A new tool released by the Office of the National Coordinator for Health IT is being offered to providers and developers to help them identify and resolve interoperability issues involving Consolidated Clinical Document Architecture (C-CDA) documents in their HIT systems.
ONC’s new scorecard provides two scores for submitted C-CDA documents—one reflects whether a document meets the requirements of the 2015 Edition Health IT Certification for Transitions of Care (pass/fail), and the other provides a grade (A+, A-, B+, B-, C and D) based on a set of enhanced interoperability rules developed by Health Level Seven (HL7).
According to ONC, higher scores and grades indicate that “information is coded with appropriate structure and semantics and hence has a better chance of interoperating with disparate systems.”
C-CDA was produced and developed through the joint efforts of ONC and HL7, among others, to create a set of harmonized CDA templates. CDA is a base standard which provides a common architecture, coding, semantic framework and markup language for the creation of electronic clinical documents.
“It is a tool designed to allow implementers to gain insight and information regarding industry best practice and usage overall,” states the ONC website. “It also provides a rough quantitative assessment and highlights areas of improvement which can be made today to move the needle forward.”
The best practices and quantitative scoring criteria have been developed by HL7. The scorecard is based on the work completed by the ONC-funded Substitutable Medical Applications and Reusable Technologies (SMART), which leverages HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standards to make it as easy as possible for app developers to get to data and for EHR vendors to implement a common application programming interface (API).
“I'm delighted that ONC has taken inspiration from SMART’s Meaning Use 2-era C-CDA Scorecard,” says Joshua Mandel, MD, a research scientist in biomedical informatics at Harvard Medical School and co-chair of the HIT Policy Committee’s API task force. “It’s exciting to see a new open-source tool that focuses on the latest Meaningful Use 3-oriented C-CDA 2.1 documents.”
Mandel sees the C-CDA scorecard first and foremost as a “tool for vendors to check their implementations, and then as a tool that providers could use to test the way their particular system is configured.” For example, he observes that a provider "could create a sample patient within their practice, generate a C-CDA, and run this tool to discover areas where their system may not be generating clean, high-quality data—the resolution here would be to check/improve local vocabulary mapping tables, or to call an EHR vendor to inquire about bugs in the EHR product itself.”
ONC emphasizes that the scorecard does not retain C-CDA files submitted by providers and that the files are deleted from the server immediately after processing. However, ONC strongly suggests not including any protected health information or personally identifiable information in C-CDA file submissions.
To upload a C-CDA file and run the scorecard, click here.
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