Improving Physician EHR Use Key to HL7/ONC C-CDA Challenge

By Kyle Murphy, PhD

– A new challenge co-sponsored by Health Level Seven (HL7) and the Office of the National Coordinator for Health Information Technology (ONC) looks to improve physician EHR use and avoid information overload.

Physician EHR use at center of new health IT challenge

The C-CDA Rendering Tool Challenge runs through May 31 and will award $20,000 total in prizes to two winners — $15,000 to first place, $5,000 to second.

“Currently, many clinicians are frustrated with the usability of C-CDA documents because an overabundance of data is rendered by the EHR system based pm C-CDA documents that are being sent/received,” the contest page states. “The providers then have to page and sort through all of the data to find the essential and relevant clinical information that triggered the clinical event for which the C-CDA document was created.”

The non-profit organization and federal agency place the blame for this information overload squarely on the shoulders on EHR vendors which “for numerous and admirable reasons, typically render more information than clinicians want, sometimes including the patient’s entire medical history.”

The solution according to HL7 and ONC is a viewer:

C-CDA Rendering Tool Challenge participants will develop a viewer that enables clinicians to effectively review the patient data from C-CDA documents that is most clinically relevant to them.  The viewer must be capable of rendering the data as specified by the user and allow them to quickly review the current health and needs of a patient.  The viewer should provide functionality to allow a clinician to view the data so they can quickly assess the status and state of the patient efficiently. The viewer needs to be easy to use and present requested data quickly and clearly, whether through section-based view preferences (ordering), filter functions, intelligent sorting, or some other functionality.

As the title of the challenge makes explicit, the impetus behind it is getting the most out of a standard promoted and widely adopted as a result of the EHR Incentive Programs and meaningful use requirements — the Consolidated Clinical Document Architecture (C-CDA).

The co-sponsors have laid out five guidelines as well as requirements for the winning solutions to be open source and certified:

• There must be a deterministic way for a recipient of an arbitrary C-CDA document to render the attested content.

• If the C-CDA document has a title it must be rendered.

•  If the C-CDA Body is structured, the label of a section, as conveyed in the Section.title component, must be rendered. The absence of the Section.title component signifies an unlabeled section.

•  When structured content is derived from narrative, there must be a mechanism to describe the process (e.g. by author, by human coder, by natural language processing algorithm, by specific software) by which machine-processable portions were derived from a block of narrative.

• When narrative is derived from structured content, there must be a mechanism to identify the process by which narrative was generated from structured data.

The challenge of the C-CDA

As far as health IT standards are concerned, C-CDA remains in vogue. Its persistence over the last few years is the result of federal officials making the decision to move forward with the CDA over its former rival the Continuity of Care Record (CCR).

The narrowing of standards and constraining of health IT standards and specifications saw Stage 1 Meaningful Use support both the CCR and CCD, but subsequent stages have only allowed for the C-CDA.

That decision was intended to limit variation and support advancing interoperability, an outcome that has yet to be realized.

“The consolidated CDA is a much more complex tool. CCR was simple and maybe limited in some ways, but there are less mistakes to make. Now, everyone has their own variation. It is a new challenge,” Drummond Group’s Director of EHR Testing Kyle Meadors told HealthITInteroperability.com less than a year ago.

According to Meadors, C-CDA was itself a sort of Pandora’s box.

“The C-CDA, as great as it was, had so much stuff in it,” Meadors continued. “You see the comments about making C-CDAs more viable, consistent. As much as we’re working on the transport side of things, getting information collected well in the EHR, putting in the bucket so to speak, enables the C-CDAs to be easily consumed and reconciled — we need emphasis there.”

For its part, HL7 admitted that its deliberate approach with Fast Healthcare Interoperability Resources (FHIR), the emergent health IT standard, stems from the experiences of operationalizing C-CDA.

“The first round of consolidated CDA was such an example. We rushed to a very prescriptive and detailed their own devices, the industry had to do what it could to manage to still define constraint,” HL7 CEO Charles Jaffe, MD, PhD, said in early April.

As the C-CDA continues to advance (especially in a post-meaningful use era), its usability among end-users (i.e., clinicians) will be critical to its continued existence.


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