Standards Analysis Summary
• vMR
– Pros
• Designed for computability
• Compact Wire Format
• Aligned with HeD Efforts
– Cons
• Limited Vendor Adoption thus far
• Represents an additional required format for EHRs
Standards Analysis Summary (cont.)
• CDA (C-CDA & QRDA)
– Pros
• Well specified for various use cases
• Established Vendor Basis
• Aligned with MU
– Cons
• Difficult for computability
• Expensive wire format
Standards Analysis Conclusion
• Conclusion
– Not likely to be able to recommend a single format
– Should provide a solution that allows flexibility in
payload formats, but still enables interoperability
Proposed IG Outline
•
•
•
•
•
DSS Profile for CDS Request
DSS Profile for CDS Response
Container Profile for CDS Request
Container Profile for CDS Response
Payload Format Guidance
– Data Requirements
– Interaction Types
• Modular Transport Options
DSS Profile
• DSS Profile for CDS Request
• DSS Profile for CDS Response
For each, either a single, general profile or one
profiled for each functional interaction type, if
necessary
Container Profile
• CDSInput
– vMR Container
– Extended w/ additional context as specified in UC2
– Extended to allow multiple payload formats
• CDSOutput
– vMR Container
– Extended to allow multiple payload formats
For each, either a single, general profile or one
profiled for each functional interaction type, if
necessary
Payload Formats
• This section would describe supported payload
formats (vMR, CDA, QRDA)
• For each format, describe generally how each
type of clinical concept would map into the target
format
– This effort would leverage the Value Sets &
Terminologies work, basically defining how to express
each clinical concept in the terminology space in each
format
Data Requirements
• Mapping between clinical concepts, data requirements,
payload standards, and vocabulary/terminology bindings
for all 225 data requirements specified in Use Case 2
• This section would describe the formal mechanism for
expressing data requirements for a particular exchange
• Each exchange would be represented by a set of data
requirements, where each data requirement includes:
–
–
–
–
Clinical Concept (Encounter, Problem, Procedure, etc.)
Value Set (A specific value set identifying codes)
Date Range (A date range, relative to the time of the request)
Number needed (e.g., collect X of most recent in timeframe)
Interaction Types
• A section for each functional interaction type,
where each section includes:
– Data Requirements, using the formal specification
described above
– Mapping for each of those requirements into a
specific format for this functional interaction type.
• This would involve selection of a specific C-CDA document
type, QRDA CDA template, or vMR template, as well as
potentially further constraints on those specifications as
appropriate
Interaction Types (cont.)
• Proposal is to select the most broadly applicable
functional interaction types, along with the most
appropriate payload format for each type to use
as examples, for example:
– Disease Management – C-CDA, History & Physical
– Quality Measurement – QRDA, specific template
– Immunization – vMR, specific template
Transport Format
• Recommend DSS Release 1
– SOAP vs REST can be addressed as an additional
profile for DSS
• This effort may be part of DSS Release 2, or may be part of
the HeD UC2 IG
CDS Request Options for Functional Interaction
Types
Functional Interaction Type A: vMR
Request Service: DSS Request Element
Request Items Organizer/Container: vMR
Request Item Payload: vMR Clinical Statement
Functional Interaction Type B: QRDA
Request Service: DSS Request Element
Request Items Organizer/Container: vMR
Request Item Payload: QRDA
Functional Interaction Type C: CCDA
Request Service: DSS Request Element
Request Items Organizer/Container: vMR
Request Item Payload: CCDA
Overview of Process to Develop Specific
Functional Interaction Type Guidance
Begin
Determine
Functional
Interaction Type
Update/Constrain
template
Select template(s)
by leveraging
mapped data
elements
Determine Data
Elements for
Functional
Interaction Type
CCDA,QRDA
What is
selected
Standard
?
Select Standard
(vMR,CCDA,
QRDA)
Include Mapped
Data Elements
into Selected
Standard
vMR
Document as
Implementation
Guide
Select template(s)
by leveraging
mapped data
elements
Create vMR data
profile by
leveraging
mapped data
elements
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