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Wednesday, September 4, 2013

CCDA Release 2.0 Out for Ballot

I'm getting ready to start reviewing the HL7 Consolidated CDA Release 2.0 specification that updates CCDA Release 1.1 presently used for Meaningful Use.  If you haven't already signed up to vote on this ballot, you have until September 9th to do so, and I would advise that you do so.

There are two main documents.  The introductory material is about 50 pages long and is in the first document.  The templates make up the second document which is now some 930 pages long (CCDA Release 1.1 was some 530 pages in length.)  To put this into context, if you spend 1 minute on each page, you will spend nearly 16 hours, or two days on the entire content.  If you spend 10 minutes a page, you would need 20 days, or four work-weeks to review it thoroughly.

I already known I'm voting negative, and that is because 63 templates now have new identifiers just because: "Updated to reference a contained template that has versioned."

  • Every existing document template ID has changed.
  • Clearly more than half of the sections have changed, and probably closer to 80% of them have.
  • Of the 110 entry templates, only 29 are unchanged.
  • And every changed template has a new identifier.

This is a mess on so many levels.  First and foremost, HL7 needs, and is working towards, a mechanism to version templates that means that we won't have to go through this exercise again.  If you agree with me, Vote Negative and simply cite my ballot comments, or write your own if you'd like.

I've been promised that the new tools will help track all those changes, but frankly, until the data is made available in an exchange formalism for the templates (which it is not), and until there are tools that can automatically generate the code from that data (which there is not, but would be once the exchange formalism was there), there's no AMOUNT of PDF or electronic text that will help my engineers avoid the pain they just went through getting to CCDA Release 1.1.  It's time to stop using DIGITAL PAPER as our mechanism to update our standards and our software.

We need to work towards a sustainable mechanism to support changing the template specifications.  We cannot afford to spend the time it took to get from CCD to CCDA again in our industry.  The templates may be good, but the mechanism by which HL7 supports the industry in adopting updated versions needs to be in place before we create another 500 pages of text to review.

Ideally, we'd also have a mechanism by which templates can be reviewed and updated individually or in smaller batches, and by which developers can access and use the content in smaller pieces.  This content is already exceeding the capacity of the software used to deliver it (as anyone with experience editing a 500 page word document can attest).  But I'll save that battle for another day.  First and foremost, I want to avoid a repeat of the painful exercise we all just finished.