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

2

planplan

CDA ?

CDA Release 1

CDA Release 2

Integration-content profiles

Conclusion

3

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

4

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

5

ApplicationApplication

6

Readable Human RenderingReadable Human Rendering

7

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.

8

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

9

planplan

CDA ?

CDA Release 1

CDA Release 2

Integration-content profiles

Conclusion

10

CDA R1CDA R1

First HL7 standard based on the RIM

HeaderHeader

BodyBody

Body : some structured clinical data for automatic processing

11

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

12

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

Nar

rativ

eeC

ompu

tabl

Com

puta

blee

13

planplan

CDA ?

CDA Release 1

CDA Release 2

Integration-content profiles

Conclusion

14

CDA R2CDA R2HL7 V3 Framework Development

HeaderHeaderRIM … XML Schema

BodyBody

Narrative blockNarrative block

EntryEntry

ObservationObservation

Substance administrationSubstance administration

ProcedureProcedure

EncounterEncounter

Observation MediaObservation Media

……

15

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

rativ

Nar

rativ

eeC

ompu

tabl

Com

puta

blee

16

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

17

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

18

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)

19

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

…

20

Example of the Sciphox ProjectExample of the Sciphox Project

21

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”

22

CDA ?

CDA Release 1

CDA Release 2

Integration-content profiles

Conclusion

23

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

24

IHE-XDS – Actors/TransactionsIHE-XDS – Actors/Transactions

Extension of Clinical Content Profile also with XDM and XDR integration profiles

25

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

26

XDS-MS – Example of guidesXDS-MS – Example of guides

27

Evolution of PCCEvolution of PCC

28

Extension to other IHE domainsExtension to other IHE domains

Laboratory domain : Example of a use case from the 2007 Sharing Laboratory Reports (XD - LAB)

29

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.

…

…

30

XDS-MS ActorsXDS-MS Actors

ContentContentcreatorcreator

ContentContentconsumerconsumer

Share contentShare content

31

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

32

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

33September, 2005 What IHE Delivers

Thank you!Thank you!

IHE Europe web site: IHE Europe web site: www.ihe-europe.orgwww.ihe-europe.org