CDA+-+Reference+Materials


 * CDA Implementation Guides Consolidation Project **

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1.1 CDA Consolidation Project
The HL7 Clinical Document Architecture (CDA) is a document markup standard that specifies the structure and semantics of clinical documents for the purpose of exchange. CDA based clinical documents are specified in Implementation Guides (IGs), which describe constraints placed upon CDA to satisfy a given set of business requirements. For example, the Continuity of Care Document (CCD) is a guide for the implementation of the CCR data set, which is used to constrain CDA specifically for the creation of Summary Documents.

Health Story is a consortium of healthcare vendors, providers, and associations which holds an Associate Charter Agreement with HL7 to develop CDA Implementation Guides for common types of electronic documents. Health Story has developed a series of IGs which use the Templates defined in CCD as basic building blocks of interoperable, reusable data elements. IHE and HITSP have reused Templates from Health Story Implementation Guides, sometimes incorporating those Templates verbatim, sometimes with modifications. While the focus on CDA Templates among these disparate organizations attests to CDA's expressive and flexible nature, the lack of coordination among those groups has also led to some issues. These include unnecessary duplication, ambiguous template derivation, or where derivation was explicit, the "onion effect" where implementers must wade through layers of IHE, HL7, and HITSP documents to understand the requirements for a single Template.

Health Story, HL7 and IHE, recognize the opportunity address these issues in the context of the Consolidation Project and are launching this effort with the support of the S&I Framework. The Consolidation Project will republish the eight HL7 Health Story Guides, harmonizing templates with related IHE templates and updating them to include HITSP mandated constraints, addressing identified issues in the HITSP templates at the same time. (Back to the top)

1.2 Health Story
Three years ago, a loosely-bound group of health IT stakeholders anticipated the need to broaden the applicability of the emerging Continuity of Care Document (CCD) standard to encompass additional use cases and scenarios. This group banded together and sponsored a series of rapid specification development projects under the banner of “Clinical Document Architecture for Common Document Types” (CDA4CDT) with a scope and mission to //reuse// the CCD components (templates) in new configurations to meet these emerging use cases. As such, the project is an instance of a broader concept called “templated CDA”. Templates, composed of re-usable data elements, represent the fundamental (atomic) units of reuse and validation among CDA and CCD instances. The effort, now known as the Health Story Project, supported development and ratification of eight implementation guides over the past three years, several of which were adopted by HITSP and cited by the Secretary. The project focused on reuse and dictated no reinvention, and the method included close review of precedents, including those within IHE, DICOM, and HITSP. The implementation guides were developed under an open call for participation, reviewed via a consensus process according to ANSI ballot requirements, and the technical artifacts were balloted and published under an Associate Charter Agreement with HL7. (Back to the top)

