DFC1 Content

1 CDA Overview

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1.1 What is the CDA

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- 20120613 - group does not feel any edits to this section are necessary. See document posted by Lisa regarding

this section.

- Does any of the text associated with the 6 document characteristics need to be made? Lisa will follow up with

Kalvin, Keith, Bob to see if they have anything from the tutorials.

1.1.1 Key aspects of the CDA

The thirds bullet that talks about expressiveness and flexibility of R2 needs to be revised slightly to

indicate that R3 is introducing additional flexibility where R2 was found limiting in some cases.

1.1.2 Scope of the CDA

Need add some text outlining the expanded scope of participation in the header as well as the expansion of the

right hand side entries to include more or less the entire RIM.

1.1.3 Goals and Design Principles

These goals and design principles were reviewed on the section and approved making the following changes:
- Change the final goal
  - From: Enable policy-makers to control their own information requirements without extension to this

specification.

- - To: Enable policy-makers and implementers to control their own information requirements without extension to

this specification.

- Following the first goal, add a new goal:
  - Provide additional support for use cases related to secondary use of healthcare data
- Add a design principle describing how we are supporting the above new goal via the expanded generic header

participant as well as the expansion of the "clinical statement" portion of CDA to encompass more or less the

entire RIM

1.2 General CDA Concepts

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1.2.1 Major Components of a CDA Document

Editor - Amnon
Note - This is probably where we need to discuss the implications of splitting semantics from rendering as

that change has a major impact on the overall structure of CDA. This file has the text:

Media:CDA_R3_Split_Semantics_and_Rendering_-_2012.07.18.docx

1.2.2 The "A" in "CDA"

Need to add a sentence that CDA R3 hasn't really changed the approach to CDA "levels" that was used in CDA R2.
One note that if we go down the split semantics from rendering path that we can no longer assume that a level

3 CDA has level 2 sections. That will need to be made explicit as opposed to being implicit as it is today.

1.2.3 Human Readability and Rendering CDA Documents

Needs to be updated to talk about CDA R3 instead of CDA R2)
Need to take a look at the last bullet to see if R2 really accomplished this and what if any change needs to be

made in R3 to allow indicating how narrative was derived from structured content.

- "When narrative is derived from structured content, there must be a mechanism to identify the process by which

narrative was generated from structured data."

Also need to add a discussion about responsibilities of creators of documents regarding what ends up as

machine readable vs. human readable.

1.2.4 XML Markup of CDA Documents

editor - Keith
Keith has some tweaks to the meaning of validation of the CDA.

Media:1-2-4 XML Markup of CDA Documents.docx

1.2.5 Security, Confidentiality, and Data Integrity

Content for this section is tied to the output from the CDA R3 Security Cookbook risk assessment. That won't

be completed in time for the draft for comment ballot, but needs to be wrapped up before normative balloting.

1.2.6 Relationship of the CDA to HL7 Messaging Standards

Leave as is for now

1.3 CDA Conformance

editor - Keith
Keith has some tweaks to the meaning of validation of the CDA.

Media:1-3 CDA Conformance.docx

1.3.1 Recipient Responsibilities

1.3.2 Originator Responsibilities

1.4 CDA Extensibility

Editor - Keith

Media:1-4_CDA_Extensibility.docx

1.5 Backwards and Forwards Compatibility

Editor -
Need to add release notes for CDA R3 (based on task tracker)

2 Introduction to CDA Technical Artifacts

Editor - Keith to review to see what edits need to be made.

Media:2_Introduction_to_CDA_Technical_Artifacts.docx

2.1 HL7 Reference Information Model

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2.2 HL7 V3 Data Types

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Adopting R2 Datatypes

2.3 HL7 Vocabulary Domains

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2.4 HL7 CDA R-MIM

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2.5 HL7 CDA Hierarchical Description

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2.6 HL7 CDA XML Implementation

Editor - Rick

Media:2.6_HL7_CDA_XML_Implementation.docx

3 CDA Document Exchange in HL7 Messages

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4 CDA R-MIM

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4.1 Clinical Document

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4.2 Header

Editor - Rick & Austin
Same content needs to be pushed into the CDA R3 RMIM as attribute level descriptions.

4.2.1 Header Attributes

4.2.2 Header Participants

4.2.3 Header Relationships

4.2.4 Header Rendering

Editor: Keith Media:4-2-4 Header Rendering.docx Could move to Rendering Section above

4.3 Body

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4.3.1 Body Choice

4.3.2 Section Attributes

4.3.3 Section Participants

4.3.4 Section Relationships

4.3.5 Section Narrative Block

Editor: Calvin Beebe

Uploaded narrative: [Section 4.3.5] additional materials are in this [Zip file] i.e.

CDA Narrative Schema (XSD) file and documentation (HTML) file.

4.3.6 Entry Acts

4.3.6.1 Document using templates for the new CDA Act Statement

Editor - Calvin

4.3.7 Entry Participants

4.3.8 Entry Relationships

4.4 CDA Context

Editor - Amnon

Media:CDA_R3_Context_Conduction_-_2012.07.18.docx

4.4.1 Overview of CDA Context

4.4.2 Technical Aspects of CDA Context

editor: Austin
Media:442-TechnicalContext.doc

5 CDA Hierarchical Description

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6 CDA XML Implementation

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Appendices

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A Samples

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A.1 Sample Document

A.2 Sample CDA Instance

A.3 Sample CDA Style Sheet

Editor - Alexander/Calvin

Requirements

SHOULD where possible stay close to the rendering done by the current cda.xsl
SHOULD try to have 1 XSL for both CDAr2 and CDAr3
SHOULD run in major browsers (Internet Explorer 8 and up, FireFox, Chrome, Safari)
- SHOULD use XSLT 1.0 without EXSLT or other extensions
SHOULD produce valid XHTML Strict 1.0 (makes sense given that NarrativeBlock is a subset of XHTML Strict)
SHOULD produce in XHTML default encoding UTF-8
SHOULD have core CSS internal, but MAY additionally provide hook to external CSS
SHOULD work well both on screen and in print (separate CSS to do this)
SHOULD be localizable, SHOULD provide at least English (en-US)
MAY use Javascript internally as long as the default is without, and MAY additionally provide hook to external

Javascript

SHOULD NOT implement cookie support
COULD be optimized for smaller screens such as phones and tablets
SHOULD display:
- All header information
- NonStructuredBody if the content type allows it in XSLT 1.0
- StructuredBody/Section attributes including NarrativeBlock and participations, but except component (Level 3)
- Images and other media as far as content type allows it and if not wrapped in Base64 (unless someone can

point out how to Base64 decode in XSL 1.0 without extensions with reasonable performance)

CDA R3 Project Editing DFC1

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