Product CDA

Product Brief - Clinical Document Architecture (CDA)

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Product Name

Clinical Document Architecture (CDA)

Standard Category

Health Information Exchange Standards

Integration Paradigm

Documents

Type

Normative, ANSI Standard

Releases

• CDA R1: ANSI/HL7 CDA, R1-2000
• CDA R2: ANSI/HL7 CDA, R2-2005
• CDA R3: in-progress see Project # 477

Summary

The Clinical Document Architecture (CDA) is a specification for the exchange of electronic clinical documents. It can contain coded data and narrative and is compatible with the electronic health record and document management systems. CDA is at the core of virtually all standards-based exchange networks in the US and abroad and is adaptable for dictated notes and highly-structured public health and quality reporting.

Description

Clinical documents are the core of a patient's lifetime health record. HL7’s CDA standard provides an exchange model for clinical documents such as discharge summaries and progress notes. A consistent approach to electronic clinical documents means that critical information contained in the documents can be used independently of the application on which it was produced. For example, CDA documents can be displayed using XML-aware Web browsers or wireless applications on mobile devices.

What Are Clinical Documents?

Clinical documents are the core of a patient's lifetime record. A "History & Physical" or a "Discharge Summary" or an "X-ray Report" are all examples of clinical documents. Typically, they contain narrative as well as discrete data. While certain structures may apply across document types, like the common SOAP note structure, individual document types vary widely in content. The HL7 CDA defines clinical documents as having these characteristics:

• Persistence
• Stewardship
• Authentication
• Context
• Wholeness
• Human readability

Why should clinical documents be standardized?

A consistent approach to electronic clinical documents means that the critical information contained in the documents can be used independently of the applications on which they were produced. For example, a Discharge Summary created by an electronic health record can be rendered on standard browsers and a repository of transcription documents can be indexed with the same metadata as the output of an EHR. Information created today can be migrated to future systems with little or no data conversion. Findings encoded in clinical documents can be used for third-party decision support and mined at a later date for new applications.

What is CDA?

First published in 2000, The HL7 Clinical Document Architecture (CDA) is a leading standard for the exchange of healthcare information and has become a pillar of interoperability for clinical care and public health. CDA Release 2 utilizes a common syntax for all clinical documents. It preserves the integrity and structure of clinical documents. It conveys authenticated content with fidelity and supports discrete data representation that is both extractable and computable. The CDA Release 2 provides an exchange model for clinical documents (such as discharge summaries and progress notes) - and brings the healthcare industry closer to the realization of an electronic medical record. By leveraging the use of XML, the HL7 RIM and coded vocabularies, the CDA makes documents both machine-readable - so they are easily parsed and processed electronically, and human-readable - so they can be easily retrieved and used by the people who need them. CDA documents can be displayed using XML-aware web browsers or wireless applications such as cell phones.

Who is using CDA?

There are large scale CDA implementations in North and South America, Europe and Asia Pacific. In the US, CDA is being implemented by groups such as New York Presbyterian, the Military Health System, University of Pittsburgh Medical Center, Kaiser Permanente and many others. Groups such as the Healthcare Information Technology Standards Panel (HITSP) and Integrating the Healthcare Enterprise (IHE) are also utilizing CDA in their work.

Implementations/ Case Studies (Actual Users)

CDA Implementation Guides

Several implementation guides passed the HL7 balloting process and were approved in 2008 in the Draft Standard for Trial Use (DSTU) status. They are as follows:

CDA IG for Reference Profile for EHR Interoperability, Release 1

This guide describes characteristics of interoperable EHR Records. An EHR Record is a persistent artifact which may be independent of the EHR or other System from which it originated. This profile shows how HL7's CDA, Release 2 fulfills requirements of the Common EHR Record Unit, as specified in the HL7 EHR Interoperability Model DSTU. It is the result of an ongoing collaboration between the HL7 EHR, Structured Documents, and Security Work Groups.

CDA IG for Healthcare Associated Infection (HAI) Reports, Release 1

This implementation guide was developed in conjunction with the Structured Documents Work Group and the Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), Centers for Disease Control and Prevention (CDC). The purpose of this Implementation Guide is to specify a standard for electronic submission of Healthcare Associated Infection (HAI ) reports to the National Healthcare Safety Network (NHSN) of the CDC. It defines the overall approach and method of electronic submission and develops a set of appendices defining specific HAI report types. As reports are modified and new report types are defined, additional appendices will be developed and published by CDC and HL7.

CDA IG for History & Physical Notes, Release 1

The implementation guide for this HL7 Draft Standard for Trial Use (DSTU) was developed in conjunction with the CDA for Common Document Types (CDA4CDT) project, which has an Associate Charter Agreement with HL7. The guide describes constraints on the CDA Header and Body for History & Physical Notes, which are two-part medical reports that document the current and past conditions of the patients.

CDA IG for Consultation Notes, Release 1

The implementation guide for this HL7 Draft Standard for Trial Use (DSTU) was developed in conjunction with the CDA for Common Document Types (CDA4CDT) project, which has an Associate Charter Agreement with HL7. The guide reuses templates developed for the HL7 Continuity of Care Document (CCD) and for the History and Physical DSTU and is suitable for consultation notes.

CDA IG for Operative Notes, Release 1

The implementation guide for this HL7 Draft Standard for Trial Use (DSTU) was developed in conjunction with the CDA for Common Document Types (CDA4CDT) project, which has an Associate Charter Agreement with HL7. The guide reuses templates developed for the HL7 Continuity of Care Document (CCD) and is suitable for any type of operative report.

CDA IG for Quality Reporting Document Architecture (QRDA), Release 1

This HL7 DSTU was supported by the Child Health Corporation of America (CHCA) with participation from the American College of Physicians, American Health Information Management Association (AHIMA), Alliance for Pediatric Quality, Iowa Foundation for Medical Care, The Collaboration of Performance Measure Integration with EHR Systems (“The Collaborative”), HITSP, Integrating the Healthcare Enterprise (IHE) and others. The guide covers patient-centric quality data reporting and lays out a framework for aggregate, population-based quality reports.

CDA IG for Personal Healthcare Monitoring Reports, Release 1

The implementation guide for this HL7 DSTU was co-developed by Continua Health Alliance, which has a Liaison Agreement with HL7. The guide conforms with the HL7 CCD and describes how to use CCD templates for communicating home health data to an electronic health record.

CDA IG for Diagnostic Imaging Reports, Release 1

The implementation guide for this informative document was developed by DICOM, with support from the HL7 Imaging Integration Work Group and CDA4CDT. It is consistent with a companion guide for transforming DICOM Structured Reports to CDA Release 2 and is suitable for use with both structured and narrative data capture.

More

There are three more CDA, Release 2 Implementation Guides are currently in the balloting process. They include the second release of the Healthcare Associated Infection Reports (Project # 319) as well as Patient Assessments, Release 1 (Project # 381) and Plan-to-plan Personal Health Record (PHR) Data Transfer, Release 1 (Project # 208).

Resources

Work Groups

• Structured Documents

Education

• See more at http://hl7new.amg-hq.net/implement/training.cfm
• Clinical Document Architecture (CDA) Introductory Tutorial
• Clinical Document Architecture (CDA) Advanced Tutorial
• CDA Certification Test Preparation

Certification Available

• CDA Certified Specialist

Presentations

From HIMSS 2009

• CDA presentation
• What's new with CDA?

Contacts: Liora Alschuler, Calvin Beebe, Keith Boone, Bob Dolin

Links to current projects in development

• CDA R3: in-progress see Project # 477