HL7 SDWG Completes Review of CDA R3 Formal Proposals

The final formal proposal for changes to the HL7 Clinical Document Architecture standard was reviewed today. The HL7 Structured Documents Work Group (SDWG) has been reviewing formal proposals for the next release of CDA for over a year. CDA R2 is the standard that is used for most of the exchange of clinical information in the Meaningful Use requirements that were published in the Federal Register this week.

I am the publishing facilitator for the SDWG, so this means that I get to work on creating the new version of the standard. I worked on CDA R2 back when I was working for HL7, converting the word document into "publishing XML." The new version of the standard will be developed using the HL7 Publishing database. I have not used the publishing db in several years, so it will be interesting to see how the tool has changed over the years.

The enhancements in CDA R3 are based on the experience of implementers. CDA will also use HL7 Version 3 Datatypes Release 2, which will give us new functionality.

Here is a link to the list of suggested enhancements for CDA R3:

http://wiki.hl7.org/index.php?title=CDA_Suggested_Enhancements

I'll post updates as we work through the process. I expect that we will ballot the new document early next year, and, hopefully, CDA R3 will become an approved standard sometime in 2011.

Meaningful Use Final Rule

The Final Rule for Meaningful Use was published today.

I haven't finished reading the 1000 pages, yet, so here are my preliminary impressions.

The document is available here..

http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

They relaxed a couple of requirements, with thresholds being reduced from 80% to 50%. I don't see this as significant, because if your organization is really committed to meeting the requirements, you will be well over 80%. If you are committed to CPOE, you will be at well over 80%. If reducing the limit means that a few more organizations qualify for MU funds, that's fine with me.

They also removed the requirement for either SOAP or REST to be used as a transport protocol, which means that those organizations that use MLLP through encrypted tunnels will not have to re-do those interfaces.

I am still a little troubled by the requirement to use CCR and CCD, but since that means that my organization can produce CCD and the other CDA based documents, we should be fine. We will have to be able to consume CCR, but that is not as onerous as it might be. HL7 and ASTM are beginning a project to translate from CCR to CCD, so that should help organizations that do not want to have to support both.

It could have been better. It could have been worse.