CDA Consolidation Project

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Please note that the 4/12 Consolidation Project Weekly meeting has been CANCELED.

Charter

Meaningful Use anticipates the widespread exchange of clinical information, and the Standards Final Rule prescribes a number of clinical content standards.  ONC has received feedback regarding implementation challenges associated with these standards, specifically HITSP C32.  At the same time, the Health Story Project, HL7, and IHE have received implementer feedback expressing the need to consolidate the Implementation Guides addressing exchange of common types of clinical documentation and to provide a comprehensive library of reusable data elements based on "Templated CDA". HL7 initiated a project to  consolidate the numerous Clinical Document Architecture (CDA) implementation guides upon which C32 and other clinical content specifications are based and to address the high-priority items for harmonization.  Health Story, IHE, and HL7 are collaborating in this initiative to harmonize and consolidate current CDA implementation guides in order to address that feedback.  This volunteer effort is being hosted within ONC's Standards and Interoperability (S&I) Framework and facilitated with the support of ONC S&I Contractors.

Purpose and Goals

Meaningful Use:  Several Meaningful Use Stage 1 objectives call for key clinical information and/or Summary Records to be exchanged among providers and to be made available from providers to patients.  One of the standards specified in the Standards Final Rule for this purpose is the HL7 CDA Release 2, Continuity of Care Document (CCD) to be implemented according to HITSP C32.  This project will identify and address issues which are impacting implementation of C32 and other clinical content specifications that are based on Templated CDA.

  • Consolidate the implementation guides for the eight HL7/Health Story clinical document types into a single library of CDA Templates and use model-driven tools to re-publish them from this library
  • Update and harmonize C32 while addressing known issues (ambiguity, gaps, etc.)
  • Rapid demonstration of templated CDA as a data element centric paradigm for health information exchange, corresponding to PCAST recommendations
  • Harmonize HL7 and IHE templates, establishing a strong process for future collaboration
  • Provide a real world demonstration of model-driven standards development using MDHT and the CDC/NCI Template Database (Tdb)
  • Resolve the ‘peel the onion’ problem: deliver a single, implementation-ready, implementer-friendly package, wihch includes both textual and computable representations
  • Development of a testing solution to enable implementers to validate their output

Scope

The Consolidation project will not introduce a review of content. The project will tackle Templates from across all eight Health Story IGs, initially prioritizing those which are called out for Meaningful Use Stage 1 in the Standards Final Rule. The Final Rule specifies "CCD implemented according to the HITSP C32 implementation specification". Beyond the Content Modules / Sections which are required by C32, the Final Rule also requires Problem List, Test Results, Medications, Medications Allergies, and Procedures. In addition to those Templates associated with the Final Rule, we will also include two or three additional sections prioritized by ONC in order to address implementation issues raised by participants in the NHIN Exchange. The intent of this initial prioritization is to cover those key Templates which are expected to most directly impact current implementation issues.

Success Metrics

Outcome Metrics
  1. Number of entities able to implement and validate C32 and related clinical content standards 
  2. Availability of Open Source, platform independent validation tools that provide
    1. Pass for good instances
    2. Fail for bad instances providing guidance on the error
  3. Tie back to reusable models supporting Meaningful Use and future initiatives
  4. Cost reduction for implementation of C32 and related content standards
  5. Number of providers able to exchange key clinical information and/or Summary Records as specified in MU
Process Metrics
  1. Number of participants / organizations actively engaged in developing Consolidation Project outputs 
    1. Wiki user counts
    2. Count of artifact downloads
    3. Number of wiki edits, etc.
    4. Participation on calls
    5. Generate and delegate work items to offline/separate groups
  2. Ballot and publication of Consolidated Implementation Guide via HL7 DSTU
    1. Ballot participation (number of entities casting ballots)
    2. Pass on first ballot
  3. Awareness
    1. Number of entities contacting project
    2. Press
    3. Presentations provided

Timeline

Dec Issue call for participation through ONC S&I Framework, participating and related organizations Jan Address header, short-list issues (VLER hot spots) Feb Publish interim guidance for short-list, continue analysis of full scope Mar Conclude analysis, generate test scripts, implementation guides Apr Ballot within HL7 May Ballot reconciliation, development of change recommendations Jun Publish full deliverables and begin implementation outreach and dissemination

Schedule

The Call for Participation is open and work will be held in open conference calls with no pre-registration or membership requirement.

Recurring meeting: Tuesday @ 11:00 AM EST - 12:30 PM EST

Announcements of calls and dissemination of agendas will be available here and through the HL7 SDWG listserv. You can sign up for the listserv here: http://www.hl7.org/Special/committees/structure/listserv.cfm, please choose the "Primary List for Structured Documents" option on the page.

About our Workgroups

Note: Initiative members will determine necessary workgroups with launch of initiative. Below are an initial list of proposed Workgroups by the Initiative Coordinators.

Committed members participate in at least one of the following workgroups under the Consolidation Project:

Workgroup WG Lead Description
Harmonization Brett Marquard
The purpose of the Harmonization Workgroup is identification, analysis and harmonization of CDA Header, Section and Entry issues.
Documentation
Keith Boone &
Pete Gilbert
The purpose of the Documentation Workgroup includes publication of DSTU and strategy for impact on HITSP documents.

The Consolidation Project is coordinated by Liora Alschuler and Dave Carlson with the guidance of the Office of Interoperability and Standards (OIS) under the Office of National Coordinator.

How to Get Involved

  • Keep me Informed
    • To be notified about significant events and announcements from the project, follow this site
  • How can I contribute?
    • Visit the "Getting Started as a Volunteer" page
    • Review the existing Lab Interface project's workgroups to see where you can contribute
    • Refrain from defacement, abuse, commercial promotion, or other content that violates our Wiki Use Guidelines

Recurring meeting: Tuesday @ 11:00 AM EST - 12:30 PM EST

    * Conference line: 1-770-657-9270, Participant Passcode: 310940
    * LiveMeeting: https://www.livemeeting.com/cc/dt/join?id=CDAconsolidation&role=attend

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