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The HL7 roadmap for CDA R3 and the CCD

Publication date: Jan 17, 2009

The HL7 Structured Document WG finalized their roadmap for the creation of a new release of the CDA specification (CDA R3) and the creation of a universally applicable CCD implementation guide.

The Structured Documents group within HL7 has created a number of standards for electronic documents - notable CDA (the Clinical Document Architecture), and the CCD, a US-specific implementation guide based on the CDA. The current release of CDA is release 2 (CDA R2), published in 2004. The Structured Documents WG has the aim to publish a new release of the CDA standard every 5 years - so it has started gathering requirements for CDA R3, which will be balloted later this year.

The roadmap for the development of the next releases of the various specifications is shown in the following figure:

Roadmap for the development of CDA R3 and CCD R2

Currently HL7 is creating the Structured Documents Architecture (SDA), a specification for all kinds of structured documents (not just those with a focus on clinical content such as the CDA specification). The SDA is basically a superset of CDA R2 and the US-specific SPL (Systematized Product Labelling) specification. SPL is an example of a structured document that doesn't have a patient-oriented medical focus.

The next step will be the development of CDA R3. CDA R3 will be based on the experiences gained with the implementations of CDA R2. For the next couple of months the Structured Documents WG will focus on requirements gathering for R3. In parallel to the development of CDA R3 (although not shown that way in the diagram) the work on a universal CCD specification will start. The current CCD (Continuity of Care Document) specification is applicable in the US only (it contains some US specific requirements). The new CCD implementation guide will be universally applicable; with a derived/constrained version for use in the US. CCD R2 is developed in parallel to CDA R3 because requirements in the one specification may impact the other specification.

See the video below in which Liora Alschuler, of Alschulerassociates, and a co-chair of the Structured Documents WG, discusses the above roadmap.

Liora raises a key issue: in future CDA implementation guides will be based on templates. Templates are pre-defined structures to express the structure of a particular element of clinical data (e.g. blood pressure, body weight), the structure of a textual section in a CDA document, or the structure of the CDA header. An implementation guide can be defined as a list of such templates. How those templates will be balloted and published isn't clear yet at this point in time - it is however certain they'll play a major role. The current implementation guides (whether created by HL7, by IHE, or by other organizations) will be reviewed, and templates will be extracted from them and stored in a central template repository.

CDA is probably the HL7 version 3 standard that has been implemented most often - it is therefore to be applauded that work has started on CDA R3, as well as on the new universal CCD R2 implementation guide.


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