New York: Springer-Verlag London Ltd, 2011. • HL7. Clinical Document Architecture Release 2. http://www.hl7.org/implement/standards/index.cfm • Atalag K, Hay D, Kenworthy A, Le Maitre A. Interoperability Reference Architecture. Version 1.0 December 2011 • HISO: Health Information Exchange Structured Documents Architecture Building Block. HISO 10040.3 Version 1.0 April 2012 • National Health IT Board. National IT Plan. September 2010 • W3C. Extensible Markup Language (XML). http://www.w3.org/XML/ at 24/01/2012 • Shadow G, McDonald CJ. The Unified Codes for Units of Measurehttp://aurora.regenstrief.org/~ucum/ucum.html • Ringholm Integration Consulting. CDA Validation Tools. https://ncisvn.nci.nih.gov/svn/cacis/ESD/trunk/docs/hl7-training/S165_CDA_validation_tools.pdf • MSDN. Improving XML Document Validation With Schematron. http://msdn.microsoft.com/en-us/library/aa468554.aspx#schematron_topic 4 September 2004 • Wikipedia. Extensible Stylesheet Language Transformations (XSLT). http://en.wikipedia.org/wiki/XSLT at 23/06/2012 • Wikipedia. Continuity of Care Document. http://en.wikipedia.org/wiki/Continuity_of_Care_Document at 14/04/2012 • Grieve G. Data Quality Requirements in v3 Data Types - Both Necessary and Spurious. Health Intersections November 29, 2011 http://www.healthintersections.com.au/?p=738 • Gower D. Some Thoughts on Cooperation, Standards and Interoperability. Pulse+IT Magazine Editorial: September 2011 http://www.pulseitmagazine.com.au/ • RIMBAA. The Software Implementation of CDA. http://wiki.hl7.org/index.php?title=Software_Implementation_of_CDA at 22/07/12 • OpenEHR. http://www.openehr.org/home.html

  10. Questions& Suggestions • Where to next for the Toolkit? • Thanks for attending! peter.jordan@patientsfirst.org.nz

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