International HL7 Interoperability Conference 2015 Presentation: Lessons Learned from the Transition of the Polish National Draft Implementation Guide for HL7 CDA Standard into DECOR Format

1. 2015-02-16 1
15th International HL7 Interoperability Conference
Lessons Learned from the Transition of the
Polish National Draft Implementation Guide
for HL7 CDA Standard into DECOR Format
Roman Radomski, Sebastian Bojanowski
iEHR.eu, Poland
Prague, February 10, 2015

2. 15th International HL7 Interoperability Conference
Presentation plan
• P1 – the core eHealth programme in Poland
• HL7 CDA adoption status in Poland
• Polish national implementation guide for CDA
• Observations from the transition of IG to ART-DECOR
• Conclusions

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eHealth programme in Poland
• Core eHealth programme in Poland (P1) aims at building a
national platform for clinical documents exchange.
• It will be a registry and repository for 3 types of clinical
documents:
– Drug Prescription
– Medical Equipment Prescription
– Referral
• It will be just a registry for other electronic clinical documents,
locally stored.
• P1 Platform will go live this year. The regulatory obligation to
process clinical documents at P1 Platform will be introduced
gradually 2015-2017.

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HL7 CDA adoption in Poland
• Formally, usage of HL7 CDA as a standard for clinical
documents in electronic form is just a recommendation.
• In practice, CDA is the only standard, that is being taken into
account in any specification for electronic clinical documents.
• The biggest private medical provider adopted CDA in 2010
and there are several other (smaller) implementations of CDA.
• The first draft national IG for CDA has been developed in
2013-2014 and covered 3 types of documents, that are going
to be stored at P1 platform.
• Now, the 10th version of the draft national IG gained
operational status and has been published as the Polish
National Implementation of HL7 CDA version 1.0

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Format of the Polish national IG for CDA
• The previous versions of national IG were developed in the
form of text document, where constraints were presented in
hierarchical description format.
• In 2014 the decision has been made to adopt DECOR as the
official format of Polish national IGs for HL7 CDA.
• Our work was to recreate the IG in the form of value sets and
CDA templates in the ART-DECOR environment and prepare
them to be published in the HTML format using ART-DECOR
tools.

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Work that was done
• Development environment of ART-DECOR has been set up
and references to the base HL7 CDA building block
repositories.
• New value sets (from the existing external international and
Polish code systems) have been defined.
• OID Registry for Polish eHealth agency (CSIOZ) node has been
designed using ISO-13582 conformant XML syntax.
• One new code system for Polish specific HL7 V3 qualifiers in
ClaML format has been defined.
• 194 CDA templates including 17 document-level templates
have been created.

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Observations
• Lack of support for definition of business rules
• Abstract and non-abstract document templates
• Problem with using open and closed templates together (in
one DECOR project)
• Unclear DECOR relationships between templates

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Support for definition of business rules
• Business rules are perceived by some of the specification
readers as the most valuable part of specifications.
• Template description is not enough (readibility and
maintenance problem)
• Our solution/proposal:
– New XML structure has been defined for business rules
– Business rules can be specified on the document-level template
– In general, the specialized templates include business rules from the
original templates
– If specified, the business rule can override another business rule

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Abstract and non-abstract document templates
• Sometimes, the template is not intended to be implemented
directly, but it is created just as a source of common/shared
constraints for another templates.
• In released IG there should be clear indication, that such
template “is abstract”.
• Our solution/proposal:
– The main list of releases/published IG contains only non-abstract
document level templates with schematron files and business rules set
for each such template.

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Using closed and open templates in one DECOR project
• ART-DECOR generates schematron rules for closed templates
to check if no forbidden element is used, but this works
properly only if you use only closed templates in your project.
• There is a need for both: closed and open templates in one IG.
• Our solution/proposal:
– still under investigation

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Relationships between templates
• Dynamic relationship in ART-DECOR means only that at the
time of template creation, it references to the newest version
of the template being contained or specialized.
• Our solution/proposal:
– We use two DECOR projects for each IG: “source “ and “final”
– All changes are being done in the source file
– Final file is being generated by transformation from the source file, at
the time of publishing new release of IG

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Conclusion
• DECOR proved to be very useful format for HL7 CDA IG on
national level, both for specification developers and for
implementers.
• The most important „feature” of ART-DECOR is its Expert
Group, which consists of people who know the best not only
their product, but also what you want/should to do with it
and how to do that.
Thank you!