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Practice Fusion · Apr 11, 2014

Understanding the C-CDA Standard for Meaningful Use EHR certification

This blog post is part of a series that discuss the technology behind Meaningful Use, the Medicare and Medicaid EHR incentive program that provides financial incentives for the “meaningful use” of certified EHR technology to improve patient care. If you’re interested in joining our talented technology team, check out our Careers page.

2014 EHR Certification and Meaningful Use Stage 2 place a heavy emphasis on health information exchange in order to improve care coordination and patient health outcomes. One of the standards that the Office of the National Coordinator for Health IT (ONC) included in the regulations for 2014 EHR Certification was the Health Level Seven (HL7) Implementation Guide for CDA® Release 2: IHE Health Story Consolidation. The HL7 “consolidated” clinical document architecture (CDA) standard contains a library of CDA template standards and represents a single, unified implementation guide for multiple electronic clinical documents.

While the HL7 Consolidated CDA (C-CDA) standard presents a single implementation guide for nine of the most common CDA documents, Practice Fusion needed to do additional work to implement this standard and meet the 2014 EHR Certification and Meaningful Use requirements. Our team had to map and translate the original standard into electronic clinical documents that our providers and patients could use to exchange health information. But before this work could be completed, it was important to understand not only the requirements of the HL7 standard, but also the EHR Certification and Meaningful Use requirements, because neither on their own would be enough to certify successfully.

What is CDA?

The CDA in and of itself is very broad, because it is a base standard that provides a common architecture, coding, semantic framework, and markup language for the creation of electronic clinical documents. It can be used to communicate just about any kind of health information created in the context of patient care, as well as a range of administrative or patient population data.

CDA defines the structure of building blocks that can be used to contain a multitude of healthcare data elements that can be captured, stored, accessed, displayed and transmitted electronically for use and reuse in many formats. CDA documents are coded in Extensible Markup Language (XML), where HTML describes presentation, and XML describes content. CDA documents are templated, which means they use standardized groupings of information organized according to clinical context. They are also object oriented, which means the standard makes use of classes, associations, and inheritance, which allows tremendous flexibility and re-use.

CDA and Meaningful Use

Stage 2 of Meaningful Use emphasizes care coordination by requiring that health care providers use and exchange electronic clinical documents that contain certain data elements, depending on the clinical context and the core/menu measure criteria. The foundation of the Meaningful Use clinical documents is a combination of CDA “building blocks,” or sections, that are arranged to create a specific clinical document. Meaningful Use requirements add data element requirements, which can be layered on top of CDA document templates to achieve Meaningful Use compliance. No single consolidated CDA document template includes all of the data elements needed to satisfy Meaningful Use data requirements, so Practice Fusion had to decide which document templates to put together to allow providers to meet the core/menu criteria.

Practice Fusion used the “Continuity of Care” CDA document as the base for creating the clinical documents required for 2014 EHR Certification and Meaningful Use: the Clinical Summary and the Transition of Care/Referral Summary, both to be used in the ambulatory setting. Because both the Clinical Summary document and the Transition of Care/Referral Summary clinical documents began from the same CDA template, they contain similar CDA sections. However, these documents also contain unique sections that are required to fulfill certain EHR certification requirements. For example, while the HL7 Implementation Guide may list the section as optional, for the purposes of EHR certification, it could be required. The table below shows which document types were used to fulfill EHR Certification requirements and how they can be used by providers to meet associated Meaningful Use core and menu measure criteria.

The next blog post in this series outlines how we approached mapping and building clinical documents formatted according to the C-CDA standard