Introduction to Green CDA CDA Forum - Open Mapping Software by pptfiles


									 Introduction to Green CDA

CDA Forum, 17th January 2013

        Robert Worden
    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+
               What is Green CDA?
               How do you use it?
• Green CDA is a way of interfacing applications to standard
• 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
                  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." >
              <assignedCustodian classCode="ASSIGNED">
                             <templateId extension="COCD_TP145018UK03#AssignedCustodian" root="2.16.840.1.113883."/>
                             <representedCustodianOrganization classCode="ORG" determinerCode="INSTANCE">
                                           <templateId extension="COCD_TP145018UK03#representedCustodianOrganization"
                                           <id extension="RYX" root="2.16.840.1.113883."/>
                                           <name>Central London Community Healthcare Trust</name>

      Corresponding fragment of Green CDA:

           <documentOwner id="RYX">
                   <name>Central London Community Healthcare Trust</name>
                 How to use Green CDA
                 Green                                               Green
                 CDA        Simple-to-   Full CDA     Full-to-       CDA
 Application                                                                  Application
                               Full                    Simple
      A                                                                            B
                            Transform                Transform

                                    Full CDA

• 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
                  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).
    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
•   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)
    Green-Full CDA Transforms: Auto-
      generated and 100% Reliable

                         to Full
      Green CDA                           Full ITK CDA
                         Full to

• The round trip (full=>green=> full) is 100% accurate
• Easily and automatically testable
• Implemented in Java or XSLT
            Questions (1)

Offline questions to
Green CDA v. Other CDA Implementation
        Routes – Buyer’s Guide
    Criterion     Model-   Example-   Green CDA CDA API
                  based    based
    Technical        *        **        ***        ***
    Templates       ***       **         **         *
    Extensible      ***       **         **        **
    Deployment      **        **        ***        **
    Dependence      **        **         **         *
    on others
    Use as CDA      **        ***       ***         *

       (Three stars good, one star bad)
          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
                        Green CDA in ISCF
The following projects in the Information Sharing Challenge Fund
are using Green CDA to implement ITK CDA:

Trust                   CDA Application Summary               CDA in use
Worcestershire Health   Health and Social Care Integration;   Non-coded document
& Care NHS Trust        sharing demographic data and          (containing CPA assessment)
                        CPA assessments
South Devon             Use of discharge letters for Out of   Non-coded document
Healthcare NHS          Hours care; stored in XDS (IHE)       (containing discharge letter)
Foundation Trust        repository
Central London          Telehealth monitoring and alerts      PHMR ( Oxygen Saturation &
Community               for COPD                              Pulse Rate)
Healthcare NHS Trust
             Questions (2)

Offline questions to

Speaker contact details:
                          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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