CDA Use in the PCEHR: Lessons learned

Apr 4, 2014

I wrote an article for the latest edition of Pulse IT (page 53) called “CDA Use in the PCEHR: Lessons learned”:

One of the key foundations of the PCEHR is that the CDA (Clinical Document Architecture) is used for all the clinical documents that are part of the PCEHR. This article describes the lessons learned from using CDA for the PCEHR.

Here’s a summary of my lessons learned:

  • When using CDA (or anything else) make the documentation easy to read and navigate, do not assume prior knowledge, and make it as short and flat as possible
  • CDA is both too simple, and too complex. Adoption requires expertise, and policies and tools to leverage that expertise as much as possible
  • The presence of both Narrative and Data means that you can do much better checking of the implementations. However it also means that you need to
  • CDA specifications need to be specific about how the clinical narrative should be presented, as this is the most important part of the document
  • the CDA Narrative/Data pattern allows for interoperability in the presence of poor agreement about the underlying data;  whether this is a good thing depends on your perspective
  • The existence of the narrative/data pattern means that a thorough conformance testing framework is required to ensure quality
  • The implementation community in Australia still has a long way to go before we have mastered the exchange of codes from terminologies
  • Syntax is less important than content. Interoperability can only fully meet business goals when there is substantial business alignment

The conclusion is pretty simple: we’ve got a long way to go yet, at lots of levels. I suspect that some of the issues are going to burn other programs too.

I’m posting this here to serve as the place for discussion about what I wrote. Btw, if you’re making comments, please take note of this disclaimer in the article:

This article is not evaluating the PCEHR program itself, nor even how the PCEHR program used CDA, but just about what was learned about CDA.

btw, I am always happy to contribute to Pulse IT. It’s a wonderful resource for our community here in Australia - Simon’s done a great job.