HL7 Guidance: C-CDA Rubric Criteria, Release 1
HL7 Informative Ballot
Copyright © 2019 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off .
Use of this material is governed by HL7's IP Compliance Policy .
I MPORTANT NOTES:
HL7 licenses its standards and select IP free of charge. If you did not acquire a free license from HL7 for this document, you are not authorized to access or make any use of it. To obtain a free license, please visit http://www.HL7.org/implement/standards/index.cfm.
If you are the individual that obtained the license for this HL7 Standard, specification or other freely licensed work (in each and every instance "Specified Material") , the following describes the permitted uses of the Material.
A. HL7 INDIVIDUAL, STUDENT AND HEALTH PROFESSIONAL MEMBERS, who register and agree to the terms of HL7’s license, are authorized, without additional charge, to read, and to use Specified Material to develop and sell products and services that implement, but do not directly incorporate, the Specified Material in whole or in part without paying license fees to HL7.
INDIVIDUAL, STUDENT AND HEALTH PROFESSIONAL MEMBERS wishing to incorporate additional items of Special Material in whole or part, into products and services, or to enjoy additional authorizations granted to HL7 ORGANIZATIONAL MEMBERS as noted below, must become ORGANIZATIONAL MEMBERS of HL7.
B. HL7 ORGANIZATION MEMBERS, who register and agree to the terms of HL7's License, are authorized, without additional charge, on a perpetual (except as provided for in the full license terms governing the Material), non-exclusive and worldwide basis, the right to (a) download, copy (for internal purposes only) and share this Material with your employees and consultants for study purposes, and (b) utilize the Material for the purpose of developing, making, having made, using, marketing, importing, offering to sell or license, and selling or licensing, and to otherwise distribute, Compliant Products, in all cases subject to the conditions set forth in this Agreement and any relevant patent and other intellectual property rights of third parties (which may include members of HL7). No other license, sublicense, or other rights of any kind are granted under this Agreement.
C. NON-MEMBERS, who register and agree to the terms of HL7’s IP policy for Specified Material, are authorized, without additional charge, to read and use the Specified Material for evaluating whether to implement, or in implementing, the Specified Material, and to use Specified Material to develop and sell products and services that implement, but do not directly incorporate, the Specified Material in whole or in part.
NON-MEMBERS wishing to incorporate additional items of Specified Material in whole or part, into products and services, or to enjoy the additional authorizations granted to HL7 ORGANIZATIONAL MEMBERS, as noted above, must become ORGANIZATIONAL MEMBERS of HL7.
Please see http://www.HL7.org/legal/ippolicy.cfm for the full license terms governing the Material.
Ownership. Licensee agrees and acknowledges that HL7 owns all right, title, and interest, in and to the Materials. Licensee shall take no action contrary to, or inconsistent with , the foregoing.
Licensee agrees and acknowledges that HL7 may not own all right, title, and interest, in and to the Materials and that the Materials may contain and/or reference intellectual property owned by third parties (“Third Party IP”). Acceptance of these License Terms does not grant Licensee any rights with respect to Third Party IP. Licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the Materials or otherwise. Any actions, claims or suits brought by a third party resulting from a breach of any Third Party IP right by the Licensee remains the Licensee’s liability.
Following is a non-exhaustive list of third-party terminologies that may require a separate license:
Current Procedures Terminology (CPT) code set
American Medical Association
SNOMED International http://www.snomed.org/snomed-ct/get-snomed-ct or email@example.com
Logical Observation Identifiers Names & Codes (LOINC)
International Classification of Diseases (ICD) codes
World Health Organization (WHO)
NUCC Health Care Provider Taxonomy code set
American Medical Association. Please see www.nucc.org. AMA licensing contact: 312-464-5022 (AMA IP services)
Table of Figures:
This document contains rubric criteria created through an ongoing project in the HL7 Structured Documents Work Group (SDWG), originating in 2016. Throughout 2018 a group of HL7 members created a new set of rubrics to add to the original rubric. This project identified key problematic areas in real system generated C-CDA documents where similar data was consistently represented differently or incompletely. Variably constructed data removes the ability to reliably share and compare data, adversely impacting interoperability. The hope is that the rubric will promote best practices by allowing providers and health IT developers to identify and resolve issues of C-CDA document data representation in their health IT systems thereby promoting interoperability and use of clinical data received in C-CDA documents.
