Wednesday, June 01, 2016

#ONC2016 Collaboration and Standards for Real Worlds Adoption

More from the ONC Annual Meeting:

Promoting Community Collaboration through Real World Standards Adoption and Implementation (Room 208A/B)

This session will show how ONC is closing the gap between standards development and implementation through a cooperative agreement with HL7. Attendees will see how the ONC-HL7 partnership is improving C-CDA implementation consistency for health IT developers by clarifying ambiguities and developing implementation best practices. Learn how interoperability issues are being addressed through collaborative working sessions using C-CDA documents. This session will also discuss national standards being tested to enable interoperable care plans and the increased support for the concept of a longitudinal person-centered care plan that includes the multi-disciplinary team as a vehicle for resolving communication issues and achieving highly coordinated care.

  • Matthew Rahn, Office of Standards and Technology (OST), ONC
  • Calvin Beebe, Technical Specialist, Mayo Clinic
  • Nagesh “Dragon” Bashyam, ONC
  • Thomas Check, President and CEO, Healthix, Inc.

Intro – Matthew Rahn

ONC has a cooperative agreement with HL7

FHIR as a path to future interoperability

HL7 Cooperative Agreement

direct engagement to advance technical standards and nationwide interoperability goals.

Scope: Consolidated Clinical Document Architecture (C-CDA)
and Fast Healthcare Interoperability Resource FHIR specification.

CDA / C-CDA – Calvin Beebe

CDA is base standard for electronic clinical documents

C-CDA is a consolidation of templates for CDA.

Release 2.1 for US Realm.

Implementation Guide.

2.1 is a balloted Draft.

A complex 1,000 page specification.

Deliverables from Agreement:
1. C-CDA Survey and implementation-a-thons
2. C-CDA Findings and recommendaitons
3. Example Taskforce
4. Publish C-CDA 2.1 Companion Guide (making available pre-ballot)
5. C-CDA Rendering tool Challenge (Better rendering of large C-CDA documents)
6. Implementation of FHIR
7. C-CDA “SITE” Scorecard
8. Other C-CDA and FHIR Work planned.

C-CDA Survey was to identify adoption rate.
Almost half of people surveyed plan to adopt R2.1

SMART C-CDA scorecard tool was not known by many people. There is an updated version for R2.1 and it tests the usability/conformance of C-CDA documents.

Implementation-a-thon is designed to engage Industry Vendors to encourage creation and sharing of C-CDA documents.
Test understanding, terminology and interpretation and vocabulary.

Findings from IAT #2:

-Devices should always be noted in Medical Equipment Section.
– Devices may be noted in procedures section
– Issues related to Birth sex and administrative gender modeling were identified.

The Care Plan template specifically precludes the Plan of Treatment information.

C-CDA Example Task Force

  • Pushing for real examples of XML documents.

39 Samples for C-CDA R1.1
13 Samples for C-CDA R2.1 (Working on many more)

The R.2.1 Companion Guide is in draft and is available in the Companion Guide Project at

C-CDA Rendering Tool Challenge

The contest is now closed. The winner will be announced at the Baltimore Working Group meeting in September, 2016.

Develop a better way to view documents.
Make it open source
Make it available to the industry.


Issues derive from:
– Ambiguities in the specs
– Interpretation issues
– Lack of Best Practice
– Errors generated by the certifications (Meet the spec and not convey the underlying data)

Smart Scorecard Demo – Dragon

SITE – Standards Implementation and Testing Environment

  • C-CDA Sandbox
  • Direct Transport Sandbox
  • Provider Directory
  • Clinical Quality Measures
  • Public Health Reporting
  • Laboratory Standards
  • Electronic Prescribing
  • SOAP Transport

C-CDA Scorecard: Certification Score + Grade Score.

Certification is pass or fail.

Grade assesses performance against real world documents.

API to post document. This enables evaluation to be embedded in to a development workflow.

Relevant & Pertinent Project


Mapping to / from FHIR. Work in progress.

Set of profiles for entry templates for DAF.

C-CDA Care Plan Document is part of the ONC 2015 Standard.

Designed to enable Longitudinal Care Planning.

Healthix – NY Care Plan Collaborative

Pilot implementation of Care Plan as CDA doc in Downstate NY.

Part of 5-year Delivery System reform for Medicaid Beneficiaries.
Focused on on complex care needs.

Coordinate across multiple care team members.

14 Performing Provider Systems (PPS) manage 3.5M beneficiaries.
Beneficiaries span multiple PPS.

4 regional HIEs

6 PPS in pilot to create care plans with common content and test workflow and governance.

Phase II – Will use Healthix HIE to receive Care Plans from 3PPSs and present via portal to community providers. Clinical Assessments from providers will be returned to care managers as CDA documents.

Some PPS have delegated Care Management to Providers.

Will patients views be incorporated in to Care Plans?

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