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Introduction to Green CDA CDA Forum, 17 th January 2013

Introduction to Green CDA CDA Forum, 17 th January 2013. Robert Worden rpworden@me.com. Outline: 30 Minutes + Questions. What is Green CDA? How do you use it? 5 Origins of Green CDA 5 Green CDA Example - PHMR 5 Questions (1) (5) CDA Implementation Routes Compared 10

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Introduction to Green CDA CDA Forum, 17 th January 2013

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  1. Introduction to Green CDA CDA Forum, 17th January 2013 Robert Worden rpworden@me.com

  2. Outline: 30 Minutes + Questions • What is Green CDA? How do you use it? 5 • Origins of Green CDA 5 • Green CDA Example - PHMR 5 • Questions (1) (5) • CDA Implementation Routes Compared 10 • Green CDA in ITK and ISCF 5 • Questions (2) (5) • Additional Topics 5+

  3. What is Green CDA? How do you use it? • Green CDA is a way of interfacing applications to standard CDA • It consists of: • An intermediate XML structure which is much simpler than full CDA (this structure is called Green CDA XML) • Supplied transforms, to convert the simple XML to full CDA, or full CDA to the simple XML • Transforms depend on templates • Interface your application to the simple XML; then use the supplied transforms to read or write full CDA. • Get ITK accreditation for the full CDA • Short-cuts the technical complexity of CDA • Avoids a long CDA learning curve

  4. Green CDA XML is Simpler than Standard CDA XML Fragment of full CDA: <custodian typeCode="CST"> <npfitlc:contentId extension="COCD_TP145018UK03#AssignedCustodian" root="2.16.840.1.113883.2.1.3.2.4.18.16" > <assignedCustodianclassCode="ASSIGNED"> <templateId extension="COCD_TP145018UK03#AssignedCustodian" root="2.16.840.1.113883.2.1.3.2.4.18.2"/> <representedCustodianOrganizationclassCode="ORG" determinerCode="INSTANCE"> <templateId extension="COCD_TP145018UK03#representedCustodianOrganization" root="2.16.840.1.113883.2.1.3.2.4.18.2"/> <id extension="RYX" root="2.16.840.1.113883.2.1.3.2.4.19.2"/> <name>Central London Community Healthcare Trust</name> </representedCustodianOrganization> </assignedCustodian> </custodian> Corresponding fragment of Green CDA: <documentOwner id="RYX"> <name>Central London Community Healthcare Trust</name> </documentOwner>

  5. How to use Green CDA Green CDA Green CDA Full CDA Application A Simple-to-Full Transform Full-to-Simple Transform Application B Full CDA Application C • Reliable transforms to full CDA are supplied; (but may need to be extended for your application requirements, commercially or using Open Source tools) • Transforms can be deployed as XSLT (licenced), or as a Java runtime engine (Open Source) • You only need to interface applications to Green CDA • This is a simple ‘vanilla XML’ interfacing job

  6. History of Green CDA • Experiments with ‘simplified XML ITS’ in UK (2006) – automated transforms to full XML ITS; not taken up by HL7 International. • ‘Green CDA’ implementation technique proposed by HL7 Structured Docs Working Group (2010): • Transforms only go one way: Green => full CDA • Transforms written by hand or low-level mapping tools (so unreliable) • SDWG published the method only, few transforms • See HL7 wiki for current status • Promoted by HL7 International as an implementation method (CCD vs CCR for Meaningful Use?) • Development of Green CDAs for ITK with reliable, automated, two-way transforms – UK (2011).

  7. Example Green CDA – ITK PHMR • Personal Health Monitoring Report – for telehealth devices in the home • DHID published CDA definition in summer 2012 • Green CDA version developed shortly afterwards; now in use on one ISCF project • Templates included so far: • Header templates (Patient, etc.) • Device definitions • Blood pressure series • Blood glucose series • Oxygen saturation series • Pulse Rate series • Thresholds and target values for these observations • Other templates can be easily included • Full round-trip transforms, 100% accurate (demo) • Full PHMR passes ITK CDA checker (demo)

  8. Green-Full CDA Transforms: Auto-generated and 100% Reliable • The round trip (full=>green=> full) is 100% accurate • Easily and automatically testable • Implemented in Java or XSLT Green CDA Green to Full Xform Full ITK CDA Full to Green Xform

  9. Questions (1) Offline questions to mailto:CFH.interoperabilityteam@nhs.net

  10. Green CDA v. Other CDA Implementation Routes – Buyer’s Guide (Three stars good, one star bad)

  11. ITK Green CDAs Available • There are Green versions of the following ITK CDAs: • Non-Coded Document • Discharge Summary • Section 2 / Section 5 Discharge (actually V3) • CAF (for HSCI) • PHMR (telehealth) • These can pass the ITK CDA checker and TKW now • Extra templates are easily added • Extensions for further application requirements are commercially available, or can be built with Open Source tools • XSLT transforms licensed commercially

  12. Green CDA in ISCF The following projects in the Information Sharing Challenge Fund are using Green CDA to implement ITK CDA:

  13. Questions (2) Offline questions to mailto:CFH.interoperabilityteam@nhs.net Speaker contact details: rpworden@me.com

  14. Additional Topics • CDA Rendered Text Entries – how do you handle them? • Investigate the requirement very carefully • ITK-supplied transforms render header data • Some text is free-standing, not related to coded entries • Additional hand-coded transforms can generate HTML tables from coded entries • Mapping and transforming CDA to other XML, V2, etc. • Making mappings is quicker than writing interface code • Generates translations to CDA in both directions • Open Source tools available (Eclipse based) • Generated Java CDA API • Simple classes and getter/setter methods for Green CDA fields • API can read or write full CDA • Open Source tools available (Eclipse) • CDA Editor/Viewer • Green CDA fields are just those a clinician may need to edit • Web-based, automatically generated editor • Configurable user interface • Outputs or reads full CDA • Open Source tools available (Eclipse)

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