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.


  1. I fully agree, and I'd vote No if I had a vote - which I don't, for this is a US-realm only ballot.

    About 2 years ago RIMBAA (the v3 software implementers group within HL7) identified both 'template management' tools as well as 'code generation' tools as key enablers of CDA implementation. Software exists for both tool categories, you rightly identify the lack of a common template definition expression language as an issue - the current tools are in now way compatible with each other.

    Any CDA implementation guide should be shipped with some electronic expression of all of the templates contained therein, and HL7 should ensure that code generators exist for at least the Java and the .net platforms.

    IMHO schematron simply don't cut it, we should NOT spend any more time on the creation or generation of schematron to validate templates.

    1. All HL7 members can vote on this document. That's on of the "benefits" of not having a US Affiliate.

    2. Not true. Quote from the GOM:

      " US Realm-specific Review Group
      A Work Group may declare an informative document as US Realm-specific in that its function is to constrain an HL7 Protocol Specification (§02.02) for implementation in the United States of America (USA). The Work Group may request that the consensus group be restricted to those applicable to US Realm-specific documents; i.e. current individual members or representatives of current
      organizational members whose primary address or place of business is in the USA. The consensus group for US Realm-specific documents shall be managed by HL7 staff via the Ballot Desktop prior to
      release of the ballot material.

      A materially affected party who does not meet the criteria for participation may petition the TSC to join the consensus group. The request to participate in a US Realm-specific consensus group shall be sent to the Associate Executive Director and shall include the rationale justifying participation. The TSC decision on such requests shall be final."

      So if you are an affiliate member or an HL7 International member with a non-US address you can't vote without convincing the TSC you have some special reason. (And not liking a particular spec probably isn't going to be sufficient.)

    3. until now HL7 CHINA have published five document level IG,we have many section and entry level templates reused in these five IG,but the template workgroup is still using the word to organize these templates,we have discussed about the version managent about template,later on we may use a tool just like Art-Decor or MDHT for this purpose.

    4. To my knowledge, the workgroup HAS NOT requested this restriction. Furthermore, ANSI rules indicate that ANY affected party may vote, location isn't a restriction. So, I'm not sure that restriction works. If you have a non-US address, you should still be able to vote. I know many people with non-US addresses that develop software for the US. Should they not be able to vote? The precedent being set in CCDA R2 is something that impacts all HL7 members.

  2. Hmmm "AMERICAN National Standards Institute" .....: The American National Standards Institute is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States.

    1. Yup, and they happen to be an Accreditor of HL7 International and a number of other SDOs which develop International standards. History.

  3. 260 pages are for the detailed changed log so adamantly requested by some people, leaving 102 additional pages covering the 40 NEW templates and changed/additional conformance statements in existing templates. Since there are 2 volumes some of the additional pages account for duplicate things, such as, Cover pages and Table of Contents.

    In life, things naturally improve over time, but not if there is nothing to improve upon. Some people complain, and some people deliver.

    1. That's good to know. That means my estimate for a detailed review goes down from four weeks to three.

      With regard to your final point, if we cannot learn from our past failures, we are doomed to repeat them. I urge that we learn from them, and thus improve the quality our processes.

      I'm suggesting a very simple change, either pre-adopt the proposed changes for template versioning that you (I'm assuming I know you given tone and style of writing) and others having been working on, or wait for it to be delivered.

  4. Hi Keith ,

    Please let me which is OID in CCDA Saple