Why and where CDA

François Macary, Christel Daniel

• Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange and sharing.

• CDA is part of HL7 V3. As such, it relies on the HL7 Reference Information Model and the HL7 V3 data type.

• It enables to represent any static clinical content in a format, which is both human-readable and system-processable.

• A single xml schema validates any kind of CDA document

What is CDA?

• Messages are appropriate artifacts to support exchange of clinical information during the production of care.

• The output of the process of care is better captured in static documents, persistently accountable to their authors and understandable per se to care providers.

• The document sharing paradigm is the best fit to enable patient care coordination and care continuity among care providers and their systems, which are not coupled to one another.

• IHE provides a set of infrastructure profiles around XDS, to support this document sharing paradigm. The shared content is most often CDA documents.

Why CDA?

• A single xml schema CDA.xsd is used to validate any instance of CDA document.

• A template of a CDA document is a set of constraints applied to the general standard. It is both a specification and a schematron, which tests the conformity of document instances to that template.

Validation & Conformance

CDA content profiles in IHE domainsDomain St. Profiles

AP AP structured report (APSR): 1 generic + 20 organ specific templates

Card. Cardiac Imaging Report Content (CIRC): 1 report template

ITI Scanned documents (XDS-SD): 1 template with a non-structured body

LAB Sharing laboratory reports (XD-LAB): 1 report template

Patient Care Coordi-nation (PCC)

7: Medical Documents, Medical Summary, Referral Summary, Discharge Summary, PHR Extract, PHR Update, Emergency Department Referral,

4: Antepartum History & Physical, Antepartum Summary, Antepartum Laboratory (from XD-LAB), Education

3: Labor and Delivery History & Physical, Labor and Delivery Summary, Maternal Discharge Summary

4 in emergency department: Triage Note, Nursing Note, Composite Triage & Nursing Note, ED Physician Note

Pharmacy 3 document templates

Testing of content profiles at Connectathons 2011

#Systems as “Content Creator” Actor

Profiles North-America 2011 Europe 2011PCC profiles 28 2

XD-LAB 5 3XDS-SD 13 2

A number of countries have adopted CDA R2 globally:• Finland was the first broad adopter• Austria: ELGA project• France: CDA is mandated for patient care coordination. XD-LAB has

been chosen for lab reports. APSR is required for cancer case AP reports. However, lab system vendors are not ready yet.

• US: in “meaningful use” ?

In other countries, adoption is made at the regional level• Italy Veneto• US Regional Health Information Organizations (RHIOs),• Spain Catalogna …

Adoption of CDA

Thank You