** 2.2.1 Harmonization Analysis **
= * Either open the link in Internet Explorer or download the file by right clicking the link and choose "save link as..."
 * = **Section** ||= **Commented CCD** ||= **Commented HITSP/IHE** ||= **Developer** ||= **"QA-er"** ||= **Projected Date** ||= **Notes** ||
 * < **CDA Header** ||< Ready for QA ||< [|QA Completed (3/29)] ||< Brett Marquard ||<  ||<   ||<   ||
 * < **Problems** ||< QA Completed ||< [|QA Completed (3/29)] ||< Gaye Dolin ||< Brett Marquard ||< 2011-2-22 ||<  ||
 * < **Results** ||< QA Completed ||< [|QA Completed (3/29)] ||< Michael Tyburski ||< Brett Marquard ||< 2011-2-22 ||< [|CCD Results - Conf Testability (MT with HITSP & IHE)] ||
 * < **Medications** ||< QA Completed ||< [|QA Completed (4/4)] ||< Cory Spears ||< Cory Spears ||< 2011-3-22 ||<  ||
 * < **Allergies** ||< QA Completed ||< [|QA Completed (3/29)] ||< Michael Tyburski ||< JD Li ||< 2011-3-8 ||<  ||
 * < **Procedures** ||< QA Completed ||< [|QA Completed (3/29)] ||< Emma Jones ||< Sean McIlvenna ||< 2011-3-15 ||<  ||
 * < **Immunizations** ||< In Progress ||< In Progress ||< Cory Spears ||< Sean McIlvenna ||< 2011-5-3 ||<  ||
 * < **Vital Signs** ||< N/A ||< [|QA Completed (3/29)] ||< N/A ||< N/A ||< N/A ||< N/A ||
 * < **Advance Directive** ||< [|QA Completed (5/3)] ||<  ||<   ||<   ||< 2011-5-10 ||<   ||
 * < **Payers** ||< [|QA Completed (5/3)] ||<  ||<   ||<   ||<   ||<   ||
 * < **Encounter**s ||< [|QA Completed (5/3)] ||< [|In Progress (5/10)] ||< Cory Spears ||<  ||< 2011-5-10 ||<   ||
 * < **Family History** ||< [|QA Completed (5/3)] ||<  ||<   ||<   ||< 2011-5-10 ||<   ||
 * < **Medical Equipment** ||< [|QA Completed (5/3)] ||<  ||<   ||<   ||<   ||<   ||
 * < **Plan of Care Activity** ||<  ||<   ||<   ||<   ||< 2011-5-3 ||<   ||
 * < **Functional Status** ||< [|QA Completed (5/3)] ||<  ||< Cory Spears ||<   ||< 2011-5-17 ||<   ||
 * < **Social History** ||<  ||<   ||<   ||<   ||< 2011-5-3 ||<   ||

2.2.2 Archived Works in Progress
Click here to view the Resolved Header Issues (which were removed from this tracker upon resolution). ||
 * = **ID** ||= **Name of the Artifact** ||= **Updated** ||= **Status** ||= **Owner** ||= **Comments** ||
 * 1 || Active Harmonization Issues ||= 3/29 ||= Ongoing ||= Brett Marquard || Click here to view the issues that were previously determined as N/A or "Out of Scope" Issues.
 * 2 || Header Analysis ||= 3/15 ||= Closed ||= Brett Marquard || Click here to view the actRelationship proposals for header consolidation. ||
 * 3 || Section Analysis ||= 3/1 ||= Closed ||= Brett Marquard || Click here to view the Discharge Summary - Section Cardinality issue. ||
 * 4 || Entry Analysis ||= 4/4 ||= Closed ||= Brett Marquard || See the Status of Harmonization Analysis ||
 * 5 || TemplateIds ||= 3/29 ||= Closed ||= Brett Marquard ||  ||
 * 6 || Template Comparison ||= 4/28 ||= Closed ||= Keith W. Boone || Access the [|comparison spreadsheet.]. ||
 * 7 || Change Tracking Proposal ||= 5/3 ||= Closed ||= Brett Marquard ||  ||
 * 8 || [|Amalgamated Ballot Comments] ||= 9/7 ||= Closed ||= Brett Marquard || Please e-mail brett.marquard@lantanagroup.com if you find any further duplicate issues. ||
 * 9 || [|Consolidated Results Section] ||= 6/28 ||= Closed ||= Pete Gilbert || Sample MDHT-generated Results Section that the Documentation WG is working on ||
 * 10 || [|Discharge Summary Gap Analysis] ||= 7/11 ||= Closed ||= Brett Marquard || Consolidated discharge summary gap analysis from Attachments WG ||