A subset of the rubric criteria are utilized to identify best practice tests and quantitative scoring criteria in the Office of the National Coordinator for Health IT (ONC) C-CDA Scorecard . The ONC C-CDA Scorecard is designed to allow implementers insight into C-CDA implementations and highlights areas of improvement which can be made today to move the needle forward. The intent is to add these additional rubrics to the ONC Scorecard.
In order for these rubric criteria to be more exposed, members of SDWG suggested it would be a good idea to put the rubric criteria through an Informative Ballot.
There is an industry need for disparate systems to be able to communicate with each other. End users can use tools that utilize these rubric criteria to determine the quality of their C-CDA applications, leading to quality improvement discussions with their vendors. The Informative Ballot will help gain widespread consensus on the appropriateness of the rubric criteria.
The rubric criteria are a set of Rubrics that go above and beyond EHR certification. They are meant to be utilized in best practice testing tools to provide feedback to industry and help drive the EHR vendor community towards consistent implementation of the C-CDA standard.
There are two types of Rubric criteria identified:
- Required – All tools adopting this criteria should throw an error.
- Informational - All tools adopting this criteria should throw a warning, not an error.
220.127.116.11 Rubric Intent
If code's DisplayName is present and it conflicts with the codeSystem's preferred displayName then a tool should throw an error. If a DisplayName isn't present, then a tool should not throw an error. Testing tools will require at least a basic terminology service to implement this Rubric.
If an @displayName is present with an @code then the text of the @displayName SHALL be the text of the code system’s preferred name.
<code code = "573621" codeSystem = "2.16.840.1.113883.6.88"
codeSystemName = "RxNorm"
"Albuterol 0.09 MG/ACTUAT [Proventil]"
<code code = "573621" codeSystem = "2.16.840.1.113883.6.88"
codeSystemName = "RxNorm"
3.1.3 Text Reference
3.2.1 Template IDs
4.1.1 Patient Name
5.1.4 Social History
- C-CDA Rubric Project Page - http://wiki.hl7.org/index.php?title=CCDA_Scorecard_Rubric_Update
This link is where the current rubric is located, where you can find more information about the process for creating a rubric, and where you can find call information.
- C-CDA Product Page - http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492
The Consolidated CDA (C-CDA) implementation guide contains a library of CDA templates, incorporating and harmonizing previous efforts from Health Level Seven (HL7), Integrating the Healthcare Enterprise (IHE), and Health Information Technology Standards Panel (HITSP). It represents harmonization of the HL7 Health Story guides, HITSP C32, related components of IHE Patient Care Coordination (IHE PCC), and Continuity of Care (CCD).
- ONC C-CDA Scorecard - www.healthit.gov/scorecard
The C-CDA Scorecard leverages the work completed by an ONC-funded grant — SMART (Substitutable Medical Apps Reusable Technologies) and promotes best practices in C-CDA implementation by assessing key aspects of the structured data found in individual documents. It is a tool designed to allow implementers to gain insight and information regarding industry best practice and usage overall. It also provides a rough quantitative assessment and highlights areas of improvement which can be made today to move the needle forward.
[GD1] One comment reconciliation was for each rubric to have a unique ID. Can the heading numbers become the unique IDs (at end of document creation) or should we make up a format?
Suggestions for format?
Have the Rubric number include if its Required or Informative??
Remember the challenge is these will not be autogenerated
[GD2] Seems like it may be meaningful to have a screen shot of the reference code system code – thoughts? Should we have additional examples here (i.e. from SNOMED CT and LOINC)
[GD3] Should the link to the C-CDA Examples Task force be under its own Heading number 4 (Like 3.1.13 Examples) or OK to “regular text under 3.1.13 Examples