The CDA Management Group (CMG) aims to use the next C-CDA Implementation-A-Thon (IAT) to expand outreach to engage new communities and increase the impact of this content improvement effort. “We learned so much last year about how to maximize the value of implementer-led implementation-a-thons,” said CMG Co-Chair Lisa Nelson. “The new approach was a step in the right direction. It helped implementers drive the conversation and focus the community on making changes that would yield valuable improvements,” she explained.
Primary author: John D'Amore, Co-Founder, Diameter Health; Co-authors: Brett Marquard, Principal, Wave One Associates and Wayne Kubick, CTO, HL7 International
While HL7 FHIR® (Fast Healthcare Interoperability Resources) is today’s hottest healthcare standard, clinical documents are already exchanged in the billions today. HL7 published the Consolidated Clinical Document Architecture (C-CDA) in 2011 to support care coordination and patient engagement. The ONC 2014 certification rule named C-CDA R1.1 and adoption exploded. The current version of C-CDA, R2.1, remains backwards compatible to that version today. While C-CDA is a flexible, robust standard to record patient care longitudinally or for an encounter, it is structurally complex. The C-CDA standard itself is over 1,000 pages long. Applying the standard to the latest US requirements for clinical data exchange, known as the US Core Data for Interoperability, also routinely requires information from the C-CDA Companion Guide.
HL7 publishes the C-CDA standard and its Companion Guide as PDF documents. That will remain the official version of the standard, but a small team from the CDA Management and Structured Documents Working Groups saw an opportunity to make the C-CDA content easier to use by developing a new web tool. Since the C-CDA has reusable parts, known as “templates,” it seemed logical to make each template searchable and distinct via unique web pages so the standard would be much easier to absorb.
The new HL7 C-CDA Online Search Tool is a searchable, web-based navigation resource for the Consolidated Clinical Document Architecture (C-CDA 2.1) and its Companion Guide. The solution includes over 240 unique web pages that make each template accessible on the web with linkage back to the original PDF content. This navigation is managed through a single searchable index page, like a smart table of contents.
Using the template webpages, health IT vendors can ensure that their C-CDAs are conformant and high-quality for document exchange. The search tool enables users to search the C-CDA by description, template object identifier (OID) or conformance number. Conformance number searches are particularly valuable for C-CDA implementers, since validators will return these numbers when there’s a violation or warning associated with C-CDA testing.
Doing Less, but Better
Imagine you’re struggling in a long race – maybe an ultra-marathon over a winding, hilly course. You’ve been running for many hours, and you’re tired, sore and hungry. You’re running up a hill, hoping the end will soon be in sight. But when you get to the top, you only see a turn, not a finish. And after that turn – oh, no! – another hill. We’ve had that feeling during the long pandemic, and, for some of us, we’ve had that feeling even longer with respect to tooling at HL7. We’ve covered a lot of ground, and climbed a lot of hills, and we can feel the end should be in sight very soon. But we’re still running.
Fortunately, we have a team of supporters handing out Gatorade, clapping and cheering us on, and we’ve got our fellow runners pulling us along. And so it is with the HL7 community. We ask a lot of you to help us move forward, with support and understanding; sometimes contributing your valuable time to help us with development or testing, or to struggle patiently with change and the unexpected discoveries of new technology rollouts. While we don’t see that finish line yet, we see plenty of blue skies and greener fields beyond. We won’t always make it on the podium, and sometimes we stumble along the way. But the important thing is to keep moving forward and getting better.
The View from Above
We may not always seem to be progressing very fast, but we’ve really come a long way in the last few years thanks to the important contributions of many of you as well as the ongoing generous support of the US Office of the National Coordinator for Health IT (ONC), which has funded many of our retooling efforts. To list a few prominent examples:
Doing Less, but Better
For many of us, this desperate pandemic year has led to plenty of introspection. This has also been true for the HL7 Board, which has been contemplating the future of the HL7 organization after emerging from the current crisis. Among a set of core principles adopted by the Board are agility and focus. To be agile, we need to simplify and refine the organization and core processes as well as provide support with continued improvements to our tooling. This also requires getting our global community to better understand and use the processes more consistently and effectively, so we can better focus on our core work of developing and implementing interoperability standards. This a perfect segue back toward my long-held core belief in essentialism.
Back to Basics
I first espoused the concept of essentialism to an enthusiastic Board and Technical Steering Committee back in 2016. While we’ve only made small incremental progress in the four years since, it has been guiding our process improvement and tooling initiatives. Essentialism was a driving force behind our adoption of Confluence and JIRA as well as efforts to simplify our product portfolio. Of course, we operate in a complex field, and there were many confounding forces acting at the same time. The HL7 community is more adept at introducing new processes, tools and content than at retiring or eliminating the old stuff. Thus, our commitment to essentialism faded over time, tempered by inertia and continuing demands, not the least of which has been the black swan events of 2020.
Perhaps it’s time to once again review the key elements of essentialism and discuss how it fits with our ongoing tooling strategy and plans.
Keeping Us Together While Apart
During this time of global crisis, it’s worth remembering the critical importance of what we at HL7 are doing to improve global health by making health information more available and useful. While so many are struggling with social distancing, we already have a culture that long ago learned to work together remotely on our common goals. But now with fewer opportunities to meet together in person, we need to move ahead to finish much of the work we’ve been doing over the past few years – so we’re better prepared to work together even more effectively, while knowing we must be further apart geographically.
Seqster has developed a platform that allows patients and their caregivers to collect, visualize, manage and share all of their health data in one app. We aggregate clinical data points across providers chronologically using the industry-standard coding systems that the HL7 community knows all too well.
The next Consolidated Clinical Document Architecture (C-CDA) Implementation-A-Thon (IAT) is scheduled this September 14-15 in Atlanta, Georgia. It will be held as a track within the HL7 FHIR Connectathon, allowing attendees to optimize participation across CDA and FHIR-related tracks.
Our ongoing tooling journey at HL7 continues, neither as a sprint nor a marathon. For us, it’s really more like an odyssey – an ongoing journey where there is always something more to be done, another path to explore, and a final destination (retirement, for example) seems far out of reach. In the case of HL7 tooling, a fair number of tooling retirements are well overdue.
Despite the wait, it’s gratifying to see when tangible progress is actually achieved. On the Confluence front, we’re in the home stretch of phase 1 of the rollout, though there’s a whole new course to pursue just around the bend. We now have all work groups on Confluence (!) and have also migrated many more projects, committees and collaborations. New functions and help features in Confluence (including a major facelift for confluence.hl7.org) are being added regularly, and you can keep up with these by checking the CTO Tooling Update page. This enabling platform is already unleashing many new opportunities within the HL7 community. Our next target is to work toward optimizing our processes with online forms and workflow. The online project scope statement (PSS) pilot is now available and will give us an opportunity to speed up reviews and approvals as well as make new projects more visible to the community in the hope we can avoid last minute catchups.
Introducing the HL7 Companion Guide to Consolidated Clinical Document Architecture (C-CDA®) 2.1
On March 3, 2017, Health Level Seven International and the Duteau Design Inc. team of Jean Duteau, Joginder Madra, Helen Stevens, and Lisa Nelson published the Companion Guide to Consolidated Clinical Document Architecture (C-CDA) 2.1. This companion guide is a supplement to HL7's CDA R2 Implementation Guide (IG): C-CDA Templates for Clinical Notes STU Release 2.1.