** 2.2.3 Archived Meeting Minutes **
Header Consolidation Tracker || Active Harmonization Issues Header Consolidation Tracker || [|NIST Testing Architecture Slides] || Problems Section Draft Publication || [|Results Sample XML File] || Merged Publication Considerations || Linking Narrative to Entries Discharge Summary - Section Cardinality || Linking Narrative to Entries Discharge Summary - Section Cardinality Header - actRelationship Proposals || Discharge Summary - Section Cardinality Harmonization Analysis || Harmonization Analysis (Seven Sections) || Tabular Format Proposal || [|Keith Boone's Template Comparison Tool] ||
 * **Meeting Date** || **Presentation** || **Minutes** || **Reference Documents** ||
 * January 4, 2011 || [|1/4 Consolidation Launch Agenda] || [|1/4 Consolidation Launch Minutes] || Comparison of CDA-Based Documents ||
 * January 11, 2011 || [|1/11 Consolidation Agenda] || [|1/11 Consolidation Minutes] || Active Harmonization Issues
 * January 18, 2011 || [|1/18 Consolidation Agenda] || [|1/18 Consolidation Minutes] || Conformance Verb Matrix
 * January 25, 2011 || [|1/25 Consolidation Agenda] || [|1/25 Consolidation Minutes] || Publishing Considerations ||
 * February 1, 2011 || [|2/1 Consolidation Agenda] || [|2/1 Consolidation Minutes] || Publication Considerations
 * February 8, 2011 || [|2/8 Harmonization Agenda] || [|2/8 Harmonization Minutes] || Commented US Realm Header
 * February 15, 2011 || [|2/15 Harmonization Agenda] || [|2/15 Harmonization Minutes] || Status of Harmonization Analysis
 * February 22, 2011 || [|2/22 Harmonization Agenda] || [|2/22 Harmonization Minutes] || Status of Harmonization Analysis
 * March 1, 2011 || [|3/1 Harmonization Agenda] || [|3/1 Harmonization Minutes] || Status of Harmonization Analysis
 * March 8, 2011 || [|3/8 Harmonization Agenda] || [|3/8 Harmonization Minutes] || Strawman IG (Problems Section)
 * March 15, 2011 || [|3/15 Harmonization Agenda] || [|3/15 Harmonization Minutes] || Strawman IG (Problems Section)
 * March 22, 2011 || [|3/22 Harmonization Agenda] || [|3/22 Harmonization Minutes] || Strawman IG (Problems Section)
 * March 29, 2011 || [|3/29 Harmonization Agenda] || [|3/29 Harmonization Minutes] || Harmonization Analysis (Seven Sections) ||
 * April 5, 2011 || [|4/5 Harmonization Agenda] || [|4/5 Harmonization Minutes] || Harmonization Analysis (Seven Sections) ||
 * April 19, 2011 || [|4/19 Harmonization Agenda] || [|4/19 Harmonization Minutes] || Merged Publication Considerations
 * April 26, 2011 || [|4/26 Harmonization Agenda] || [|4/26 Harmonization Minutes] || Merged Publication Considerations ||
 * May 3, 2011 || [|5/3 Harmonization Agenda] || [|5/3 Harmonization Minutes] || Harmonization Analysis (Additional Sections) ||
 * May 10, 2011 || [|5/10 Harmonization Agenda] || [|5/10 Harmonization Minutes] || [|HL7 WG Meeting - Orlando Agenda]
 * May 24, 2011 || [|5/24 Harmonization Agenda] || [|5/24 Harmonization Minutes] || [|Amalgamated ballot spreadsheet] ||
 * May 31, 2011 || [|5/31 Harmonization Agenda] || [|5/31 Harmonization Minutes] || [|Amalgamated ballot spreadsheet] ||
 * June 7, 2011 || [|6/7 Harmonization Agenda] || [|6/7 Harmonization Minutes] || [|Amalgamated Ballot Spreadsheet] ||
 * June 14, 2011 || [|6/14 Harmonization Agenda] || [|6/14 Harmonization Minutes] || [|Amalgamated Ballot Spreadsheet] ||
 * June 21, 2011 || [|6/21 Harmonization Agenda] || [|6/21 Harmonization Minutes] || [|Amalgamated Ballot Spreadsheet] ||
 * June 28, 2011 || [|6/28 Harmonization Agenda] || [|6/28 Harmonization Minutes] || [|Amalgamated Ballot Spreadsheet] ||

