Introducing the SMART C-CDA Scorecard

The SMART team is proud to introduce the C-CDA Scorecard, a web-based tool to help vendors, providers and other health data holders produce high-quality clinical summaries for Meaningful Use Stage 2.

Get ready for Meaningful Use Stage 2

Consolidated Clinical Document Architecture (C-CDA) is the specification cited by Meaningful Use Stage 2 for creating structured clinical summary documents. C-CDA documents are required by MU2 to support transitions of care, to enable patient-driven “view/download/transmit” objectives, and to promote medical record data portability.

The SMART team is excited that there is a single clinical summary standard poised for broad vendor and provider adoption in MU2. And because we believe in the power of structured, computable data, we want to help data holders generate the highest-quality C-CDA documents possible.

Clinical Documents have “quality”?

Yes! A high-quality document expresses structured data clearly and consistently. Standards like the Clinical Document Architecture (CDA) provide a rich language for expressing clinical data. With the CDA standard, it is possible to create documents with highly structured data components as well as loosely structured ones. Highly structured components enable individual pieces of data to be tagged with meaning so that they are ready for other software to interpret them correctly. Loosely structured components, on the other hand, communicate information expressly intended for human beings, and as such, they cannot be interpreted without human assistance.

The SMART team believes that key clinical data—medication and problem lists, lab results, allergies, vital signs, and many patient demographics—need to be expressed in a highly structured way to fuel structured data import, modularize clinical decision support systems, and foster an ecosystem of substitutable medical apps. Critically, to support the use cases envisioned in MU2, the highly structured data needs to be consistent across vendors.

Consistency means following best practices

We have found that achieving interoperability with Consolidated CDA documents requires more than just implementing HL7’s C-CDA 1.1 specification. Interoperability means agreeing upon “best practices” above and beyond the base specification and implementing them. (HL7 members can view 1.1 here. HL7 has committed to making it free to the public by April 2013.)

Where do best practices come from?  They emerge from the experience of the vendor and application developer community. As such, they are often “discovered” in:

  • Blog posts and comments – such as Keith Boone’s Motorcycle Guy or Grahame Grieve’s Health Intersections
  • Q&A on mailing lists – such as the HL7 SDWG mailing list
  • Implementation guides derived from specific use cases – such as the Transitions of Care Initiative’s C-CDA Companion guide, which describes how C-CDA can be used to support MU2 objectives.

But it is difficult for implementers to keep up with multiple, fragmented sources of truth. Crucially, “best practices” are not required for NIST’s certification process: only conformance to the base specification is required.

SMART’s C-CDA Scorecard can help

The SMART C-CDA Scorecard promotes best practices in C-CDA implementation by assessing specific elements of the structured data found in individual C-CDA documents. The tool helps implementers assess how well and how often C-CDA best practices are followed individual C-CDA documents. The Scorecard identifies and tabulates exceptions, providing both a quantitative assessment of the document and a qualitative list of the exceptions to best practice, highlighting the  improvements that can be made today.

C-CDA Scorecard fills gaps and complements official validation tools

The SMART C-CDA Scorecard runs alongside official C-CDA validation tools like the NIST Transport Testing Tool and Model-Driven Health Tools. The official validation tools provide comprehensive assessment of syntactic conformance of C-CDA documents to the C-CDA specification but do not provide visibility into document conformance to best practices in C-CDA implementation. The SMART C-CDA Scorecard fills in these gaps, providing visibility into those constraints missing from either the official specifications or from the official validation tools. Our initial focus is on value set membership for three key vocabularies used in C-CDA: LOINC, RxNorm, SNOMED CT.

For more information and to learn how you can contribute, check out the C-CDA Scorecard online.