Articles
The Center for Disease Control and Prevention (CDC), as part of National Healthcare Safety Network (NHSN), is developing a standard framework to support the electronic submission of health care-associated infections (HAIs) and antimicrobial use and resistance (AUR).
The article outlines 3 key challenges to collecting this data electronically and shares background and success stories on the sharing of Lab, ADT and pharmacy data. Future exchanges, currently under development, will utilize the Clinical Document Architecture (CDA). One reason for choosing CDA is its ability to provide semantic interoperability.
Alschuler Associates, LLC provided expertise on the use of CDA and supported development of the HL7 Healthcare Associated Infections CDA Implementation Guide. The guide includes guidance on electronic reporting of Bloodstream Infections Reports, Surgical Site Infection Reports, Procedure Denominator Reports and the ICU Denominator Report.
The Quality Reporting Document Architecture (QRDA) initiative results from a private collaboration sponsored by the Alliance for Pediatric Quality (Alliance) a joint effort of the American Academy of Pediatrics, The American Board of Pediatrics, Child Health Corporation of America, and the National Association of Children's Hospitals and Related Institutions. Its goal is to develop an electronic data standard for exchange of patient-level quality measurement data between health care information systems.
The Centers for Disease Control and Prevention (CDC)...is developing a standards-based solution for transmission of healthcare-associated infection (HAI) data from existing commercial software systems to the agency's National Healthcare Safety Network (NHSN). ... CDC's pilot project of the new solution in July and August, 2007 was the first field test of the Health Level Seven Clinical Document Architecture Release 2 (HL7 CDA R2) for public health reporting purposes.
The "Single Source" concept applies the write-once,
use-many principle to data gathering for clinical trials,
in this case study, using CDA as the key to interoperability.
The article reports on a pilot implementation done at the
Duke Clinical Research Institute which radically streamlined
the data gathering process by eliminating redundant data entry.
On a side note, the authors observed that the highest degree
of reuse was not between the clinical trial and the patient chart,
rather, between previous notes in the chart and the note
documenting the current encounter.
"Implementation guides for documents containing 'history and physical reports' were submitted Monday to Ann Arbor, Mich.-based HL7. It is the first ballot in what is expected to be a series of interoperability specifications under a project called Clinical Document Architecture for Common Document Types, or CDA4CDT."
Standards development expert Liora Alschuler, the CDA4CDT project leader, said balloting is the least of the worries ahead.
"The first challenge is to get this adopted," Alschuler said. "We have high hopes that this will see relatively rapid, widespread adoption because it has a really minimal impact on workflow. ...
"So what does that do for humanity? If we look at building interoperability and patient-centered records, this is the largest single gain in interoperability that the industry could see," Alschuler said.
"Dictated medical notes and other types of transcribed patient records are usually available in electronic form, but have traditionally not been very useful in the context of an electronic medical record (EMR) system. Transcribed records follow a variety of formats depending on the clinical setting and type of transcription service used, making them difficult to search.
"There's no real structure to the narrative that's being inserted into the EMR," says Jay Cannon, president of the Medical Transcription Industry Association (MTIA), Chicago. "The information is visibly accessible, but within the system it's just a text blob."
...Now, a new standard, based on the Health Level Seven (HL7) Clinical Document Architecture (CDA), could help improve the utilization of these types of documents.
Jim Klein, executive vice president of product management and chief technology officer at QuadraMed Corp., describes how standard electronic documents in the form of HL7's Clinical Document Architecture (CDA) integrate electronic medical records with the electronic health record. He states that "Even in hospitals with advanced EMRs, 60 percent of a typical patient's medical record consists of narrative text, ..." and concludes that "Healthcare organizations should require medical transcription applications to produce HL7 CDA compliant documents ..." (At Alschuler Associates, we quite agree!)
Release Two (CDA R2), became an ANSI-approved HL7 Standard in
May 2005 and is the subject of this article, where the focus is
primarily on how the standard has evolved since CDA R1, particularly
in the area of semantic representation of clinical events. CDA is
a document markup standard that specifies the structure and semantics
of a clinical document (such as a discharge summary or progress note)
for the purpose of exchange.
This was our debut to the informatics community in 2000. We've just
had an article accepted on Release 2.0, look for that soon.
The Mt. Washington Vision was created in response to the
Brailer RFI
HL7 commissioned this survey under its EHR contract with the
National Library of Medicine (NLM). The objective was to identify
areas for leadership in standards development and tool development
that can accelerate adoption of exchange networks in the US.
