1. eHealth DSI – 2019 Technical Boot Camp CDA Implementation Guides
, Mathias Ghys

2. Topics
CDA in the eHDSI landscape
Clinical Document Architecture (CDA)
Supported CDA documents
ART-DECOR: Template management
Validation of CDA documents

3. CDA in the eHDSI landscape

4. IHE Profiles used in eHDSI context
Look for patient on the A side
Retrieve the list of documents available for this specific person (PS and eP)
Retrieve a specific document from the list
provides document interchange using a reliable messaging system (used for eD)

5. Portal view

7. Clinical Document Architecture (CDA)

8. Challenge
"Adherence to Standards ensures interoperability between different medical information systems"
Standards:
IHE profiles
HL7 CDA documents
Project specific implementation guides of HL7 CDA templates specifying the format of exchanged messages.

9. What is CDA?
The HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange.

10. STANDARD CONCEPTUAL IMPLEMENTATION
prCEN/DTS IPS
Provide implementation guidance for
prCEN/EN IPS
TECH AGNOSTIC
HL7 Reference Information Model (RIM)
Refine
Subset of RIM
Tighten constraints
eHN EU guidelines
eHDSI Requirements
CDA RMIM
IMPLEMENTATION
EHDSI CDA IG
STANDARDS
IHE PCC
HL7 CCD
C-CDA

11. CDA Levels overview

12. CDA Document structure
Header
Structured metadata about the document itself.
Body
Contains the clinical report.
Non-XML body or non-structured body
Structured body

13. CDA Document structure
Header
Structured metadata about the document itself.
Body
Contains the clinical report.
Non-XML body or non-structured body
Structured body
Section
Contains :
human-readable narrative block (the section tekst)
number of entries (with clinical statements) in a structured computer- processable form.

14. Examples of Sections
Contains a human-readable narrative block (the section text and a number of entries (with clinical statements) in a structured computer-processable form.
Sections used for Patient Summary
Medication Summary
Allergies and Other Adverse Reactions
Immunizations
History of Past Illness
Coded List of Surgeries
Active Problems
Medical Devices Coded
Health Maintenance Care Plan
Functional Status
Coded Social History
Pregnancy History
Coded Vital Signs
Coded Results
Sections used for ePrescription
Prescription
Source: eHealth Network Guideline

15. CDA Document <component> <structuredBody>
<section moodCode="EVN">
<templateId root=" "/>
<templateId root=" "/>
<code code=" "
codeSystem=" "
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<title>History of allergies</title>
<text>Allergies and alerts</text>
<entry>
<act classCode="ACT" moodCode="EVN">
<templateId root=" "/>
<templateId root=" "/>
<templateId root=" "/>
<id root=" " extension="15"/>
<code nullFlavor="NA"/>
<statusCode code="active"/>
<effectiveTime>
<low value=" "/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="false">
<observation classCode="OBS" moodCode="EVN" negationInd="false">
<templateId root=" "/>
<templateId root=" "/>
<templateId root=" "/>
<templateId root=" "/>
<id root=" "/>
<code code=" "

16. Supported CDA Documents

17. CDA document types used within eHDSI
Following document types support the two use cases used in eHDSI:
Patient Summary
ePrescription/eDispensation
CDA Level 1:
ePrescription (Embedded PDF)
Patient Summary (Embedded PDF)
CDA Level 3:
ePrescription
Patient Summary
eDispensation

18. ART-DÉCOR: Document management

19. What is ART-DECOR? ART-DECOR in 4 bullets: Open-source tool
Collaboration tool
Single documentation for different domain experts
Support for creation and maintenance of HL7 templates
decor/decor-project-- epsos-

20. ART-DECOR template management
ART-DECOR defines different Document Level CDA templates for usage in the eHDSI project:
CDA Level 1:
ePrescription (Embedded PDF)
Patient Summary (Embedded PDF)
CDA Level 3:
ePrescription
Patient Summary
eDispensation

21. Validation of CDA Documents

23. IHE Gazelle EVS Client CDA DOCUMENT TO VALIDATE SCHEMATRON FILE TO USE
MODEL BASED VALIDATOR TO USE

24. Validation of CDA Documents
Publication
Formats:
HTML
PDF
XML
Schematron
ART-DECOR RELEASE
IHE Gazelle EVS Client

25. Future challenges For the eHDSI Solution Provider
Continuously improve the quality of the templates
Three draft change proposals being prepared
Fix long-term challenges like the duplicate OID issue
For the member states
Harmonize CDA documents generated by your national infrastructure with the specifications in ART-DECOR (IHE Gazelle EVS Client)
Help us to improve the overall template quality (raise issues)
Try it out!

26. Find out more on CEF eHealth DSI
These materials have been crafted to provide a comprehensive summary on the issues in stake.
For further clarifications, please: