SDC+-+CAP+eCC+Reference+Implementation

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Although not shown here, we create CDE equivalents in a “base template,” which is a hierarchical database structure that holds prototypes for our question/answer sets (QAS) and groups of QAS (eCC templates). Our rele ased QAS items map back to the base template QAS items. This is a somewhat different model than ISO 11179 or Open EHR, and it works better for our use case. By design, any of our QAS or templates can be mapped to an external CDE repository, but to be useful, the repository would need to keep up with our rapid rate of change, which can be thousands of QAS items and semantic codes, plus all their metadata and change logs, in a yearly release. Thus good tools, data management principles and QA are really critical. We experimented with getting our templates into the caDSR, but it was far too difficult without a custom tool to upload directly to the caDSR from our eCC database. (These projects take considerable resources, and that costs money.)

I’ve pasted an image of some hierarchical QAS structures from out Template Editor tool as a concrete example of how we model our templates, which are ultimately exported as XML files.

The Reference Implementation
The CAP eCC Reference Implementation uses a set of design principles to produce a group of related modular components.

Major Design Principles

 * The editing of checklist line items (e.g., Questions and Answers, headers, notes) in a “template editor” is database-based, whereas the checklist distribution format is XML-based.
 * The implementation of the checklist XML documents is independent of the technology of the template editing environment.
 * The CAP eCC XML format may be used to support multiple user implementations derived from a single checklist XML document. These implementation variations may be present in:
 * generation of data-entry forms
 *  format and storage of the completed form data
 *  transmission of checklist data sets between informatics systems
 * Regardless of the above variations, the CAP eCC model will support the interoperable transmission of checklist data
 * Each checklist and checklist item is assigned a unique code, which is associated with an institution-specific namespace
 * Checklists may be released in new versions, while retaining the ability to query the checklist data across any subset of versions
 * <span style="font-family: Arial,Helvetica,sans-serif;">The authority that produces each checklist or checklist line item should be documented.
 * <span style="font-family: Arial,Helvetica,sans-serif;">All checklist changes must be documented.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Certain Questions are required (must be answered) to produce a valid data set.
 * <span style="font-family: Arial,Helvetica,sans-serif;">The parent-child structure and sort order of the Questions and Answers is significant, and adds semantic context to the end user. However, users may wish to modify a checklist (produce a new version) to suit their needs. These locally-modified versions must remain interoperable with the original (parent) version.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Semantic encoding of data elements is essential for informatics use cases, and mappings to any number of coding systems must be supported.
 * <span style="font-family: Arial,Helvetica,sans-serif;">The design of the CAP eCC must be suitable for similar Question/Answer set templates in other clinical fields.

<span style="font-family: Arial,Helvetica,sans-serif;">Modular Components of the CAP eCC
<span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: Arial,Helvetica,sans-serif;">Information Courtesy of Richard Moldwin M.D., Ph.D. [] <span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: Arial,Helvetica,sans-serif;">
 * Checklist Authoring Module:<span style="font-family: Arial,Helvetica,sans-serif;">
 * <span style="font-family: Arial,Helvetica,sans-serif;">The CAP eCC template editing environment is distinct from the release technology. This module is not included in the Reference Implementation.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Checklist Distribution Module:
 * <span style="font-family: Arial,Helvetica,sans-serif;">This release contains one XML document template (XDT) for each current checklist version. These files have an “.xml” extension.
 * <span style="font-family: Arial,Helvetica,sans-serif;">The release contains one XML schema file to constrain the XDT documents: The schema file, <span style="background-color: #ffb100; font-family: Arial,Helvetica,sans-serif;">sr-template.xsd <span style="font-family: Arial,Helvetica,sans-serif;">, describes and constrains the XDT structure.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Checklist XML Transformation Module (Generation of GUI data-entry forms):
 * <span style="font-family: Arial,Helvetica,sans-serif;">An XML transform (XDT-T) can convert an XDT file into any desired format (e.g., HTML forms). In this release, the transform, <span style="background-color: #cac0ce; font-family: Arial,Helvetica,sans-serif;">srtemplate.xslt <span style="font-family: Arial,Helvetica,sans-serif;">, transforms the checklist XDT into an HTML form.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Cascading style sheet(s) (CSS) are used to format the transformed XDTs. The css file, <span style="background-color: #70cd71; font-family: Arial,Helvetica,sans-serif;">srtemplate.css <span style="font-family: Arial,Helvetica,sans-serif;">, is used to format the HTML derived from the transformed XDT file.
 * <span style="font-family: Arial,Helvetica,sans-serif;">The file <span style="background-color: #ffff00; font-family: Arial,Helvetica,sans-serif;">sr-toc.xml <span style="font-family: Arial,Helvetica,sans-serif;"> is used to generate a list of checklists for the left-hand margin of the generated web page. This is only used in scenario 2 of the Reference Implementation (see below).
 * <span style="font-family: Arial,Helvetica,sans-serif;">The schema, <span style="background-color: #ffb100; font-family: Arial,Helvetica,sans-serif;">sr-toc.xsd <span style="font-family: Arial,Helvetica,sans-serif;">, describes and constrains the table of contents format. This is used only in **scenario 2** of the Reference Implementation (see below).
 * <span style="font-family: Arial,Helvetica,sans-serif;">Checklist Data Output Module (handles the data output from the data-entry form):
 * <span style="font-family: Arial,Helvetica,sans-serif;">An XML-based output format based upon the line-item keys (“Ckeys”) in the XDT; the XML output may be transformed into other formats such as HL7. Semantic codes may be incorporated in this output format. An early example is present in this release. The schema file, <span style="background-color: #ffb100; font-family: Arial,Helvetica,sans-serif;">sr-data.xsd <span style="font-family: Arial,Helvetica,sans-serif;">, describes and constrains the data output structure, but does not validate the content (see below). This is used only in scenario 3 of the Reference Implementation (see below).
 * <span style="font-family: Arial,Helvetica,sans-serif;">Checklist Mapping Module:
 * <span style="font-family: Arial,Helvetica,sans-serif;">An XML-based mechanism for mapping the XDT Questions and Answers to any arbitrary coding system for query purposes. In this release, the schema file, <span style="background-color: #ffb100; font-family: Arial,Helvetica,sans-serif;">sr-codesystems.xsd <span style="font-family: Arial,Helvetica,sans-serif;"> describes and constrains the contents of a single code-mapping file, <span style="background-color: #ffff00; font-family: Arial,Helvetica,sans-serif;">sct-codes.xml <span style="font-family: Arial,Helvetica,sans-serif;">. In this release the code-mapping file contains a map to SNOMED CT. The use of this file is demonstrated in scenario 3 of the Reference Implementation (see below).
 * <span style="font-family: Arial,Helvetica,sans-serif;">Other mappings may be released in the future.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Checklist Data Validation Module:
 * <span style="font-family: Arial,Helvetica,sans-serif;">An XML-based mechanism (e.g., XML schemas, RELAX NG, etc.) for validating the structure and content of the checklist-derived patient dataset (future)
 * <span style="font-family: Arial,Helvetica,sans-serif;">Ontology and Query Modules: (future)

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