**2.3.1 Archived Meeting Minutes**
CDA - Initial Publication Requirements || CDA - Publication Issues || Merged Publication Considerations || Tabular Format Proposal || Tabular Format Proposal || Non-consolidated TemplateIds || [|Template Meta-Model (Keith Boone)] ||
 * **Meeting Date** || **Presentation** || **Minutes** || **Reference Documents** ||
 * February 9, 2011 || N/A || [|2/9 Documentation Minutes] || Merged Publication Considerations
 * February 16, 2011 || [|2/16 Documentation Agenda] || [|2/16 Documentation Minutes] || Merged Publication Considerations ||
 * February 23, 2011 || [|2/23 Documentation Agenda] || [|2/23 Documentation Minutes] || Merged Publication Considerations
 * March 2, 2011 || [|3/2 Documentation Agenda] || [|3/2 Documentation Minutes] || Problems Section Draft Publication
 * March 9, 2011 || [|3/9 Documentation Agenda] || [|3/9 Documentation Minutes] || Problems Section Draft Publication ||
 * March 16, 2011 || [|3/16 Documentation Agenda] || [|3/16 Documentation Minutes] || Problems Section Draft Publication
 * March 23, 2011 || [|3/23 Documentation Agenda] || [|3/23 Documentation Minutes] || Problems Section Draft Publication
 * March 30, 2011 || [|3/30 Documentation Agenda] || [|3/30 Documentation Minutes] || Problems Section Draft Publication
 * April 6, 2011 || [|4/6 Documentation Agenda] || [|4/6 Documentation Minutes] || N/A ||
 * April 20, 2011 || [|4/20 Documentation Agenda] || [|4/20 Documentation Minutes] || Merged Publication Considerations ||
 * April 27, 2011 || [|4/27 Documentation Agenda] || [|4/27 Documentation Minutes] || Merged Publication Considerations ||
 * May 4, 2011 || [|5/4 Documentation Agenda] || [|5/4 Documentation Minutes] || [|IG for CDA R2 Genetic Testing Report (GTR)] ||
 * May 11, 2011 || [|5/11 Documentation Agenda] || [|5/11 Documentation Minutes] || [|HL7 WG Meeting - Orlando Agenda]
 * May 25, 2011 || [|5/25 Documentation Agenda] || [|5/25 Documentation Minutes] || [|Amalgamated Ballot Spreadsheet] ||

