TOC+Path-Foward+for+GreenCDA

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**Summary of GreenCDA**

 * The Challenge:** The creation of an instance conforming to a particular CDA Implementation Guide may require knowledge of: CDA R2 base specification; HL7 Version 3 data type specification; CDA templates defined in the particular IG; and CDA templates referenced by the particular IG Terminology code lists defined/referenced by the particular IG. In addition, the validation of an instance conforming to a particular CDA IG may require: W3C Schema validation; and schematron validation.


 * The Solution:** Create an "authoring schema" that simplifies the creation and processing of a particular CDA IG and is clinically meaningful XML element and attribute names; 100% transformable into conformant CDA IG; and hides certain CDA complexities (such as moodCodes, fixed attributes, etc).

The Clinical Document Architecture Release 2.0 (CDA R2) addresses universal requirements for exchange and management of structured clinical documents. GreenCDA maintains the full utility of the CDA R2 while defining a method of working with an implementation-specific XML (Extensible Markup Language) that is easier to implement. GreenCDA provides a strategy for developers who generate templated CDA. This is not a substitute for CDA.

Simplified approaches to working with CDA will promote greater adoption of the standard and also the fulfillment of real connected and interoperable health care and as such it is in the interest of the Standard Analysis WG to support an effort like greenCDA to ensure providers can shift to a CDA-based approach for care transitions.

Role of Standards Analysis WG
The Standards Analysis WG shall move forward with the development of greenCDA instances of ToC Information Packets (e.g., "Green Discharge Summary," "Green Consultation Request") in support of the CIM and TOC Use Cases. The Standards Analysis WG will need to stay aligned with on-going developments with TOC CIM and namely the push for greenCDA as the strategy for developers implementing documents based on the TOC Consolidated CDA standard. GreenCDA facilitates the conversion of CDA from the essential data and metadata necessary to create a health information exchange document. From the standpoint of the Standards Analysis WG, greenCDA instances are delivered in modules which contain the greenCDA schema, the transform to normative CDA, and the documentation which describes the business process that greenCDA is capturing. As each conformant instance is a streamlined version of the Consolidated CDA instances, it is vital that the HITSP/C32 and CCD schema and underlying data elements are properly represented into the Content Module Index for the intent of supporting the development of greenCDA schemas.

This will require the Standards Analysis WG work to support the process of defining business names for data elements. The problem is that at times an ambiguous data element such as "medication codes" can warrant potential misunderstanding within vendors, implementers, clinicians, and interfacing parties. As such, a business name, for example "dosage form" can be assigned in place of "medication codes" to reduce any potential complications and achieve interoperability. The Standards Analysis WG will conduct an analysis of the "A" and "B" priority data elements to determine element needs for business names and in a subsequent phase develop relevant business names. During this process, the Standards Analysis WG may wish to develop rules for the development of business names to apply as other initiatives add data elements in support of a Standards & Interoperability Framework CIM.

In the interest of time, the Standards Analysis WG will need to determine the most appropriate activities beyond the development of business names for data elements to pursue in support of greenCDA. Workgroup members should review the HL7 GreenCDA Project page and the initial balloted package to make this determination. A subsequent activity includes creating a simple XML schema based on the business names for each TOC document subset which become greenCDA modules as part of a TOC document greenCDA implementation.

To support this work, the Standards and Harmonization Team has created a worksheet to facilitate the Standards Analysis WG in the development of business names for CIM data elements. As a starting point, CIM “A” and “B” priority data elements are being mapped to the HITSP C154 Data Dictionary. Upon the completion of the TOC CIM v2.0, the worksheet will be updated to reflect the most recent approved data elements. Standards Analysis WG members are encouraged to recommend possible standards for additional mapping efforts in order to determine the most relevant and concrete business names in support of the TOC Use Cases and universal, "simplified" TOC implementation guidance.

Reference Materials

 * = **Name** ||= **Description** ||= **Owner** ||= **Upload Date** ||
 * HL7 GreenCDA Project || http://wiki.hl7.org/index.php?title=GreenCDA_Project#General_Process ||  || 10-10-2011 ||

Works in Progress

 * = **Name of the Artifact** ||= **Description/Purpose of the Document** ||= **Current Status** ||= **Upload Date** || **Owners** ||
 * [|GreenCDA Business Names Worksheet] || Maps ToC CIM data elements to business names in support of GreenCDA || In Progress || 10-26-2011 ||  ||

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