HL7 Clinical Document Architecture
An Introduction
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Presentation Outline
• Brief description of HL7
• Brief history of CDA
• Description of Document Paradigm
• CDA levels
• CDA components
• Examples
Disclaimer: This presentation is not a comprehensive training in the
HL7 standard. The HL7 organization offers many training courses
that provide more in-depth training.
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Standards: Critical to Achieving Interoperability
• Semantic interoperability
– Do we speak the same language?
• Grammar
• Vocabulary
• Syntactic interoperability
– Is the data structure compatible?
• Technical interoperability
– Can we connect to each other?
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Organizational History of HL7
• Founded as an international standards development
organization in 1987 to promote communication
between hospital data systems
• Stated a goal of creating a platform independent method
of moving data between different systems
• Developed grammar for messaging and a standardized
vocabulary
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
HL7: The Primary Standard for Communicating Health Data
• ANSI standard for clinical interoperability
• The standards continue to evolve and are widely
adopted
• Meaningful Use has identified a number of HL7
standards to support sharing data between systems
• HL7 website: http://www.hl7.org/
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Messaging Business Process HL7 i
s criti
but n cal
enou ot
trigge
gh by
r
itself.
HL7
1) Prepare 2) Parse data HL7
data for received
transport
3) Process
Transport
HL7 Data
Layer
5) Parse
Sender Receiver
Response
HL7
4) Prepare
6) Process Response
Response
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
HL7 Versions
• HL7 Version 2.x messaging
• HL7 Version 3 messaging
• HL7 Clinical Document Architecture (CDA)
• HL7 Fast Healthcare Interoperability Resources (FHIR)
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Clinical Document Architecture - CDA
• An electronic equivalent of a paper document
• Has an author/attester
• Represents a point in time view of data
• Persists as an artifact over time
• Supports simple to very complex document types
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
o is t h e s ub j ec t
• Wh
o is t h e r e p orter
• Wh th is
o is g e tti n g
• Wh
HEADER • Where is th
e
rom
document f
dable
• Human rea
section
• Computer
BODY n su mab le date
co
(Entry)
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
CDA - Structured Body
The CDA body is composed of a Narrative block and an
Entry block
• Narrative block. A text section that a browser
can render so that it is readable by a human
• Entry block. The data formatted in a way that
facilitates computer consumption of the
structured data and represents the same
information as the data in the Narrative block
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Profiles Constrain the HL7 Base Standard
• Base standard is designed to meet many needs from
many countries
• To be useful, the standard must be constrained to meet a
specific need in a specific realm
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
CDA Profiles Building Blocks
• Profiles are built from components
– Patient
– Medication List
– Immunization Record
• Profiles specify which components must be included and
which may be included
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Example Clinical Document Architecture (CDA) Profiles
CCD Consolidated Birth and Fetal
(Continuity of CDA Death
Care reporting
Document)
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
CDA Public Health Examples
• Consolidated CDA (Continuity of Care Document)
• Cancer reporting
• Vital records fetal birth and death
• Quality Reporting Document Architecture (QRDA)
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
When to Use CDA Documents
• The focus is on persistence of the artifact
• Need tight control over authenticated content
• When human readability across platforms is desirable
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
When to Avoid Using CDA Documents
• Need for workflow
– Decision support
– Request - response
• Data are dynamic
– Want view of data now, not when authored
– Multiple contributors over time
• Data from disparate systems need to be integrated
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
Additional Resources
• HL7 (hl7.org) has a variety of materials including
tutorials where you can get the specifics for each of its
standards.
• HL7’s website is at: http://www.hl7.org/
• CDC’s Vocabulary Access and Distribution Systems
(PHIN VADS) can be found at https://phinvads.cdc.gov/
Toolkit for Planning an EHR-based Surveillance Program | www.phii.org/EHRtoolkit
