IHE DCC Documentation Work Group Teleconference Minutes 2012-02-13
Special C-CDA webex Monday, Feb 13th, 2012, 9am CT
Attending:
- Harry Solomon
- Keith Boone
- Tom Dolan
- Chris Melo
- Wendy Sharber
- Wendy Blumenthal
- Chris Carr
- Teri Sippel Schmidt
- Mary Jungers
- may have missed others
Agenda: Purpose of the call next week is to get Keith Boone's and Harry Solomon's input on new Consolidated CDA (C-CDA) specification from HL7. IHE needs a method for consistently and accurately/adequately expressing CDA content across domains. The current plan had been to model the IHE template from CIRC. What is the relationship between C-CDA and CIRC? Is there an international flavor of C-CDA? soon? Will CIRC need to be restructured? What are recommendations for the new IHE Supplement Template Section Z? Are there changes to cardinality and optionality between CIRC and C-CDA?
Minutes:Different IHE Domains are looking at incorporating C-CDA requirements in different phases, depending on their workload. PCC is looking at 2013 cycle to create CPs to existing profiles while trying to maintain compatibility with existing profiles. Cardiology may look at 2012 for the new Cath report profile. For PCC, the problem is the same information may need to be structured in a different way. eg., Concern code may be null in IHE, but C-CDA requires a specific code to be sent.
C-CDA was motivated by the US HHS Meaningful Use adoption, that is why it is US Realm specific. IHE, obviously, wants to be universal realm.
Look to PCC Reconciliation Profile for most recent PCC representation model.
PCC thoughts are to adopt the C-CDA codes/differences that make sense internationally and made the rest as National Extensions (for meaningful use/HHS). If this is the case, IHE will need to assign different top level doc template oids (different from C-CDA oids) for international use. Other examples of C-CDA differences include name and address (state/zip) formats and, possibly, use of SNOMED code sets (not all countries have adopted SNOMED/have the right to use the codes free of charge).
Cardiology CIRC formatting and references are done differently, but because they are two different purposes: 1.) highly constrained content (standard legos building blocks): CIRC, e.g., is trying to efficiently present 150+ discrete observational elements to clinicians in a human consumable tabular format so that they can agree on the content of a cardiology report. In the C-CDA and PCC representations, each row of the table would expand into 5-6 sentences. Too much data for a human to be able to sift through. 2.) structural changes to documentation (need to build a new type of lego building block): Reconciliation, e.g., contains more xml examples and "shorthand" which is good for developers.
FORMAT versus CONTENT needs to be understood well. We are looking to CIRC for the format of a "Section Z of the TF of the Supplement Template". Most of the C-CDA changes will be to CONTENT. We are moving forward with CIRC as the IHE format spec. Although there are still known outstanding issues and questions which need to be addressed, the general direction is clear.
CIRC: Harry has proposed more details for CIRC 6.1.1.1 "Cardinality". (email) On the webex, Keith worked through a potential method to represent xml samples in tabular format. In CIRC 6.1.2.1 Template ID would be replaced with xml element.
NIST and test tools were also discussed (and will need to be discussed again in the future with NIST). Will have to think about how to generate a tabular format that developers want/need that can also be fed directly into the NIST tool simultaneously to create a validator.
Action: Need to look at consolidating sections/entries across domains. See Problem Concerns in CIRC and PCC as an example. Both content (constraints) and format are different. This is primarily a communication issue between domains, it appears.
Action: Put onto DCC agenda - should IHE mandate/recommend a date/time/path that each IHE Domain works towards incorporating C-CDA requirements into new profiles? existing profiles?