Extend CDA R3 scope to include Public Health requirements

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Submitted by: Austin Kreisler	Revision date: 2/18/2009
Submitted date: 2/18/2009	Change request ID: <<Change Request ID>>

Issue

CDA R2 scope and design limit its utility for use in public health.

Recommendation

• Expand the scope the CDA R3 to include public health reporting requirements. This would include the following requirements:
  • Allow any entity to be the record target of a document. Many entities can't be considered as patients, so allow the investigated subject role along with allowing any entity (including individuals, populations, herds, groups, etc.) to be the record target of a document. This can be accomodated by allowing the R_InvestigativeSubject CMET as a record target.
  • Allow AssociatedEntity to be any entity (just as record target) not just a person. This can be accomodated by allowing the E_PublicHealthEntity CMET as player/scoper of the Associated Entity role.
  • Allow use of the updated Clinical Statment model that includes public health related acts such as public health case, outbreak, exposure, investigation, etc. This can be accomodated by allowing the public health statement CMET in the model as an entry.

Rationale

Expanding the scope of CDA R3 will allow its re-use in areas that are not focused on the care of individual patients. Expanding the scope will avoid the creation of a second similar CDA structure that can be used for public health.

Discussion

There is interest in public health to use CDA documents for public health reporting. The currtent limitations of CDA R2 that human patients are the only allowed record target limits CDA's utility for public health. See the Public Health Document Architecture document for additional discussion.

Resolution

Agree to adopt this in principle. As we get into the details we may end up needing to create two basic templates, one for patient oriented documents and one for public health documents. Approved. See SDWG minutes from 7/21/2009

From the minutes

CDA R2 was patient related, need to formally expanded to support public health.

Discussion: The question of the broader requirements required for public health reporting were discussed. Liora indicated a number of issues, relationship of entries to narrative, specific implementation issues, each record be a discrete file. The essential question is whether we make CDA R3 more general with regards to Record Target and some of the Clinical Statement modeling or we have a separate public health document standard?

Motion: Agree to adopt this in principle. As we get into the details we may end up needing to create two basic templates, one for patient oriented documents and one for public health documents. By: Austin, Second – Rita Abstain: 0 Against: 0 For: 16 Motion passed