2.4 CDA Consolidation Document References
The following materials are to be reviewed and considered during the analysis phase of the work. [|TF_Rev6-0_Vol_2.pdf] ||  || Size: 30”x36” || [|HITSP 09 N 451.pdf] ||  ||
 * [|HL7 Health Story Implementation Guides] (**Note:** this is a complete list of links, the material resides on hl7.org)
 * Comparison of CDA-Based Documents - Spreadsheet summarizing sections prepared by Health Story and EHR Association
 * Health Information Technology Standards Panel - [|http://hitsp.org]- the most current version of the HITSP constructs at the following locations should be used.
 * Note that not all documents listed below will be completely covered within the scope of this project; at a minimum they all share the common CDA header constraints for the US realm.
 * **Document** || **Download File** || **Source Profile** ||
 * HL7 **Clinical Document Architecture** (CDA) Release 1 || Instructions Here ||  ||
 * ASTM/HL7 **Continuity of Care Document** (CCD) Release 2 || Instructions Here ||  ||
 * [|IHE PCC Technical Framework] - Three IHE PCC Integration Profiles are specified as Final Text in Version 6.0 of the PCC Technical Framework (PCC-TF V6.0): Cross Enterprise Sharing of Medical Summaries Integration Profile (XDS-MS), including Medical Summary Document Content (MS) specification, Emergency Department Referral (EDR), and Exchange of Personal Health Record Content (XPHR). || [|TF_Rev6-0_Vol_1.pdf]
 * [|HITSP 09 N 451] This table provides an overview of, and cross-reference between HL7 CCR/CCD, HL7 CDA and HITSP C83 and HITSP C32 constructs.
 * [|HITSP/TN901 - Technical Note for Clinical Documents V1.0] Top-level reference for the HITSP constructs using the HL7 Clinical Document Architecture (CDA) Release 2.0. It includes a design map of existing standards and specifications. || [|TN901.pdf] || HL7 CDA R2 ||
 * [|HITSP/TN903 - Data Architecture Version 1.0] - Describes the HITSP Data Architecture, i.e., the data elements, templates and value sets used in Information Exchanges. It explains how within HITSP Specifications base and composite standards are related to the data architecture; data elements are harmonized across various standards; constraints are applied within HITSP Specifications; and metadata registry requirements to support development and implementation. || [|TN903.pdf] || ASTM/HL7 CCD ||
 * [|HITSP/C32 - Summary Documents Using HL7 Continuity of Care Document (CCD) Component Version 2.5] || [|C32.pdf] ||  ||
 * [|HITSP/C28 - Emergency Care Summary Document Using IHE Emergency Department Encounter Summary (EDES) Component Version 1.3.1] || [|C28.pdf] ||  ||
 * [|HITSP/C35 - EHR Lab Result Terminology Component Version 2.3] - Defines the vocabulary for either message-based or document-based laboratory results reporting || [|C35.pdf] ||  ||
 * [|HITSP/C37 - Lab Report Document Component Version 2.3] || [|C37.pdf] ||  ||
 * [|HITSP/C38 - Patient Level Quality Data Document Using IHE Summary (XDS-MS) Component Version 1.2] || [|C38.pdf] ||  ||
 * [|HITSP/C48 - Encounter Document Using IHE Medical Summary (XDS-MS) Component Version 2.5] || [|C48.pdf] ||  ||
 * [|HITSP/C62 - Unstructured Document Component Version 1.1] || [|C62.pdf] ||  ||
 * [|HITSP/C74 - Remote Monitoring Observation Document Component Version 1.1] || [|C74.pdf] ||  ||
 * [|HITSP/C75 - Healthcare Associated Infection (HAI) Report Component Version 1.1] || [|C75.pdf] ||  ||
 * [|HITSP/C80 - Clinical Document and Message Terminology Component Version 2.0.1] || [|C80.pdf] ||  ||
 * [|HITSP/C83 - CDA Content Modules Component Version 2.0.1] || [|C83.pdf] ||  ||
 * [|HITSP/C84 - Consult and History and Physical Note Component Version 1.1] || [|C84.pdf] ||  ||
 * [|HITSP/C151 - Clinical Research Document Component Version 1.0] || [|C151.pdf] ||  ||
 * [|HITSP/C154 - HITSP Data Dictionary Version 1.0.1] || [|C154.pdf] ||  ||
 * [|HITSP/C161- Antepartum Record Component Version 1.0] || [|C161.pdf] ||  ||
 * [|HITSP/C162 - Plan of Care Component Version 1.0] || [|C162.pdf] ||  ||
 * [|HTISP/C166 - Operative Note Document Component Version 0.0.1] || [|C166.pdf] ||  ||
 * [|HITSP/C168 - Long Term and Post Acute Care Assessments Component Version 0.0.1] || [|C168.pdf] ||  ||
 * [|HL7 Project Scope Statement]
 * [|Link to EHRA analysis]
 * [|HITSP_Open_Comments_20101202.xlsx]
 * Open C32 issues as recorded by NIST, et al as of Dec. 2, 2010, filtered to show only issues against Constructs that are related to the C32 stack.
 * [|Header_Consolidation_tracker.xls_(U16463).xls] (Archived. Last updated: 2011-1-24)

3. Educational Material

 * //Quick Start Guides//**
 * [|CDA Quick Start Guide (v1.5)]
 * This Quick Start Guide supports implementers working with simple CDA documents. It covers required elements in the CDA header and body and explains fundamental concepts including the CDA approach to identifiers, vocabulary and data types.
 * [|Continuity of Care Document (CCD) Quick Start Guide (v1.0)]
 * This Quick Start Guide is for implementers working with the Continuity of Care Document (CCD). If not already familiar with the underlying Clinical Document Architecture Release 2.0 (CDA R2) standard, readers should also take advantage of the CDA Quick Start Guide available here.
 * [|Care Record Summary (CRS) Quick Start Guide (v1.0)]
 * This Quick Start Guide is for implementers working with the Care Record Summary (CRS).