Why and where CDA
François Macary, Christel Daniel
What is CDA?
• Clinical Document Architecture (CDA) is an XML-based markup
standard intended to specify the encoding, structure and
semantics of clinical documents for exchange and sharing.
• CDA is part of HL7 V3. As such, it relies on the HL7 Reference
Information Model and the HL7 V3 data type.
• It enables to represent any static clinical content in a format,
which is both human-readable and system-processable.
• A single xml schema validates any kind of CDA document
Why CDA?
• Messages are appropriate artifacts to support exchange of clinical
information during the production of care.
• The output of the process of care is better captured in static
documents, persistently accountable to their authors and
understandable per se to care providers.
• The document sharing paradigm is the best fit to enable patient
care coordination and care continuity among care providers and
their systems, which are not coupled to one another.
• IHE provides a set of infrastructure profiles around XDS, to support
this document sharing paradigm. The shared content is most often
CDA documents.
Validation &
Conformance
• A single xml schema CDA.xsd is used to validate any instance of
CDA document.
• A template of a CDA document is a set of constraints applied to
the general standard. It is both a specification and a schematron,
which tests the conformity of document instances to that
template.
CDA content profiles in IHE domains
Domain
St. Profiles
AP
AP structured report (APSR): 1 generic + 20 organ specific templates
Card.


ITI

Scanned documents (XDS-SD): 1 template with a non-structured body
LAB

Sharing laboratory reports (XD-LAB): 1 report template

7: Medical Documents, Medical Summary, Referral Summary, Discharge
Summary, PHR Extract, PHR Update, Emergency Department Referral,

4: Antepartum History & Physical, Antepartum Summary,
Antepartum Laboratory (from XD-LAB), Education

3: Labor and Delivery History & Physical, Labor and Delivery Summary,
Maternal Discharge Summary

4 in emergency department: Triage Note, Nursing Note, Composite
Triage & Nursing Note, ED Physician Note

3 document templates
Patient Care
Coordination (PCC)
Pharmacy
Cardiac Imaging Report Content (CIRC): 1 report template
Testing of content profiles
at Connectathons 2011
#Systems as “Content Creator” Actor
Profiles
North-America 2011
Europe 2011
PCC profiles
28
2
XD-LAB
5
3
XDS-SD
13
2
Adoption of CDA
A number of countries have adopted CDA R2 globally:
• Finland was the first broad adopter
• Austria: ELGA project
• France: CDA is mandated for patient care coordination. XD-LAB has
been chosen for lab reports. APSR is required for cancer case AP
reports. However, lab system vendors are not ready yet.
• US: in “meaningful use” ?
In other countries, adoption is made at the regional level
• Italy Veneto
• US Regional Health Information Organizations (RHIOs),
• Spain Catalogna …
Thank You