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Friday, August 7, 2015

Moving forward from CCDA 1.1 to C-CDA 2.1

I just finished cleaning up the C-CDA 2.0 samples and reworking them for C-CDA 2.1.  As a result, I have a few notes already on what it takes to move up from 1.1 to 2.1 for those of you looking to plan ahead.

For any changed templates (there will be a list in C-CDA 2.1), you'll need to add the C-CDA 2.1 template identifier to your existing 1.1 template.

For problems, you'll need to add the LOINC equivalents in code/translation, as shown below.

<code code="64572001" displayName="Condition" codeSystemName="SNOMED CT" codeSystem="2.16.840.1.113883.6.96">
    <translation code="75323-6" displayName="Condition" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1"/>
</code>

<code code="409586006" displayName="Complaint" codeSystemName="SNOMED CT" codeSystem="2.16.840.1.113883.6.96">
    <translation code="75322-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Complaint"/>
</code>

For the vital signs organizer, you'll need to do something very similar.

<code code="46680005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Vital signs">
    <translation code="74728-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Vital signs"/>
</code>

And also for Cognitive Function.

<code code="2264892003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Number of pressure ulcers">
    <translation code="75277-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Number of pressure ulcers"/>
</code>

And Pressure Ulcers.
<code code='373930000' displayName="Cognitive function" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
    <translation code="75275-8" displayName="Cognitive function" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
</code>

And a few places where ASSERTION shows up.
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4">
    <translation code="75321-0" displayName="Finding" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
</code>

You may yet find a few others, these were simply the ones that went on my electronic scratch pad as I did various edits to correct the samples.  This kind of stuff will take longer for an engineer to work out than it will to implement, probably on the order of 10:1.  So call it two weeks to design the changes, and then a day to implement them.  There's more to 2.1 than making it easy to move up a version, the main point was to retain compatibility with what's already in the field.  However, there's also some new stuff (like the Care Plan document), which will be incredibly valuable.

   Keith

P.S.  NOTE: While this post is tagged Stage 3 we have NO GUARANTEES that CCDA 2.1 will be named for Stage 3.  However, given how hard everyone has worked to make this happen, I am quite hopeful.

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