S&I Framework F2F: Session Notes
Initiative: Transitions of Care
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MDHT Capabilities and Success
Stories
Rama Ramakrishnan
The Westin: Alexandria, Virginia
Date / Time
April 12, 2012 10:30 am
Scribe
Materials
Kelly Conlin
Key Points
MDHT – Model Driven Health Tools
Motivation for creation:
o Steep learning curve
o Lack of tooling
o Lack of formal methodology/ best practices
o Current implementation approaches are inadequate
MDHT Benefits:
o Decreased costs and accelerated adoption of CDA R2
o Model-Driven framework
MDHT Users:
o Healthcare IT Standards Developers and Publishers
 Used to create new models and templates and to publish implementation
guides
o Healthcare IT Standards Users and Implementers
MDHT Architecture;
o EMF – Eclipse modeling framework
o Custom Tools help use the product in a more efficient way
MDHT uses EMF code technology with a UML Model Table Editor to add and edit constraints
Java API is used to create and edit documents, validate routines, and generate unit test code
Document publishing is based on model using ‘shall’ ‘should’ and ‘may’
o Uses standard DITA-OT toolkit for documentation generation
Able to handle Non CDA models since it is UML based
If HL7 ballots a change, how does that work?
o Is there a labeling mechanism that responds to the HL7 balloting convention?
Is MDHT content specific or is it transport specification specific?
o There could be an API to create a document, how you send it is out of the realm of
MDHT.
o Can you use tool to validate transport?
 This tool only handles payload, not transport itself.
MDHT create UML Models which express the domain template model as a UML Profile
Each model constraint is given a unique number within the model (known as a conformance
rule)
Validation:
o Constraints specified in the form of standard UML constructs such as cardinality
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OCL constraints
The user can decide the appropriate level of validation messages
A user may upload a document to cdatools.org and choose ‘errors and warnings’ to
validate the document
o In the real world, CCD consumers are failing validation continually – what would be nice
that is there is a way to put a hook into place where third party processors can handle
those errors and continue to get data
 The MDHT actually has that capability – discussion to be taken offline
o NIST/ MDHT/ RA validation – there are three different modules for validation
 As a user, which one should I trust?
o Requests for schematron bubble up and down; generally there are more requests for
.net
Existing MDHT Models:
o HL7 CCD
o HL7 Common Document Types
o IHE Patient Care
o HITSP
o 3 additional models
MDHT Consolidated CDA Model Accomplishments:
There aren’t real life patient examples; it would be beneficial to have real-world examples
o This needs to be validated in a real life scenario
o Spearhead the effort by creating documents within MDHT and having users fill in the
data
o Is there anyone in the room who has a robust set of test data?
 Critical issue going forward that everyone knows the answer coming out
 We should have a common body of test data (scrubbed for PHI or hypothetical
data)
 David Tao (Siemens) may be able to offer up test data eventually
Underlying functionality is reusing Consolidated CDA sections
MDHT C-CDA has been integrated into the ToC RI (discharge summary, discharge instructions,
consultation request, consultation summary)
o Only a version of the discharge summary exists in the C-CDA IG but medications section
is optional
Moving towards MU2:
o April Release will be a V1.1 (to include many changes that needed to be resolved)
MDHT is available on mdht.projects.openhealthtools.org as an open source project
o User scenarios and changes are developed in two week sprints; Sprint Builds are
available on the MDHT website
o JUnit Testing is done and results are provided on the MDHT Website
Call for participation:
o Developer Discussion Forum
o Submit bugs and enhancement requests
o Contribute Source code
Users of MDHT:
o IBM
o Mirth
o Orion
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S&I Framework F2F: Session Notes
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Success Stories from Mirth Corporation:
o Mirth had many products that needed to be able to generate CDAs of all types and they
needed to receive data and generate it into usable data
o Mirth needed something simple for developers to say “here’s data, turn it into
o CDAPI is a high level abstraction on top of MDHT
 Turns CDA into clinical document model
 Also gives user access to MDHT directly
o MDHT is open source and very stable
o Two ways to use CDAPI:
 Take clinical document model, put it through CDAPI and uses MDHT, to give you
CDA
 Reverse process also possible
o Performance metrics? Do those exist?
 There was benchmarking done
o CDAPI is not an open source library and there isn’t a roapmap for consolidation
Actions Items
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Test Data
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Create or Identify a Common Set
of Test Data
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Risk
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Identified Risks, Issues, or Concerns
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Timeline
Ongoing
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