CDA R2 Stylesheet

Introduction

The CDA Release 2.0 and 2.1 publications come with an informative stylesheet based on XSLT 1.0. The stylesheet is maintained under responsibility of the Structured Documents Workgroup. The download location is through the GForge StrucDoc project.

The intent of the stylesheet is to offer an example of how to render a CDA document. It does this by rendering XHTML 1.0 Strict with the following information:

• a summary of the header for the most important context, i.e. patient, author, encounter, documentationOf and inFulFillmentOf
• the section code, title and text (human readable text)
• the full header information

No CDA level 3, i.e. entry level information, is rendered.

License

Apache License, Version 2.0

Compatbility

The CDA XSL has been tested to work with Saxon-PE. The HTML output has been tested to work with all major browsers. Effort is put in to make rendering friendly for visually impaired people, based on the American Foundation for the Blind Section 508. Effort has been put in to make the document friendly for screen and for print.

Warranty

The CDA XSL has been tested and updated for cross site scripting attacks and other maliciously crafted CDA documents. The CDA XSL is sample rendering and should be used in that fashion without warranty or guarantees of suitability for a particular purpose.

Package contents

The CDA XSL contains at minimum two files that you need accessible for CDA documents to call or for programmatic access (see #Manual)

• cda.xsl - main logic
• cda_l10n.xml - location file containing translations for terms

Manual

There are multiple ways to apply the stylesheet. If you have files on disk or on a webserver for a web browser to consume, you need a hint for the web browser how to render to document. This hint is called a processing instruction and needs to be inserted before the ClinicaiDocument element:

 <?xml-stylesheet type="text/xsl" href="cda.xsl"?>

or with an absolute path:

 <?xml-stylesheet type="text/xsl" href="http://example.org/cda/cda.xsl"?>

The web browser needs to be able to access the relative or absolute location of the stylesheet. For security reasons, you probably want that location to be inside your own environment.

Although the stylesheet supports many parameters, these are not configurable from a browser. If you need a different value for a stylesheet parameter than the default you can either update the default in the stylesheet, or run the stylesheet programmatically e.g. using Saxon-PE. If you update the defaults in the stylesheet, you might have a harder time updating the stylesheet if the base receives updates that you want in your environment too.

Running the stylesheet programmatically could be done in any environment that supports XSLT 1.0. The major implementations of XSLT are Saxon, libxslt and Xalan. Example command line call for Saxon where the parameter for rendering the header is set to false could be:

 java -jar ../lib/saxon-9/saxon9.jar -s:cda-example.xml -xsl:cda.xsl -o:cda-example.html dohtmlheader=false

What this says:

• Run java
• With the saxon9.jar file
• To transform input file cda-example.xml
• Using stylesheet cda.xsl
• To output file cda-example.html
• Without rendering the header info

Parameters

The stylesheet supports many way to parametrize.

• currentDate
  • XSLT 1.0 does not have date function, so we need something to compare against e.g. to get someones age
  • Default: /hl7:ClinicalDocument/hl7:effectiveTime/@value
• vocFile
  • Vocabulary file containing language dependant strings such as labels
  • Default: cda_l10n.xml
• textLangDefault
  • Default language for retrieval of language dependant strings such as labels, e.g. 'en-US'. This is the fallback language in case the string is not available in the actual language. See also textLang.
  • Default: en-US
• textLang
  • Actual language for retrieval of language dependant strings such as labels, e.g. 'en-US'. Unless supplied, this is taken from the ClinicalDocument/language/@code attribute, or in case that is not present from textlangDefault.
  • Default /hl7:ClinicalDocument/hl7:languageCode/@code or if missing the value of $textlangDefault
• textEncoding
  • Currently unused. Unsupported by Internet Explorer. Text encoding to render the output in. Defaults to UTF-8 which is fine for most environments. Could change into more localized encodings such as cp-1252 (Windows Latin 1), iso-8859-1 (Latin 1), or shift-jis (Japanese Kanji table))
  • Default: utf-8
• useJavascript
  • Boolean value for whether the result document may contain JavaScript. Some environments forbid the use of JavaScript. Without JavaScript, certain more dynamic features may not work.
  • Default: true
• externalCss
  • Absolute or relative URI to an external Cascading Stylesheet (CSS) file that contains style attributes for custom markup, e.g. in the @styleCode attribute in Section.text
  • Default: none
• font-family
  • Determines the font family for the whole document unless overruled somewhere
  • Default: Verdana, Tahoma, sans-serif
• font-size-main
  • Determines the font size for all text unless otherwise specified, and is the base value for other font sizes
  • Default: 9pt
• font-size-h1
  • Determines the font size for text in the h1 tag
  • Defaults to font-size-main + 3
• font-size-h2
  • Determines the font size for text in the h2 tag
  • Defaults to font-size-main + 2
• font-size-h3
  • Determines the font size for text in the h3 tag
  • Defaults to font-size-main + 1
• font-size-h4
  • Determines the font size for text in the h4 tag
  • Defaults to font-size-main
• font-size-h5
  • Determines the font size for text in the h5 tag
  • Defaults to font-size-main
• font-size-h6
  • Determines the font size for text in the h6 tag
  • Defaults to font-size-main
• font-size-footnote
  • Determines the font size for text in footnotes
  • Defaults to font-size-main - 1
• bgcolor-th
  • Determines the background-color, as any legal hex, rgb or named color, for header like table elements, e.g. th tags
  • Defaults to "LightGrey"
• bgcolor-td
  • Determines the background-color, as any legal hex, rgb or named color, for body like table elements, e.g. td tags, defaults to "#f2f2f2".
  • Defaults to "#f2f2f2"
• dohtmlheader
  • Determines if the document title and top level summary of header information (patient/guardian/author/encounter/documentationOf, inFulfillmentOf) should be rendered. Defaults to "true", any other value is interpreted as "do not render". Some systems may have a context around the rendering of the document that would make rendering the header superfluous. Note that the footer, which may be switched off separately contains everything that the header does and more.
  • Default: true
• dohtmlfooter
  • Determines if the document footer containing a listing of everything in the CDA Header should be rendered. Defaults to "true", any other value is interpreted as "do not render". Some systems may have a context around the rendering of the document that would make rendering the footer superfluous, or just want to concentrate on document contents.
  • Default: true
• menu-depth
  • Determines depth of menu at the top of the document. Default is 1, which means just head section. Max is 3 which is head section + 2 levels (if any)
  • Default: 3
• external-image-whitelist
  • Security parameter. When a vertical bar separated list of URI prefixes, such as "http://www.example.com|https://www.example.com"
  • Default: none
• limit-external-images
  • Security parameter. When set to 'yes' limits the URIs to images (if any) to locally attached images and/or images that are on the external-image-whitelist. When set to anything other than 'yes' also allows for arbritrary external images (e.g. through http:// or https://). Default value is 'yes' which is considered defensive against potential security risks that could stem from resources loaded from arbitrary source.
  • Default: yes