Facilitators

  • Lisa Nelson (MaxMD)
  • Jean Duteau (Duteau Design)
  • Joginder Madra (Madra Consulting)

Goal

  • Improve consistency and quality of information representation in C-CDA exchange documents


Sign in:   Attendee List

Attendance

2020.05.20 Virtual C-CDA IAT Attendee List

Executive Summary of the Event Results


Participant System Roles

Role 1: Document Creator – A system that creates a specific type of document. (Note: this track focuses primarily on the creation of C-CDA Documents, but the material covered is relevant to Document Creators who make FHIR Documents as well.)

Role 2: Document Consumer - A system that receives a document and processes it in one or more of 4 possible ways:

  • (Required) Renders the document for human readers

  • (Optional) Imports the document into its system

  • (Optional) Imports the narrative information from one or more portions of the document (section(s)), into its system

  • (Optional) Imports the discrete data from one or more portions of the document (section(s)), into its system

Bonus Role (for Data Provenance Discussion, Sunday Q1)

Role 5: HIE Transformer- A systems that receives documents and processes the data in them to aggregate, de-duplicate and re-assemble information to be shared in document-based exchange

Bonus Roles (for Saturday Q5)

Role 3: Document Transformer – A system that converts a C-CDA document into a FHIR Document of the same type or a FHIR document into a C-CDA document of the same type following one of 3 possibilities:

  • (Required) Transforms the header and body of the document without transforming any machine-coded entries.

  • (Optional)Transforms the header and body of the document and transforms some by not all machine-coded entries.

  • (Optional) Transforms the header and the body of the document and transforms all of the included machine-coded entries.

Role 4: Document Registry/Repository – A system that offers a FHIR API for storing and querying/retrieving documents. Documents may be any type of document.

  • (Required) Supports DocumentReference resource for documents available to be queried.

  • (Optional)Supports DocumentManifest for documents available to be retrieved as part of a set of documents intended to be kept together as a collection.

Scenarios

Access the Ted Leven Patient Story to get the scenario information for document creation.

1.    Create/Consume a Patient Summary

Action: Create a CCD/Progress Note/H&P to summarize the patient’s completed annual visit to his PCP on 3/5/2018. (ok to use other dates if your system can't create data historically.)

-differentiate Patient Summary from Encounter Summary

-use Section Time Range Entry

-include Clinical Notes Section, Note Activity entry

-use many USCDI data elements

Precondition: none

Success Criteria: document is schema valid and has no schematron errors. The narrative note information is coded correctly, categorized appropriately. 

Bonus point: Document scores B or better under ONC Scorecard

Bonus point: Create the Referral Note that would have been created for the Endocrinologist.


2.    Manually inspect, Validate, Consume and Render the Encounter Summary

Action: Inspect, validate with ONC Scorecard, Consume (if possible) and Render the Encounter Summary Produced in Scenario 1.

Precondition/Trigger: Visit has completed or a request has come in for the document.

Success Criteria: Document renders successfully

Bonus point: Document is attached to the patient's record in the consuming system

Bonus point: Consume or inspect the Referral Note document and determine what id would need to be returned in the associated Consultation Note.


3.    Create a C-CDA Document with a Notes section or a Note Activity entry in an existing section

Action: CCD/Progress Note/Consultation to summarize the patient’s annual visit to his PCP on 2/11/2019. (ok to use other dates if your system can't create data historically.)

-include Care Teams Section

-use Section Time Range Entry

-include Clinical Notes Section, Note Activity entry

-include many USCDI data elements

Precondition/Trigger: Visit has completed or a request has come in for the document.

Success Criteria: Section Time Range entry is coded and rendered correctly. Care Team Section is present and renders correctly, some care team members are included in the associated machine entries. Persistence of id's seems to have been used appropriately. (Changes in Problem List items, Medications, Patient Address, and Social History.)

Bonus point: Add Note Activity information onto an existing entry and confirm the authorship of the note is clear and correct.

4.    Consume the Clinical Note Document produced in Scenario 3.

Action: Inspect, validate with ONC Scorecard, Consume (if possible) and Render the Encounter Summary Produced in Scenario 1.

Precondition/Trigger: Visit has completed or a request has come in for the document.

Success Criteria: Document renders successfully; LOINC code use for coded Clinical Notes Section is correct. LOINC codes use in Note Activity entries seem correct. 

Bonus point: Document is attached to the patient's record in the consuming system


5UPER BONUS - Considered during Saturday Q5.

5. Create/Consume a C-CDA Care Plan Document

Action: Create a C-CDA Document of the following type:  Care Plan

Precondition:

Success Criteria: Document scores B or better under ONC Scorecard

Bonus point: Transform document to a FHIR Document

6.    Create/Consume FHIR Document that conforms to the C-CDA on FHIR IG

Action: Create a Document that conforms to one of the document types profiled in the C-CDA on FHIR Implementation Guide

Precondition:

Success Criteria: Documents validates using FHIR Validation tools

Bonus point: Transform that FHIR document into a C-CDA document of the same type.

7.    Consume and Render a FHIR Document

Action: Retrieve and render a FHIR document

Precondition: Assumes the ability to receive a document or query for a document from a Document Registry/Repository.

Success Criteria: Visual representation of the document shows all the attested clinical content.

Bonus point: Implement one or more of the additional options for a Content Consumer

8.    Create/Consume an Unstructured C-CDA Document – C-CDA Header with embedded pdf

Action: Create a C-CDA Document of any type of C-CDA with an embedded pdf document.

Precondition:

Success Criteria: The non-xml body is coded correctly, and the document renders correctly with your stylesheet of choice.

Bonus point: Transform document to a FHIR Document

TestScript(s)

Testing will utilize the tools available at:

https://sitenv.org/home

One Click Scorecard can be accessed using a Direct

C-CDA Scorecard includes validation against CDA schema and C-CDA template, plus other C-CDA document “best practice” criteria.


Security and Privacy Considerations

Do not supply, test or post sample files that include any PHI that has not been consented to be shared for educational purposes. 

Event Notes 

Item

Notes
Workflow
Using C-CDA Document to support Quality Measurement
Encounter Documents
Rendering, being explicit about contained content and Human readability
Provenance
Section Time Range
Care Team Templates

Clinical Notes


C-CDA Rubric
USCDI


Action/Followup Items

Grouping

Item

Responsible for Follow-up