The Use of CCTS in HL7 CDA

The Use of CCTS in HL7 CDA Asuman Dogac, Yildiray Kabak, Mustafa Yuksel METU, Ankara, Turkey OASIS SET TC Working Document

HL7 CDA • The HL7 Clinical Document Architecture (CDA) is a document markup standard that specifies the structure and semantics of "clinical documents" for the purpose of exchange • CDA documents derive their machine processable meaning from the HL7 Reference Information Model (RIM) and use the HL7 Version 3 Data Types • They are encoded in Extensible Markup Language (XML) OASIS SET TC Working Document

Main Components of a CDA Document A CDA document is wrapped by the <ClinicalDocument> element, and contains a header and a body The header lies between the <ClinicalDocument> and the <structuredBody> elements, and provides information on authentication, the encounter, the patient, and the involved providers 9/2/2014 3 OASIS SET TC Working Document

Main Components of a CDA Document • The body contains the clinical report, and can be either an unstructured blob, or can be comprised of structured markup • A CDA document section is wrapped by the <section> element • Each section can contain a single narrative block, and any number of CDA entries and external references OASIS SET TC Working Document

Major Components of a CDA Document CDA entries represent structured content provided for further computer processing (e.g. decision support applications) 9/2/2014 5 OASIS SET TC Working Document

HL7 CDA Interoperability • HL7 CDA helps with interoperability through • Structured body • Coded elements • HL7 Data Types • CDA Entry classes: RIM Act, Observation, SubstanceAdministration, Supply, Encounter, Procedure, ObservationMedia, Organizer, RegionOfInterest • But • CDA Documents can have any structure by nesting the sections at any depth and in any way • There can be data elements that are not defined for CDA but are necessary for local implementations such as Vaccination, Discharge Method (referral, death or cured), Type of Contagiousness, … • There is a need for expressing the CDA concepts in local languages OASIS SET TC Working Document

To Enhance CDA Interoperability… • Start from UN/CEFACT CCTS • Define BCCs • Reuse existing HL7 Data Types and Data Elements • Define the missing data elements by constraining relevant RIM classes • Define ACCs • Use BCCs to define minimum health data sets • Hence create a local (or national) data dictionary • It will be much better if HL7 defines these constructs and the countries customize these according to their context OASIS SET TC Working Document

Building a National Data Dictionary For Creating CDAs • Building a local or national common data dictionary consisting of data elements (BCCs) and minimum health data sets (ACCs) will • Clearly define the meaning of data elements • Give their corresponding explanation in the local language • Create the additional data elements needed locally from the corresponding RIM Classes • Also note that defining minimum health data sets as Aggregate Core Components will determine their structure and semantics • All these will help with the interoperability of CDAs OASIS SET TC Working Document

Data Types in HL7 • http://hl7.org/v3ballot/html/infrastructure/datatypes/datatypes.htm • The Data Types in HL7 constitutes the Qualified Data Types • Define your BCCs using already defined data elements in HL7, e.g., “houseNumber” • Define your ACCs based on the data elements defined in HL7, e.g., “addr” OASIS SET TC Working Document

Creating the Missing Data Elements by Constraining RIM Classes • Assume you need a “Vaccination” • Data Element (ACC) with the following • properties (BCCs): • Type of Vaccination • Date of application • RIM Class ACT • SubstanceAdministration • code • effectiveTime OASIS SET TC Working Document

Creating the Minimum Health Datasets by Constraining RIM Classes: An Example RIM Class Entity (ACC) ManufacturedMaterial - lotNumberText (BCC) • Then you need a “Vaccination” • minimum data set (A bigger ACC) • Lot number of the vaccination • Organization • Professional Identifier • General Practitioner consumable Role therapeutic agent (ACC) RIM Class Entity Organization - Addr (BCC) Performer responsible party Location Role Physician (ACC) Role Physician (ACC) Role HealthcareProvider (ACC) RIM Class Entity Person (ACC) - Id (BCC) RIM Class Entity Person (ACC) - Id (BCC) Played Entity (ASCC) Participation (ASCC) OASIS SET TC Working Document

Mapping the Minimum Datasets to the CDA Sections • There is not a unique way of doing this ! OASIS SET TC Working Document

An Example Mapping Minimum Health Datasets to CDA Sections and Entities CDA HEADER author custodian BODY Section Component Component Code: Vaccine Section Section Code: consumable Code: responsible party Entry Entry Code: Role Code: Role Value: Therapeutic Agent Value: Physician Entry Entry Code: Entity Code: Entity Value: Manufactured Material Value: Person Entry Entry OASIS SET TC Working Document Code: lotNumberText Code: id Value: 123456 Value: 789123

Another Example Mapping Minimum Health Datasets to CDA Sections and Entities CDA HEADER author custodian BODY Section Code: Vaccine Entry Observation Code: Vaccination Participation 2 Participation 1 Participant Participant typeCode: Consumable typeCode: Responsible Party participantRole participantRole classCode: Therapeutic agent classCode: Physician playingDevice id: 789123 classCode: Manufactured Material playingEntity OASIS SET TC Working Document code: 123456 classCode: Person

Increasing CDA Interoperability… • However, when CCTS Approach is used in forming the CDAs, the document components are well defined • Hence, SET TC specifications can be used to map different CDA documents • These are just the initial ideas OASIS SET TC Working Document

Thank you for your attention OASIS SET TC Working Document

The Use of CCTS in HL7 CDA