MAY 2011 The HL7 greenCDA Implementation Guide has been published by the HL7 Structured Documents Work Group. The HL7 Clinical Document Architecture (CDA®) is at the core of the requirements for Meaningful Use of Electronic Health Records. It supports continuity of care and re-use of clinical data for public health reporting, quality monitoring, patient safety and clinical trials. greenCDA maintains the utility of CDA while making it easier to implement. It is a simplified XML for CDA templates. “Any developer with basic XML knowledge and a tool that can process simple XML sche- mas can create green instances. We flattened the hierarchy, focused on variable data ver- sus fixed structural markup, and removed complexities like xsi:type. The result is simple and intuitive,” said Rick Geimer, Lantana Group CTO and co-editor of the greenCDA Implementation Guide. greenCDA features include: • XML schema validation • Simple business names • Tagged data elements in extensible library • Rapid path to Meaningful Use compliance • Modular XML with business names generate JAVA, .NET • Single style sheet display, as for all CDA • Extensible to physician documentation requirements and quality The enthusiastic response to the development of greenCDA is driving rapid experimenta- tion and has raised the question of how greenCDA fits into the larger ecosystem of clini- cal information systems. This trial use and experimentation will help us understand how going green affects ease of use for data capture; management and analysis; when it might be an appropriate wire format for CDA; if there are significant limits on expressivity; and where the cost and benefits may lie. continued on next page greenCDA™ Implemenon Guide Now Available By Liora Alschuler, Co-Chair, HL7 Structured Documents Work Group and Co-Editor, greenCDA ® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered in the US Trademark Office Liora Alschuler
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MAY 2011
The HL7 greenCDA Implementation Guide has been published by the HL7 Structured Documents Work Group. The HL7 Clinical Document Architecture (CDA®) is at the core of the requirements for Meaningful Use of Electronic Health Records. It supports continuity of care and re-use of clinical data for public health reporting, quality monitoring, patient safety and clinical trials. greenCDA maintains the utility of CDA while making it easier to implement. It is a simplified XML for CDA templates.
“Any developer with basic XML knowledge and a tool that can process simple XML sche-mas can create green instances. We flattened the hierarchy, focused on variable data ver-sus fixed structural markup, and removed complexities like xsi:type. The result is simple and intuitive,” said Rick Geimer, Lantana Group CTO and co-editor of the greenCDA Implementation Guide.
greenCDA features include: • XML schema validation • Simple business names • Tagged data elements in extensible library • Rapid path to Meaningful Use compliance • Modular XML with business names generate JAVA, .NET • Single style sheet display, as for all CDA • Extensible to physician documentation requirements and quality
The enthusiastic response to the development of greenCDA is driving rapid experimenta-tion and has raised the question of how greenCDA fits into the larger ecosystem of clini-cal information systems. This trial use and experimentation will help us understand how going green affects ease of use for data capture; management and analysis; when it might be an appropriate wire format for CDA; if there are significant limits on expressivity; and where the cost and benefits may lie.
continued on next page
greenCDA™ Implementation Guide Now Available
By Liora Alschuler, Co-Chair, HL7 Structured Documents Work Group and Co-Editor, greenCDA
® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered in the US Trademark Office
Liora Alschuler
In This Issue... greenCDA™ Implementation Guide, continued
The CDC is planning a pilot project with vendors interested in using greenCDA to enable use of their systems for submitting Central Line Insertion Practices (CLIP) data to the National Healthcare Safety Network (NHSN).
“Use of greenCDA and supporting transformation tools show great promise as an approach for reducing the effort required to implement fully normative CDA,” said Daniel A. Pollock, MD, Surveillance Branch, Division of Healthcare Quality Promo-tion, Centers for Disease Control and Prevention.
HL7 looks forward to a robust and informative discussion with all stakeholders leading to acceleration of the development and adoption of interoperable clinical information systems. We encourage a broad range of experimentation across different use cases and environments and welcome the trial use and the opportunity to review the oppor-tunities, costs and benefits of going green across the spectrum of implementation.
For more information on the greenCDA, visit the greenCDA wiki at http://wiki.hl7.org/index.php?title=GreenCDA_Project.
