The purpose of this document is to provide guidance on the use of Health Level 7 Clinical Document Architecture Release 2 (HL7 CDA R2) for use within Canadian projects. This guidance document is meant to be read in conjunction with the pan-Canadian CDA Header Implementation Guide in order to understand the complete CDA R2 specification as it relates to deployment in the Canadian environment.
The audiences for this guidance paper are the architects and developers of healthcare information technology (HIT) systems in the Canadian realm that exchange patient clinical data. It could also be of interest to business analysts and clinical managers who could benefit from a basic guidance on the use of Clinical Document Architecture (CDA) for exchanging clinical documents between care settings and care providers.
This document assumes the reader is familiar with CDA concepts found in the CDA Release 2, 2005 Normative Standard. In addition, the reader should be familiar with the relationship between the HL7 CDA Standard and IHE technical frameworks and profiles. Finally, many components of the document were influenced by the HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, DSTU Release 1.1 – US Realm.
This document is not meant as an HL7 CDA R2 training document.
The purpose of the Pan-Canadian CDA Header Implementation Guide is to provide formal, implementable specifications for information exchanges using the HL7 Clinical Document Architecture (CDA). This document is scoped by the content of HL7 CDA R2, the Consolidated CDA Implementation Guide, the CDA implementation guides in Canada, and additional constraints from IHE. For now this guide contains a Draft Canadian CDA Header. As additional Canadian CDA content specifications are created they will be added.
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The recommendations included in the document will evolve as more Canadian CDA implementation experience is gained.
Recommendation 1: Apply constraints to the CDA R2 normative specification within the Canadian realm (pan-Canadian CDA Header, and Canadian document templates).
Recommendation 2: Reuse/refactor templates (document, section, entry level) from other implementation guides when possible.
Recommendation 3: When using CDA to represent data already defined with the pan-Canadian HL7 V3 Messages, use CDA section entries to convey this data.
Recommendation 4: One size does not fit all. Evaluate the best exchange paradigm (messaging or document) for each information sharing requirement.
Recommendation 5: To achieve consistency in CDA implementations follow the CDA R2 standard as per the HL7 specification and the pan-Canadian CDA Header Implementation Guide.
Recommendation 6: Extensions to the CDA R2 schema should be optional and brought forth to the Infoway HL7 Community to be vetted with the HL7/IHE community or promoted nationally.
Recommendation 7: Use templates to constrain the CDA R2 standard for specific use cases. This document recommends a future project to establish a set of pan-Canadian templates based on “common” use cases for use within the pan-Canadian CDA Header Implementation Guide.
Recommendation 8: This document recommends that all templates (open or closed) should be included within the CDA section of InfoCentral or a registry and managed/maintained by Infoway.
Recommendation 9: Until a template registry is created, include all details of the template(s) used within the local CDA Implementation Guide. Do not just include the OID – include all details within the guide or as an appendix.
Recommendation 10: Use a single pan-Canadian CDA header, and when possible pan-Canadian CDA templates as they become available.
Recommendation 11: Use OID 2.16.840.1.113883.2.20.4 as a root to register Canadian CDA templates.
Recommendation 12: Canada should follow a similar approach to the US and maintain all pan-Canadian templates within a single guide and/or location. [HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, DSTU Release 1.1 (US Realm)].
Recommendation 13: HL7 CDA documents should be exchanged and managed within an enterprise environment like those described within the Infoway EHR Blueprint or IHE ITI Technical Framework using XDS.
Recommendation 14: Current guidance contained within the pan-Canadian HL7 v3 standards (PCS) should eventually be replaced/ deprecated. Canadian CDA implementations should use the information described in the pan-Canadian CDA Header Implementation Guide.
Recommendation 15: Canada should continue to monitor tooling solutions that can support Canada’s requirements for the governance, creation and management of CDA templates. As these solutions mature Canada should identify pan-Canadian tooling requirements and solutions.