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Route from CCDA to FHIR by Grahame Grieve Slide 1 Route from CCDA to FHIR by Grahame Grieve Slide 2 Route from CCDA to FHIR by Grahame Grieve Slide 3 Route from CCDA to FHIR by Grahame Grieve Slide 4 Route from CCDA to FHIR by Grahame Grieve Slide 5 Route from CCDA to FHIR by Grahame Grieve Slide 6 Route from CCDA to FHIR by Grahame Grieve Slide 7 Route from CCDA to FHIR by Grahame Grieve Slide 8 Route from CCDA to FHIR by Grahame Grieve Slide 9 Route from CCDA to FHIR by Grahame Grieve Slide 10 Route from CCDA to FHIR by Grahame Grieve Slide 11 Route from CCDA to FHIR by Grahame Grieve Slide 12 Route from CCDA to FHIR by Grahame Grieve Slide 13 Route from CCDA to FHIR by Grahame Grieve Slide 14 Route from CCDA to FHIR by Grahame Grieve Slide 15 Route from CCDA to FHIR by Grahame Grieve Slide 16 Route from CCDA to FHIR by Grahame Grieve Slide 17 Route from CCDA to FHIR by Grahame Grieve Slide 18 Route from CCDA to FHIR by Grahame Grieve Slide 19 Route from CCDA to FHIR by Grahame Grieve Slide 20 Route from CCDA to FHIR by Grahame Grieve Slide 21 Route from CCDA to FHIR by Grahame Grieve Slide 22
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Route from CCDA to FHIR by Grahame Grieve

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Route from CCDA to FHIR by Grahame Grieve

Route from CCDA to FHIR by Grahame Grieve

  1. 1. CCDA to FHIR Grahame Grieve FHIR Developer Days November 26, 2014 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  2. 2. CDA vs FHIR  I am CDA subject matter expert for the Australian national program  I was co-chair of Structured Documents WG, which owns the CDA standard  I am the lead for FHIR © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  3. 3. CDA vs FHIR Through 2010/2011, it became clear that:  CDA was too hard to construct and read  Documents not good for granular data exchange  CDA used for exchanging data because the alternatives were worse  CDA getting pushback from implementers  The SD committee was about to double down  These strategic frustrations were part of why FHIR was invented 3 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  4. 4. CDA vs FHIR  The design of FHIR was strongly influenced by CDA:  Narrative/Data in every resource  Need to a document package  Use of “must understand” ( isModifier)  CDA content model a first point of reference  Green CDA simplification  CDA usage guided our resource priority 4 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  5. 5. CDA vs FHIR  CDA community was focused on their task  Mostly didn’t even pay attention to FHIR  Common Questions to us:  Why does FHIR have “documents”?  What is the relationship between CDA and FHIR?  What does Lantana think about FHIR?  Do you have a transform from (C)CDA to FHIR? 5 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  6. 6. CDA vs FHIR  Joint Position Statement from leaders in the FHIR and CDA community  Focus: The future of CDA and FHIR  This statement is not official policy https://www.lantanagroup.com/wp-content/uploads/Lantana-Position-Statement-CDA-FHIR.pdf © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  7. 7. CDA vs FHIR  Position: CDA addresses interoperability for clinical documents, mixing narrative and structured data. FHIR provides granular access to data, a contemporary, streamlined approach to interoperability, and is easy to implement. FHIR can be the future of CDA, but it is not there yet 7 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  8. 8. Documents vs APIs “The medical record is not data. It contains data, as do many forms of writing, but it is not data, nor is it simply a repository into which data are poured. Although its raw material is information—some of which, importantly, can only be expressed with words and not with numbers—a finished medical record is information that has been transformed by the knowledge, skill, and experience of the physician, motivated by the healing impulse, into an understanding of human experience that makes the care of the patient possible.” 8 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  9. 9. Documents vs APIs  This dual nature of a medical record—the combination of data and narrative—runs deeply through the clinical process and, consequently, through the clinical record  Why CDA is narrative based  Why FHIR resources have narrative 9 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  10. 10. Documents vs APIs  Packaged Access  Trust from document context & obligations  Independent of system integration  Import data from documents  Granular Access  System-based trust framework  Tightly integrated IT and business systems  Export data from APIs 10 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  11. 11. Documents vs APIs  Documents are the correct way to exchange information between clinicians in disparate parts of the healthcare system  APIs will integrate access to the data between applications where the context is unambiguous.  Both the document and API should seamlessly use the same syntax and semantics and Narrative approach 11 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  12. 12. Call to Action (1)  Recognize the duality and interdependence of data and narrative in clinical information  Understand the gaps in support for clinical documents in the current FHIR Draft Standard for Trial Use (DSTU)  Ensure that FHIR 2.0 addresses clinical document requirements 12 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  13. 13. Call to Action (2)  Establish, publish, and test CDA/FHIR, FHIR/CDA mapping  Define, document, and promote a future where clinical documents and Application Programming Interfaces (APIs) share a common syntax and set of resources  Establish, in technical and regulatory policy, a smooth roadmap to the future of clinical document exchange 13 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  14. 14. CDA -> FHIR project  Map CDA header to FHIR  Resolve issues around sections in FHIR  Map basic CDA entries to FHIR (general)  Map CCDA sections & entries to FHIR (specific) 14 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  15. 15. CDA -> FHIR Project  Work is in a google spreadsheet  Ongoing calls on a weekly basis  Up to step #3 15 https://docs.google.com/spreadsheets/d/1KctdexG3oB2QBiBQNH1Rbt2uJ6Dx QFROyIFKo5q95WU/edit#gid=1223244219 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  16. 16. Working Spreadsheet  Basic Information from CDA  Element  Cardinality  Mandatory  Conformance  Type  Domain  Extensible  Notes 16 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  17. 17. Working Spreadsheet  FHIR Specification Mapping – where it goes in FHIR  Base Card – what the FHIR cardinality is  Profile Card – what the CDA-on-FHIR cardinality will be  Type – what the FHIR type is  Notes / CDA on FHIR call decisions – discussion of issues 17 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  18. 18. CDA  FHIR outcomes  The mapping spreadsheet itself  A series of change proposals to the base FHIR specification  Corollary: CDA -> FHIR requires DSTU2  A formal “Clinical Document” profile which will be part of the FHIR specification  CCDA section/entry mappings and profiles  Conversion Libraries? 18 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  19. 19. CDA Profile in FHIR  http://hl7-fhir.github.io/cda.html  Profiles and Extensions  Very incomplete  This will develop as the project goes on 19 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  20. 20. CCDA  “Consolidated CDA”  Harmonised several US and IHE CDA implementation guide  In service of “Meaningful Use Minimal Data Set” though it includes more 20 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  21. 21. CCDA  FHIR  The project is not up to this  Some work has been done by a variety of individuals and groups  CCDA is hard to understand, and there is much variance in it’s use  It’s unclear at what level this needs to be useful  ..Demonstration 21 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  22. 22. From CCDA to FHIR  This is an active area of investigation  DSTU 2 will be “Clinical Document” ready  DSTU 2 will include a base Meaningful Use Profile  A formal CCDA profile will follow in due course 22 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  • ArindamDuttaChoudhury

    May. 16, 2020

Route from CCDA to FHIR by Grahame Grieve

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