2
is the official publication of: Health Level Seven International3300 Washtenaw Avenue, Suite 227, Ann Arbor, MI • 48104-4261 USAPhone: +1 (734) 677-7777 • Fax: +1 (734) 677-6622 • www.HL7.org
Mark McDougall, Publisher • Andrea Ribick, Managing Editor • Karen Van Hentenryck, Technical Editor
greenCDA: Transforming the Essential into the Interoperable
greenCDA™ Implementation Guide..... 1-2
CDA®: Spirometry Test Standardization....................................3-4
Software Implementation of CDA......... 5, 9
Update From Headquarters.................. 6-7
Report from the HL7 International Council Meeting in Sydney................... 8-9
Post Sydney WGM Survey and First Time Attendee Survey.................... 10
News from the PMO and Project Services Work Group............................. 11
Healthcare Information Standards for Active Aging: State of Play for Patient Summaries............................................ 12
eHealth Week: “eHealth: Investing in Health Systems of the Future”............... 13
New Chair for the Joint Initiative Council.......................... 14
EFMI Special Topic Conference 2011: eHealth across Borders without Boundaries ............................ 15
TSC Newsletter Update.................... 16-17
Upcoming International Events............. 17
SAIF Architecture Program.............. 18-19
4th Annual SOA in Healthcare Conference........................................... 20
Certification Exam Congratulations..... 21
HL7 Benefactors................................... 22
Welcome HL7 Luxembourg................... 22
Affiliate Contacts................................... 23
Organizational Members.................. 24-26
2011 Technical Steering Committee Members ............................ 27
Steering Divisions................................. 27
HL7 Work Group Co-Chairs.............. 28-30
HL7 Facilitators............................... 31-32
HL7 Staff Members................................ 33
2011 Board of Directors....................... 34
Educational Summits.............................35
Upcoming Working Group Meetings................................................36
3MAY 2011
Clinical Document Architechture: Spirometry Test Standardization ByM.DOMINGOandM.LIZANA,CentredeCompetènciesd’Integració.Parcdela ciènciailainnovacióTecnocampusdeMataró.08304-Mataró.Espanya C.GALLEGO,Oficinad’EstàndardsiInteroperabilitat–FundacióTicSalut.Departament deSalutdelaGeneralitatdeCatalunya–ChairOfHL7Spain
Respiratorydiseases,especiallychronicobstructivepulmonary
disease(COPD),lungcancerandtuberculosis,aremaincausesofmortalitythatwillcontinuetoincreaseinthecomingdecades.Aspirometeristhemedicaldevicemandatedtomeasurethepulmo-naryvolumeandcapacity,identifyingpossiblealterations.Commonly,alldeviceshaveapropri-etarydataformatoutput.Thisisasetbackfortheirintegrationindifferentenvironmentsbecausewhendataisstoredonasharedrepository,itisnotin-teroperablesinceallofthedatadoesnotsharethesameformatnordoesitcontainstructureddata.
Drivenby“Oficinad’EstàndardsiInteroperabilitatdeTICSalut”and“PladeDigitalitzaciódelaImatgeMèdicadelDepartamentdeSalutdelaGeneralitatdeCatalunya,”astandardhasbeencreatedbasedontheHL7ClinicalDocumentArchitecture,Release2(CDA®R2).Thegoalofthestandardistonormal-izeacompletedataset,includingbothdatareceivedfromspirometersaswellasthosethatcomefromthetestcitationprovidedbytheelectronicclinicalhistoryfromahospitalormedicalcenter.
Consequently,thisstandardcreatesaspirometryreportthatcontainsnotonlytheinformationre-
latedwiththespirometrytest,butalsoallthedatafromthetestrequest,patientidentification,andspirometer.Thissetofdatacompiledfromdiffer-entsourcesrequiresapplyingaCDAR2structure,orientedtoeasetheintegrationbetweenmedicaldeviceandthehealthinformationsystem(HIS),andahigherinteroperabilityamonghospitalinfor-mationsystems.
Thedatamodel1hasbeendevelopedbyamultidis-ciplinaryscientificteam,consistingofpulmonolo-gists,health-techexpertsandspirometermanufac-turers,thusprovidingdifferentperspectivesaboutthismodel.Themodelisthusenrichedbythediversityandvastknowledgeoftheteam.
Twoversionsofthisdatamodel1exist.Thefirstversionismoredetailedandisclearlyorientedtoasubsequentexecutionofadataminingsystem.Thesecondversionismorebasicandtakesintoaccountthatnotallthecentersorhospitalscanprovidetheinformationrequiredbythedetailedversion.
