CDA in Canada

Recently came across this excellent comparison of what data is available in each of the different standard CDA document types. I just really like the format.

Comparison of CCR/CCD and CDA Documents

"Single CDA standard for the entire country" can be an interesting discussion. Are we talking about the information model structure, or the terminology, or both? In the information model structure, are we talking about header, section templates? If common clinical requirements are defined, variances in implementation of a base CDA structure to support those requirements are ideally minimal.

I’ve reviewed the file Jason posted. Some of the variances are valid. For example, one is a constraint of the other either at the terminology level (ConceptA is a specialization of ConceptB), or at the information model level (ModelA allows more instances of the same class than ModelB, and ModelB is a constraint of ModelA). One type of issue is when the implementation requires a more relaxed constraint than the base CDA structure allows for (e.g. base standard only allows support of 1 patient name while the implementation requires support of more than 1 patient name, or base standard requires exactly one observation, but implementation makes the observation optional). Discussion then should take place to understand the variance and determine next steps on the variance.

As for conformance to HL7 standards (in general), we can have further dialogue on how to: specify (business and technically), test conformance of HL7 standards. I would encourage those who are interested in this topic to post this topic in our forum.

I would also encourage those who are looking to implement or have implemented CDA to share their thoughts, lessons learned on this thread.

Wendy

kstevens wrote: At a minimum, I would advocate that Canada adopt a single CDA standard for the entire country.

I recently had the opportunity to compare the latest pan-Canadian CDA Header specification with the equivalent specification from eHealth Ontario. I noticed a few discrepancies, so I took some time and went through the documents with a fine tooth comb to compile a list of all the differences that I could find. The list is longer than I was expecting it to be.

It is worth noting that not all of these differences are equally critical. One very large category that I identified, for instance, has to do with the conformance level of fixed value attributes. If a fixed value attribute is optional in one template when the other template expects it to be mandatory, a document conformant to the first may not, strictly speaking, be conformant to the second, but it is probably still interpretable. As another example, if the two templates differ in terms of the Value Sets they have bound to, they may still produce mutually conformant documents if both Value Sets draw from the same Code System and have a significant overlap in their specific concepts. However, there is no a priori reason to expect that a document that is conformant to one of these templates will necessarily be conformant to the other.

I have uploaded my notes to the "documents" area of this community. ic.infoway-inforoute.ca/resources/hidden-docman-menu/hl7/62-cda-header-comparison

Thanks for the posting Ken. I agree there is increasing interest and use of CDA in Canada. During the last HL7 Canada Council meeting there was discussion of additional communities associated with CDA and FHIR. If you are interested in participating, post your comments, interests. We'll be looking at setting up both communities in the near future.

Hi,

My name is Andrew Liu and I'm a Solutions Manager at Infoway working on tools and enablers to accelerate Interoperability.

I agree with Ken that CDA, especially Consolidated CDA are gaining more and more momentum and adoption in U.S., Europe and Australia. We should take a serious look at CDA specification and implementation.

Many Canadian jurisdictions have CDA based implementation projects in the plan, in progress or even completed. You can find some of such projects on Infoway wiki at:
infocentral.infoway-inforoute.ca/2_Standards/1_pan-Canadian_Standards/Messaging/t_Clinical_Document_Architecture_(CDA)/CDA_dashboard
Please note this is not a complete list of CDA projects in Canada.

Since early last year, at Infoway we've been thinking of ways to support CDA implementation in Canada. On top of the complexity of CDA specification and templates themselves, Canadian implementers face additional challenges of supporting CDA documents using pan Canadian Header, Canadian Data Types and Vocabularies. Vendors who already have CDA capabilities usually support Consolidated CDA, or the IHE content profiles such as XDS-MS, XD-LAB, XDS-SD etc. The solution support for Canadian flavoured CDA implementation are rare, if not non-existent.

To fill in the gap, Infoway has invested in providing Canadian focused CDA programmatic API support, by leveraging the tools that Infoway invested for messaging (MessageBuilder, more info can be found under the "Solutions" tab of this community). MessageBuilder CDA API project is currently in Alfa testing, it will be released in Q1 this year, and it supports the generation, parsing and runtime validation of Consolidated CDA documents as well as CDA documents using pCS CDA header and pCS data types. It is a CDA toolkit.

We welcome CDA implementation projects to consider leveraging Infoway CDA API solution. We're identifying and planning for further CDA tooling opportunities, such as CDA template repository/registry, online CDA template authoring/editing tool, online CDA validation service for Canadian CDA specifications.

Please feel free to post your thoughts, questions or get in touch with Infoway if you're interested in more in-depth information regarding CDA tools and other Health IT interoperability tooling solutions.

Andrew

I've been doing a bunch of EMR integration work in the U.S. recently. The Meaningful Use incentive program in the U.S. has had a huge impact on clinical interoperability down there to the point where I believe they are going to leapfrog Canada on eHealth integration by the end of this year. Specifically, the Meaningful Use program has resulted in every major EMR vendor in the U.S. supporting the comprehensive export of patient medical records via CCDA over XDR. (See this presentation for specifics.)

This has a couple of implications for Canada:
1) As Canadian Clinics and Hospitals upgrade their systems, the capability of exchanging clinical data via CCDA over XDR will become increasingly available here in Canada.
2) As Canadian healthcare software vendors sell their products in the U.S., they will need to support this standard.

For these two reasons, I believe it's in Canada's best interest to take a serious look at CDA, and specifically CCDA over XDR as a cornerstone standard our jurisdictions support for the exchange of clinical data between systems.

Some work has been done already in Canada on CDA. I'm keen to find out where that's at. Are there any projects already underway in Canada that use CDA today? Do we use the same message format that is used in the U.S. or do we have a Canada specific format? What are the differences? At a minimum, I would advocate that Canada adopt a single CDA standard for the entire country. Ideally, I believe it would be in our best interest if the Canadian CDA standard were compatible with the U.S. standard.

What Canadian CDA implementations are you aware of? Which Templates are they using?

Ken