Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. LTPAC Interoperability Toolkit Details

12/01/2011

This section provides additional details on some of the LTPAC Interoperability Toolkit items, introduced above.

Implementation Guide for CDA Release 2 CDA Framework for Questionnaire Assessments (Universal Realm) and CDA Representation of the Minimum Data Set Questionnaire Assessment (US Realm)

The Implementation Guide for Questionnaire Assessments provides a framework for any patient questionnaire assessments to be represented in a CDA Release 2 format. The IG provides an example of how to represent questionnaire assessments in a CDA using the MDS as an example. The MDS CDA IG specifies a standard for electronic submission for CDA questionnaire assessments that allows health care facilities to communicate case reports in an interoperable, industry-standard format. The questionnaire assessments contain multiple questions with specific answers.

The MDS CDA IG defines both a required Model of Use representation (described below) and an optional Model of Meaning representation for each entry in the CDA Body. These models support both a faithful representation of the exact questions and answers on an assessment questionnaire and a semantically interoperable and re-usable representation that encodes their meaning. The EHR system may have data needed to determine the answer to a particular form's question.

MDS Conversion/Validation Utilities

These include various tools for transforming the MDS between CDA and CMS-expected format, validating that a MDS in CDA format is conformant, etc.

MDS CDA Narrative Generator

A CDA document contains a Header and a Body. The Header identifies and classifies the document and provides information on authentication, the encounter, the patient, and the involved providers, etc., while the Body contains the clinical report. For the MDS report, the Body is comprised of structured markup that is further divided into recursively nestable document sections. Each section can contain a single CDA narrative block and any number of CDA entries.

The CDA narrative block contains the human-readable content to be rendered, while the CDA entries contain coded data for machine computation. A proven approach is used to generate narrative block from CDA entries to reduce narrative errors introduced by human editing and maintain a consistent narrative style (i.e., the narrative is derived from the CDA-coded entries).

MDS CDA Rendering Style Sheet

The CDA narrative content is generally in XML format. A rendering style sheet is essential to transform the CDA-XML instance into a human-readable format that can be displayed in a web browser.

MDS CDA Validation Utility

Syntactically, a CDA document must be valid to the XML Schema Document. Semantically, it must be valid by conforming to all pertinent implementation constraints, including (but not limited to) vocabulary, data type, mandatory/optional, cardinality, and value constraints.

The CDA document must always be validated before transmission to a trading partner. The validation utility will be responsible for accurately and effectively performing batch CDA instance validations. A proven CDA validation technology is the Schematron-based CDA template.

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