Afterthedatamodelwasdeveloped,asetofnor-mativeandtechnologicalarticfactswasgeneratedtofacilitatethestandardimplementation:
continued on next page
Manuel Domingo
Matias Lizana
This standard creates a spirometry report that contains not only the information related with the spirometry test, but also all the data from the test request, patient identification, and spirometer.
4 MAY 2011
• CDAR2SpirometryImplementationGuide2:ThisguidecontainsthenormstofollowtoimplementCDAR2correctly,includingmanda-toryfieldsandtheircontent.Twoversionsofthisimplementationguidehavebeencreated—oneforeachversionofthedatamodel.
• CDAR2XMLFormattedTemplates:AsetofCDAR2spirometrytemplateshasbeencre-ated.Templatesexistforbothversions,basicanddetailed.
• XSLStyleSheet:ThisisafileneededtovisualizespirometryCDAR2,whichfollowsastandardstylesheetforCDA-HL7presentation.
UsingspirometryCDAR2allowsfortheresultingreportstobesharedthroughdifferenthospitalhealthinformationsystems,andexecutesdataminingservices,thatareveryimportantformedicalresearchprocesses.Itisalsoimportanttonotethatthedoctorcanviewthespirometrydigitallyfromhisworksta-tionandwatchthetestshistoryforeachpatient.
ThefirstimplementationoftheCDAR2spirometrystandardwasthroughanopen-sourceintegrationframeworkcalledEI2Med,basedonMirthConnect,inwhichmanytoolshavebeendevelopedtoeasegenerationandintegrationbetweenstandardfilesandHIS.ManufacturersandspirometrymodelshavebeenintegratedwiththeintegrationframeworkEI2Med.
PublichospitalsinCataloniaarecurrentlycollabo-ratingonpilotprojectstovalidatethenormaliza-tionandintegrationtechnologyofthespirometrytests.ThereareplanstostarttheimplementationinallhealthfacilitiesinCatalonia.
References1 T. Salas, M. Domingo, y F. Burgos. Data model of the
CDA R2 spirometry standard to the “Departament de Salut de la Generalitat de Catalunya.” 2010.
2 M. Domingo, M. Lizana y D. Kaminker. CDA R2 spirometry implementation guide to the “Departament
de Salut de la Generalitat de Catalunya.” 2010.
Figure 1. Visualization of spirometry report CDA R2
Spirometry Test Standardization continued from page 3
5MAY 2011
Software Implementation of CDA®
ByReneSpronk,Co-Chair,HL7RIMBAAWorkGroup;Trainer/Consultant,Ringholm
ThisarticleisanabridgedversionofaRIMBAAwhitepapercreatedbytheRIMBAAWorkGroup.Thewhitepa-perisbasedonactualHL7Version3implementationexperiences.Afullversioncanbefoundathttp://j.mp/gDwZKm.
IntroductionTheimplementationoftheCDAstandardandthevalidationofCDA-conformantXMLinstancesisbasedontwotypesofspecifications:
1. TheCDAclassmodel,arefine-mentoftheHL7ReferenceInformationModel(RIM).TheclassmodelisexpressedinMIF(ModelInterchangeFormat),HL7’smetamodelformat.
2. Context-specificconstraints(templates)ofthegenericCDAmodel,asdefinedinaCDAimplementationguideforspecificdocumenttypeandonespecificcontext.Atthispointintimetemplatesaremostlyde-finedintextualform.AsingleCDAimplementationguidemaydefinehundredsoftemplates.
AnHL7MIFdefinitionoftheCDAclassmodelisprovidedwiththeHL7Version3standard.TheCDAMIFfilecanbetransformedintoless“rich”expressionssuchasUMLandXMLschema.PartsoftherequirementsasexpressedbytheMIFarelostduringthetransformationprocess.
CDA implementation using XML techniquesThestandardrequiresthatallCDAinstancesvalidateagainstapublishedCDAXMLschema.ThisisthemainreasonwhyalotofCDAimplemen-tationsarebasedontheCDAXMLschema.ThewideavailabilityofXMLtoolsisadefiniteadvantage;however,therearedisadvantagesaswell.TheXMLschemalanguageisnotrichenoughbyfartoexpressalloftherequirementsthatpresentintheoriginalCDAclassmodel.ACDAdocumentinstancethatvalidatesagainsttheXMLschemaisnotguar-anteedtobeavalidCDAinstance–tobeavalidCDAinstanceonehastocreateXMLthatconformstotherequirementsthatareexpressedintheCDAclassmodel.
