1. September, 2005What IHE Delivers 1 CDA-based content integration profiles Philippe Lagouarde, Cegedim Co-chair Vendor, IHE-France

2. 2 plan CDA ? CDA Release 1 CDA Release 2 Integration-content profiles Conclusion

3. 3 CDA : Clinical Document Architecture CDA is an international standard ANSI/HL7 CDA R1.0-2000 ANSI/HL7 CDA R2.0-2005 CDA is an XML-based format for clinical document

4. 4 Interoperability CDA proposes two levels of interoperability Human CDA describes traditional structure of a document CDA does not required sophisticated tools to be directly read by Healthcare professionals or patients Application interoperability multimedia content data

5. 5 Application

6. 6 Readable Human Rendering

7. 7 Characteristic of a CDA document Persistence Stewardship Potential for authentication Context Wholeness Human readability A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content.

8. 8 Structure of a CDA document Document context Clinical information Header Body XML encoding Human readable… …and by computers Diagnosis: Asthma Diagnosis Asthma Generiic stylesheet

9. 9 plan CDA ? CDA Release 1 CDA Release 2 Integration-content profiles Conclusion

10. 10 CDA R1 First HL7 standard based on the RIM Header Body Body : some structured clinical data for automatic processing

11. 11 CDA Header Document Identification (ID, code, title, date …) Confidentiality, language, authorisations Authenticator(s), including legal authenticator recipient(s) du contenu Author(s), Data enterer Patient Informants Related Document(s) Service Event(s), Participant(s), Encounter

12. 12 CDA R1 - Example of Body Allergies and Adverse Reactions Penicillin - Hives Aspirin - Wheezing Codeine – Itching and nausea <coded_entry.value ORIGTXT=A1 V="DF-10074" S= SNOMED DN=Allergy to Penicillin/> Narrative Computable

13. 13 plan CDA ? CDA Release 1 CDA Release 2 Integration-content profiles Conclusion

14. 14 CDA R2 HL7 V3 Framework Development Header RIM … XML Schema Body Narrative block Entry Observation Substance administration Procedure Encounter Observation Media …

15. 15 CDA R2 – Example of Body … Penicillin – Hives … <code code="84100007" codeSystem="2.16.840.1.113883.6.96 codeSystemName="SNOMED CT" displayName="History taking"/> <value xsi:type="CD" code="247472004" codeSystem="2.16.840.1.113883.6.96" displayName=" Hives "> <code code="84100007" codeSystem="2.16.840.1.113883.6.96" displayName="History taking"/> <value xsi:type="CD" code="91936005 CodeSystem="2.16.84…" displayName= PCN Allergy "/> … Narrative Computable

16. 16 Benefits of CDA R2 Non limited Vocabularies (SNOMED, LOINC, national vocabularies…) Structured data coherent with the HL7 RIM Modification of Confidentiality code, language, auteurs, within a section Internal and external links An observation (eczema) a substance administration (penicillin) An observation (fracture) une image (radiology) Current document (Discharge letter) another document (referral) A unique schema an a generic XSL stylesheet

17. 17 For all type of documents Communication Admission evaluation Transfer of care referral Pre-operative evaluation and management Evaluation and management Subsequent evaluation Conference Summarization of episode Case conference Transfer summarization Consult Discharge summarization Confirmatory consultation Summary of death Counseling Transfer of care referral Group counseling Supervisory direction Education Telephone encounter History and Physical Interventional Procedure Admission history and physical Operative Comprehensive history and physical Pathology Procedure Targeted history and physical Autopsy Initial evaluation Admission evaluation Admission evaluation Pre-operative evaluation and management

18. 18 CDA Implementation guides The objective is to give a common table of contents to all document of a specific type Additional constraints to the generic CDA standard First initiatives for CDA medical summaries e-MS (British Columbia) Clinical Record Summary (HL7/ASTM – US)

19. 19 Example - CRS Section TitleCODELOINCCard Advance Directives X ADVDIR ADVANCED DIRECTIVES 0..1 Functional Status 10158 4 HISTORY OF FUNCTIONAL STATUS 0..1 Conditions X COND CONDITIONS 1..1 Active 11450 4 PROBLEM LIST 1..1 …

20. 20 Example of the Sciphox Project

21. 21 Important development International Germany SCIPHOX (medical summary) Finland (~ 100 CDA guidelines) France Volet Médical (medical summary) New Zeland Health Information Summaries Italy TeleMed Escape UK (NHS, South Staffordshire) Japan MERIT-9 Greece HYGEIAnet/WebOnColl … IHE IHE Transactions profiles are extended by IHE integration content profile

22. 22 CDA ? CDA Release 1 CDA Release 2 Integration-content profiles Conclusion

23. 23 IHE-XDS Cross Document Sharing integration profile Neutral from format RTF, PDF, DICOM, JPEG… and CDA Neutral from type of CDA document Metadata used for management of the document inherits from the CDA header

24. 24 IHE-XDS – Actors/Transactions Extension of Clinical Content Profile also with XDM and XDR integration profiles

25. 25 XDS-MS 2006 : PCC a new IHE domain PCC (Patient Care Coordination) First focus : To leverage IHE-XDS for Medical Summary Documents A class of clinical documents that contain the most relevant portions of information about the patient intended for a specific provider or a broad range of potential providers in different settings. Content Profiles define how the content used in a transaction is structured. Implementation guides for types of CDA document

26. 26 XDS-MS – Example of guides

27. 27 Evolution of PCC

28. 28 Extension to other IHE domains Laboratory domain : Example of a use case from the 2007 Sharing Laboratory Reports (XD - LAB)

29. 29 LAB CDA report constraints A clinical laboratory report SHALL have a structuredBody. This body is organized as a tree of up to two levels of sections. Top level sections represent laboratory specialties. … …

30. 30 XDS-MS Actors ContentcreatorContentconsumer Share content

31. 31 XDS-MS Options ActorOptions Content ConsumerView Option Document Import Option Section Import Option Discrete Data Import Option Content CreatorReferral Option Discharge Summary Option

32. 32 Conclusion CDA R2 a flexible tool to manage electronic document Ready to use Implementation guides to constraint CDA document types New localisation possibilities for national IHE Rapid development International initiatives outside IHE context IHE Content profiles

33. September, 2005What IHE Delivers 33 Thank you! IHE Europe web site: www.ihe-europe.org