WHY DEAL WITH A CDA INCARNATION OF X73?Or, do we really need more problems…

Hint: perhaps we do

The “usual” use case for device data is streaming

But what about inclusion in encapsulated record of clinical happenings?

• Key feature is boundedness• Who wants it?

• First use case from anesthesiologists: anesthesia record

• (use case detail)

• Fair to say it is a gap even though groups involved are hard at work elsewhere (? -> discussion topic)

Things fly apart(with apologies to Yeats and Chinua Achebe)

Centripetal Forces in Play

Stop the world, I want to stay on

Desirability of pulling together

Lots of disparate: • Goals• Organizations/groups• People • Ideas

Involved. Current project is another instance of an opportunity to diverge – we don’t want to do that

Building Blocks

• 11073-10101 Nomenclature• 11073-10201 Domain Information Model (DIM)• Document architectures

• Clinical Document Architecture (CDA)• Continuity of Care Document (CCD)• Implementation Guide for CDA Release 2.0 Personal Healthcare

Monitoring Report (PHMR)

Personal Healthcare Monitoring Report (PHMR)

• Intended Use: Remote monitoring• Stimulus from Continua Alliance• Status: expired Draft Standard for Trial Use (resuscitation

underway?)

Previous work• Martin Hurrell• Alan Nicol

Devised a schema incorporating 11073 concepts and models; went through an iteration with HL7 Structured Documents group

Current work relies on this

Current work• (Hardly deserves the name of work – mea culpa. John

Rhoads is working on modeling and schema – John Walsh is offering clinical guidance and support)

Basic CCD• Very general – can be (and has been) used or extended

for very many kinds of medical events and sequences• Framework for inclusion of minimum needed information

on what happened and who it happened to

What PHMR added to CCD• Inherits general form and may constraints from CCD• Structural adds to CCD: device details• RIM Observation object: device supplements

PHMR as is

Required sections:• Medical Equipment 46264-8• Vital Signs 8716-3• Results 30954-2

PHMR as is, contd.

Optional sections:• Purpose 48764-5• Medications 10160-0• Functional Status 30954-2

PHMR as is, contd.• Medication administration• Supports inclusion of waveforms

 Limited (PHD) nomenclature and examples• Glucose meter• Thermometer

PHMR, contd.

Constraints section• General Clinical Statement Constraints• Device Definition Organizer• PHMR Product Instance• PHMR Product Instance Reference• Sampling Frequency Observation• Device Resolution Observation• Device Accuracy Observation• Numeric Observation• Waveform Series Observation• Waveform Sample Period Observation• Waveform Observation• Event Observation

Semantic fidelity challenges

We tend to funnel device data through HL7 V2, for example, with the IHE PCD Device Enterprise Communications profile

Since HL7 V2 was really not purpose-built for this, certain contortions occur to meet challenges of:

Supplementary backup measurement information

Provenance / traceability

What more would be useful to add

Provenance (promotes traceability• Medical Device Systems MDC• Virtual Medical Device VMD• Channel• Metric

Supplementary measurement and device information

CCD HL7 quasi-UML, in part

Alan Nicols model proposal

As embodied in XML

To do• Work in additional DIM material as required• Identify 11073 nomenclature to use• Document• Work through process

You too can be part of this magnificent effort

• Fortunately we have a CDA expert who has actually volunteered and others we can dragoon, that is, politely call on

• 11073 expertise wanted – in any case you will be solicited