Classgeneratorsarecommonlyusednexttootherwell-knownXMLtechniquessuchasXpathandDOM/SAX.JAXBisanexampleofaclassgenerator:atoolwhichtrans-formsXMLschematocorrespond-ingJavaclasses.
Model driven CDA implementationInordertofulfillallrequirementsasexpressedbytheCDAclassmodel,thestartingpointforallCDAimple-mentationswouldhavetobetheCDAMIF.MIF,however,hasthedisadvantagethatitisanHL7spe-cificformatthatisonlysupportedbyalimitednumberoftools.BecauseCDAisessentiallyaninformationmodelwithoutanybehavioralas-
pectsassociatedwithit,onehastheoptionofcreatingaverysolidmap-pingfromCDAMIFtoUML,whichinturnallowsfortheuseofUMLbasedtools.
TheCDAMIF(ortheUMLequiva-lentthereof)canbeusedbyclassgeneratorstocreateasetofclasses(ine.g.JavaorC#).Thereareafewfreelyavailableclassgeneratorsthatonecouldconsiderwhenimple-mentingCDA:
1. MDHT(http://www.cdatools.org/),aCDAspecificclassgenerator.ThistoolgeneratesJavaclassesbasedonaUMLrepresentationoftheCDAclassmodelandonanOCLrepresentationofappli-cabletemplates.
2. MARC-HIEverest (http://everest.marc-hi.ca/),an
HL7Version3(notjustCDA)MIF-basedclassgenerator.
3. JavaSIG(http://aurora.regen-strief.org/javasig),anMIF-basedtoolkitwhichgeneratesJavaclasses(unfortunatelynotre-centlyupdated).
SummaryThediagramonpage9showstherelationshipsbetweenthevariousartifactsdiscussedinthisarticle.ACDAdocumenthastoconformtotherequirementsasdefinedinaCDAimplementationguide.IthastoconformtoboththeformalCDAclassmodelaswellasthetemplates.The
continued on page 9
Rene Spronk
9MAY 2011
decisiontoselectanotherrepresentativeattheOrlandomeetinginMay.AffiliateChairsareencouragedtonominatethemselvesoroneoftheirmemberstothatposition.
DiegoKaminker,chairofHL7ArgentinaandpioneeroftheHL7eLearningprogram,presentedrelevantdevelop-mentsfocusingonthesignificantbacklogofrequeststoparticipateintheprogram.Henotedthatthisismainlyduetothelackoftutorsandtheemphasisoncompre-hensivenessandquality.HL7Indiareporteditspositiveexperiencewithrunningthecourse,andseveralother
affiliatesexpressedinterestinlaunchingtheirownpro-grams.Thetopicraisedalotofdiscussionaseducationisoneoftheprimaryfunctionsofmostcountries.Anotherimportantitemontheagendawastherevi-sionoftheAffiliateAgreement.TheCouncildecidedtorecommendtotheHL7Boardthattheexisting2009/2010agreementbeextendedtoendof2011andthatduring2011,consultationwiththeInternationalCouncilwillreviewissuesofconcern,suchasIP.
Intheafternoon,the“HL7aroundtheworldsession”included24countryreports,all
ofwhichareavailableaspartoftheminutesontheHL7Interna-tionalCouncil.AverytouchingmomentwaswhenByoung-KeeYisharedwithusthepainandsorrowofDr.Kwak’sprema-turedeath.Wewillallmisshiswarmth,kindness,andsupport.
Formoreinformationontheac-tivitiesoftheHL7InternationalCouncilanditsmeetingspleasevisit:http://www.hl7.org/Spe-cial/committees/international/
Internaltional Report cont. from pg. 8
CDAclassmodelcanbeexpressedineitherMIF,orinaderivedformatsuchasUMLorXMLschema.TemplatescanbeexpressedinSchematron,inOCL,orinMIFwithOCLanno-tations.TheactualvalidationofCDAinstancesisbasedontheexpressionsoftheCDAclassmodelandtheapplicabletemplates.
AsoftwareapplicationwillhavetobebasedontheCDAclassmodelifonewishestoensurethatonecreatesvalidCDAinstances.ApplicationsthatarebasedontheCDAXMLschemacan’tguaranteethatthedocumentsarevalidCDAinstances.TheMDHTtooliscurrentlythebesttoolavailabletosupportthecreationofCDAmodelbasedapplica-tiondevelopment.
Software Implementation of CDA continued from page 5
In memory of Dr. Yun Sik Kwak
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