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Improving the Quality of CDA Documents with Testing and Tooling

In keeping with Health Story Project’s goal of promoting the value of the patient’s story through the use of interoperable CDA documents, we were pleased to host Didi Davis of the Sequoia Project and Nagesh “Dragon” Bashyam, a senior consultant for the ONC, for our November 2016 Roundtable presentation. 

Our presenters described their respective organizations’ roles within the private and public sectors in advancing interoperability.  They also provided excellent demonstrations of available tools and services for assessing both the content quality and the technical quality of Consolidated CDA (C-CDA) documents.  These tools address a range of challenges involved in the exchange of clinical content.  Whether you are in need of a primer on CDA validation tools or in the process of selecting a tool for your organization, you will find valuable information in this presentation. 

Document Exchange Pain Points

Validation tools will play an important role, as we work toward a more interoperable health IT system. The sharing of accurate and pertinent health information is critical to improving patient care. Four significant pain points, listed below, can lead to inconsistencies in C-CDA documents and limit meaningful document exchange between disparate systems.

  • Optionality issues, such as the use of free text, how to handle missing information, and how to apply data ranges in care summaries
  • Terminology issues, resulting from greater than 1 million terms across 5 coding vocabularies and varying expressions of units of measure
  • Complexity issues involved in reconciling human-readable sections with machine-readable sections when the two conflict
  • Ambiguity of the specifications such as how much information to include and how far back to search for data to include in a summary of care document when there are multiple patient encounters

Without consistency within each of these areas, C-CDA documents may lack pertinent information, or may not seamlessly integrate into a destination system. Poor data quality can impact medical decision-making and efforts toward evidence-based medicine, all affecting the ability to provide quality patient care.

Sequoia Project and ONC Validation Solutions

Because of their ability to address these common pain points, C-CDA validation and scoring tools can be extremely valuable to improving the content of a patient’s health record.

Ms. Davis gave a live demonstration to show how the Sequoia project is using new validation and scoring tools to address the pain points.

DH Analyze, a tool created by Diameter Health, checks completeness (are expected sections present?) and syntax (has the correct structure and appropriate vocabulary been used?), and also includes rules for checking content accuracy related to patient safety, such as discrepancies in medication regimens, discordant interpretation of lab values, and incorrectly recorded values such as body mass index (BMI).

Gazelle, a tool created by IHE, combined with Art Decor (advanced requirement tooling, data elements, codes, OIDs, and rules) are used together to  validate a document and output an interactive report with errors described per document section, making it easier to identify and address problems with incoming CDA documents.

Mr. Bashyam explained ONC’s role in assisting organizations in the implementation of CDA documents, including the development of ONC’s open-source validation tools: SITE C-CDA Validator and the SITE C-CDA Scorecard. 

The SITE Validator provides the implementer community with the means to produce an extensive and detailed report of errors in their CDA documents. The Scorecard is currently available as a beta version and helps implementers understand whether the CDA documents they produce are meeting industry best practices. 

Pulse on the Industry: Current Status of C-CDA Validation Tools and Practices

A survey conducted during the Roundtable event about the use of CDA tools in the marketplace revealed some interesting insight into the varied implementation statuses and practices for validating CDA documents across organizations.  Of those attending the Roundtable, 90 participated in the poll with the results highlighted below:

The poll sparked follow-up conversation from the audience and among the presenters regarding the inconsistency of these practices throughout the industry. Such results highlight the need for standard methods of ensuring CDA document quality.

If your organization is in the process of implementing C-CDA or currently capable of exchanging documents based on C-CDA, we invite you to watch the recording of the webinar and learn how your organization can improve the quality of clinical documents and support the success of your clinical document exchange efforts.

Health Story Project’s presentations, recorded roundtable events, question-and-answer sessions, and blogs are excellent ways to connect with colleagues in order to share challenges and successes as we all tackle this vital goal of improving patient safety and realizing optimal patient outcomes. 

If you have a C-CDA implementation story you would like to share with the HIMSS community, we invite you to consider presenting at a future roundtable event. Share your C-CDA story with the Health Story Project today!

Keywords: 
CDA; interoperability; health IT; patient care