CDA-based Clinical Patient Summary Import/Export

Background

This project is to support OpenMRS’ ability to generate and exchange patient clinical summaries using the Clinical Document Architecture (CDA) model, an xml-based HL7 version 3 standard for clinical documents. (http://wiki.hl7.org/index.php?title=Product_CDA)

The project is an extension of current work in Western Kenya done in conjunction with CDC called OpenEMRConnect (OEC, https://sites.google.com/site/oeckenya/). OEC is open source software to connect Electronic Medical Records (EMR) systems with lab, pharmacy, household demographic surveillance (HDSS) and other systems to facilitate health care delivery and reporting at the local, regional and national levels. OEC is directed by I-TECH (in collaboration with Kenya MOH and CDC) and is based on a design and initial work by programmers with the UCSF Faces OpenMRS project. One aspect of OEC currently integrates CDA documents between the ICAP C-PAD EMR, which is not based on OpenMRS, and CDC’s HDSS. The next extensions are expected to integrate information from the ADT pharmacy system, and from OpenMRS.

This is a great opportunity for an individual to work with the CDA format and existing code libraries, as well as, make a direct impact on functionality that will be deployed over the coming year as part of a broad expansion of systems and services.

Objectives

1. Generate CDA based patient clinical summaries within OpenMRS
2. Receive CDA based patient clinical summaries from external sources (such as other OpenMRS implementations)

Extra Credit

• Display imported patient summary CDA’s within OpenMRS.

Project Plan

Milestone 1: CDA Generation and Export

1. Determine data elements to use from OMRS encounters/observations for clinical summary
2. Map OMRS data elements to CDA format
3. Use existing tools from OEC to generate CDA

Milestone 2: CDA Import

1. Map CDA import to OMRS db model
2. Insert CDA import data elements into OMRS
3. Display CDA import for patient (wish list)

Resources

OpenEMRConnect (https://sites.google.com/site/oeckenya/home)

https://sites.google.com/site/oeckenya/homeOpen Health Tools - Model-Driven Health Tools project - https://www.projects.openhealthtools.org/sf/projects/mdht/  The Model-Driven Health Tools (MDHT) Project focuses on the development and promotion of model-driven Health Information standards within the standards community by providing a unified set of modeling tools for standards organizations and standard implementers to design, publish, and implement standards such as Clinical Document Architecture all from a UML model.

The MDHT CDA Component supports the Full Life Cycle of Design, Publishing, Software Development, Validation and Verification needed to properly develop high quality, effective, and implementable HL7 Clinical Document Architecture (CDA) Implementation Guides.

MDHT CDA Tools - http://cdatools.org/
This web site contains demonstrations and other reference documents from the Open Health Tools (OHT) Model-Driven Health Tools (MDHT) project.
Documentation on creating, editing, and generating Java code from CDA models.
Example web application that validates CDA instances. Supports models defined in the above implementation guides. All validation rules are executed as Java and OCL code generated from the UML models.

Mirth CDAPI User Guide - http://www.mirthcorp.com/community/wiki/display/mr/cdapi+user+guide
CDAPI is a Java library that leverages MDHT to accomplish two things:
Populate an object model and convert it into a CDA document
Converts a CDA document to a populated object model
Note: Mirth CDAPI Java library is only available at the Platinum Support Service level (cost differs depending on organization type). From the Mirth Community forum, posted on 3/30/2011: "CDAPI isn't public at this time. It can be used as part of our early-adopters program. You can contact sales for more information."

Mirth CDAPI ONC Presentation - https://www.projects.openhealthtools.org/sf/projects/mdht/cda/presentations/20101029/ONC_Mirth.pdf

Mirth Results - http://www.mirthcorp.com/products/mirth-results
Mirth Results builds upon the success of Mirth Connect by leveraging the integration engine’s powerful message processing capabilities as the foundation for a new open source Clinical Data Repository (CDR). Mirth Results can collect, organize, and aggregate clinical data from many different sources. This clinical data is easily viewed and queried, and patient matching across these sources occurs seamlessly when coupled with Mirth Match. The types of clinical data that can be stored in Mirth Results currently include full patient demographics and clinical observations such as laboratory and imaging results. All accesses to clinical data are fully audited, and a user’s ability to view this data can be restricted to specific providers, source data streams, and/or delivery sites. Incoming data streams can be further transformed, filtered, and delivered to participating EMRs/EHRs to keep them synchronized with the CDR. Mirth Results supports flexible deployment patterns ranging from a single centralized instance to a more distributed, compartmentalized topology.