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C-CDA 2.1 Companion Guide Project

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Return to C-CDA: Enhancing Implementation (ONC Grant Project) page.

Overview

This page supports the HL7 Contract work for the C-CDA R2.1 Companion Guide Project. This project's goal is to produce a new C-CDA Companion Guide to support C-CDA R2.1 and to provide more context in assisting implementers. The purpose of the new Companion Guide is to:

  • Supplement the C-CDA R2.1 Implementation Guide to provide additional context to assist implementers and connect them to tools and resources
  • Map the common clinical data set (CCDS) to the appropriate C-CDA locations
  • Provide technical guidance for representing the 2015 Ed. CEHRT data requirements using the C-CDA Implementation Guide
  • Include clinically-valid examples of C-CDA components necessary to meet 2015 Ed. CEHRT requirements
  • Recommend an approach to implementations using the C-CDA IG to meet the needs of clinicians and achieve ONC Certification

Resources

To assist with finding "pain points" for implementers, the following initiatives have been taken:

Issues/Guidance To Consider for Inclusion

  • examples (vetted by the Examples Task Force)
  • general nullFlavor clarification on how to use and when it is allowed - including examples where valuesets are explicitly declared (e.g. code SHALL be selected from valueset XXX)
  • clear conformance statement guidance - i.e. what does SHALL mean as compared to SHOULD or MAY
  • discussion re: guidance on narrative text representation
  • how to represent gender identity concepts - i.e. beyond administrativeGender value set
  • how to represent no known (allergies, meds, etc.)
  • how to represent no information about (allergies, meds, etc.)
  • guidance for CCDS sections when they are not noted as being part of the base document template
  • guidance on how to represent medications for discharge summaries where one could have admission meds, administered meds and discharge meds (and possibly in addition to a medications section)
  • examples for detailed race and detailed ethnicity and use of the sdtc extension
  • language code clarification as per http://www.hl7.org/dstucomments/showdetail_comment.cfm?commentid=806
  ONC 2015 certification references RFC 5646 which states in 2.2.1 Primary Language Subtag: 
  "When languages have both an ISO 639-1 two-character code and a three-character code (assigned by ISO 639-2, ISO 639-3, or ISO 639-5), only
  the ISO 639-1 two-character code is defined in the IANA registry.
  When a language has no ISO 639-1 two-character code and the ISO 639-2/T (Terminology) code and the ISO 639-2/B (Bibliographic) code
  for that language differ, only the Terminology code is defined in the IANA registry.  At the time this document was created, all languages
  that had both kinds of three-character codes were also assigned a two-character code; it is expected that future assignments of this
  nature will not occur."
  • using open templates vs. closed templates
  • how to represent pregnant / not-pregnant / unknown

Deliverables for Review