The Use of CCTS in HL7 CDA

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The Use of CCTS in HL7 CDA

• Asuman Dogac, Yildiray Kabak, Mustafa Yuksel
• METU, Ankara, Turkey

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HL7 CDA

• The HL7 Clinical Document Architecture (CDA) is a
  document markup standard that specifies the
  structure and semantics of "clinical documents"
  for the purpose of exchange
• CDA documents derive their machine processable
  meaning from the HL7 Reference Information Model
  (RIM) and use the HL7 Version 3 Data Types
• They are encoded in Extensible Markup Language
  (XML)

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Main Components of a CDA Document

• A CDA document is wrapped by the
  ltClinicalDocumentgt element, and contains a header
  and a body
• The header lies between the ltClinicalDocumentgt
  and the ltstructuredBodygt elements, and provides
  information on authentication, the encounter, the
  patient, and the involved providers

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Main Components of a CDA Document

• The body contains the clinical report, and can be
  either an unstructured blob, or can be comprised
  of structured markup
• A CDA document section is wrapped by the
  ltsectiongt element
• Each section can contain a single narrative
  block, and any number of CDA entries and external
  references

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Major Components of a CDA Document

• CDA entries represent structured content provided
  for further computer processing (e.g. decision
  support applications)

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HL7 CDA Interoperability

• HL7 CDA helps with interoperability through
• Structured body
• Coded elements
• HL7 Data Types
• CDA Entry classes RIM Act, Observation,
  SubstanceAdministration, Supply, Encounter,
  Procedure, ObservationMedia, Organizer,
  RegionOfInterest
• But
• CDA Documents can have any structure by nesting
  the sections at any depth and in any way
• There can be data elements that are not defined
  for CDA but are necessary for local
  implementations such as Vaccination, Discharge
  Method (referral, death or cured), Type of
  Contagiousness,
• There is a need for expressing the CDA concepts
  in local languages

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To Enhance CDA Interoperability

• Start from UN/CEFACT CCTS
• Define BCCs
• Reuse existing HL7 Data Types and Data Elements
• Define the missing data elements by constraining
  relevant RIM classes
• Define ACCs
• Use BCCs to define minimum health data sets
• Hence create a local (or national) data
  dictionary
• It will be much better if HL7 defines these
  constructs and the countries customize these
  according to their context

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Building a National Data Dictionary For Creating
CDAs

• Building a local or national common data
  dictionary consisting of data elements (BCCs) and
  minimum health data sets (ACCs) will
• Clearly define the meaning of data elements
• Give their corresponding explanation in the local
  language
• Create the additional data elements needed
  locally from the corresponding RIM Classes
• Also note that defining minimum health data sets
  as Aggregate Core Components will determine their
  structure and semantics
• All these will help with the interoperability of
  CDAs

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Data Types in HL7

• http//hl7.org/v3ballot/html/infrastructure/dataty
  pes/datatypes.htm
• The Data Types in HL7 constitutes the Qualified
  Data Types
• Define your BCCs using already defined data
  elements in HL7, e.g., houseNumber
• Define your ACCs based on the data elements
  defined in HL7, e.g., addr

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Creating the Missing Data Elements by
Constraining RIM Classes
Assume you need a Vaccination Data Element
(ACC) with the following properties (BCCs) Type
of Vaccination Date of application

• RIM Class ACT
• SubstanceAdministration
• code
• effectiveTime

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Creating the Minimum Health Datasets by
Constraining RIM Classes An Example
RIM Class Entity (ACC) ManufacturedMaterial -
lotNumberText (BCC)
Then you need a Vaccination minimum data set
(A bigger ACC) Lot number of the
vaccination Organization Professional
Identifier General Practitioner
consumable
Role therapeutic agent (ACC)
RIM Class Entity Organization - Addr (BCC)
Performer
responsible party
Location
Role Physician (ACC)
Role Physician (ACC)
Role HealthcareProvider (ACC)
RIM Class Entity Person (ACC) - Id (BCC)
RIM Class Entity Person (ACC) - Id (BCC)
Played Entity (ASCC)
Participation (ASCC)
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Mapping the Minimum Datasets to the CDA Sections

• There is not a unique way of doing this ?!

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An Example Mapping Minimum Health Datasets to CDA
Sections and Entities
CDA
HEADER
author
custodian
BODY
Section
Component
Code Vaccine
Component
Section
Section
Code consumable
Code responsible party
Entry
Entry
Code Role
Code Role
Value Therapeutic Agent
Value Physician
Entry
Entry
Code Entity
Code Entity
Value Manufactured Material
Value Person
Entry
Entry
Code lotNumberText
Code id
Value 123456
Value 789123
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Another Example Mapping Minimum Health Datasets
to CDA Sections and Entities
CDA
HEADER
author
custodian
BODY
Section
Code Vaccine
Entry
Observation
Code Vaccination
Participation 2
Participation 1
Participant
Participant
typeCode Consumable
typeCode Responsible Party
participantRole
participantRole
classCode Therapeutic agent
classCode Physician
playingDevice
id 789123
classCode Manufactured Material
playingEntity
code 123456
classCode Person
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Increasing CDA Interoperability

• However, when CCTS Approach is used in forming
  the CDAs, the document components are well
  defined
• Hence, SET TC specifications can be used to map
  different CDA documents
• These are just the initial ideas

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Thank you for your attention