Group C HL7 France

1
Group C HL7 France

• Objective Definition of CDA implementation
  guides.
• 17 participants
• Public entities
• DHOS, GIP-CPS, GIP-GMSIH
• Primary care sector
• 7 participants.
• Hospital sector
• 4 participants
• Shared EHR, Exchange infrastructure providers
• 3 participants

2
 Volet Médical  Project

• Objectives
• Synthesis of essential patient data (allergies,
  drug treatments,).
• It represents a patient clinical synthesis
  relevant for any Healthcare Professional that
  will have to treat the patient independently of a
  specific care plan or a current care workflow.
• Hence in practice, the CDA-R2 Volet Médical
  will need to be associated with complementary
  information (maybe another CDA documents) to
  reflect exchange context (referral between a GP
  and a specialist, consultation report, pathology
  orientated baseline ).
• This project give a first practical field for
  HL7 France members to develop CDA know-how.
• Structured data exchange between Primary care
  applications for essential data
• References
• Formalism
• Electronic Medical Summary (e-MS) CDA
  Implementation Guide
• Care Record Summary (CRS HL7 US Realm)
• Medical
• Consensus made by HL7 France members

3
Sections (first proposal)

• French title LOINC code LOINC term Card
• Antécédents personnels 0..1
• Antécédents médicaux 11348-0 HISTORY OF
  PAST ILLNESS 0..1
• Antécédents chirurgicaux 10167-5 HISTORY
  OF SURGICAL PROCEDURES 0..1
• Antécédents obstétricaux 10149-6 PREGNANCY
  STATUS 0..1
• Autres antécédents 11329-0 HISTORY
  GENERAL 0..1
• Antécédents familiaux 10157-6 HISTORY OF FAMILY
  MEMBER DISEASES 0..1
• Allergies 10155-0 HISTORY OF ALLERGIES 0..1
• Allergies médicamenteuses 11382-9 MEDICATIO
  N ALLERGY 0..1
• Allergies alimentaires X-DTALRT DIETARY
  ALERTS 0..1
• Autres allergies X-ALERT GENERAL
  ALERTS 0..1
• Episodes de soins ouverts 0..1
• Pathologies associées 11450-5 PROBLEM
  LIST 0..1
• Traitements de fond ?? ?? 0..1

4
Sections (new proposal)

• French title LOINC code LOINC term
• Antécédents personnels ?? ??
• Antécédents médicaux 11348-0 HISTORY OF
  PAST ILLNESS
• Antécédents chirurgicaux 10167-5 HISTORY
  OF SURGICAL PROCEDURES
• Antécédents obstétricaux 10149-6 PREGNANCY
  STATUS
• Antécédents psychiatriques ?? ??
• Autres antécédents 11329-0 HISTORY
  GENERAL
• Antécédents familiaux 10157-6 HISTORY OF FAMILY
  MEMBER DISEASES
• Allergies et intolérances 10155-0 HISTORY OF
  ALLERGIES
• ? means that we have not find an equivalent
  Loinc Code for this section or we are not sure to
  have used the right one.
• Semantic interpretation does not depend of
  section hierarchy.

5
Sections (new proposal)

• French title LOINC code LOINC term
• Liste des problèmes 11450-5 PROBLEM LIST
• Trt. De fod médicamenteux 19009-0 MEDICATION.CUR
  RENT
• Autres Traitements de fond ?? ??
• Autres traitements 29554-3 PROCEDURE
• Autres données médicales ?? ??
• Données biométriques 8716-3 PHYSICAL
  FINDINGS
• Vaccinations 11369-6 HISTORY OF
  IMMUNIZATION
• Habitus 29762-2 SOCIAL HISTORY
• Décès ?? DEATH ?

6
CDA R2 Header

• Ongoing localization (Group C HL7 France)
• Vocabulary for document type
• LOINC codes or alternative French localization
  vocabulary ?
• LOINC codes may fit with pure clinical
  documents, but we will have to manage
  medico-administrative documents (related with
  the social insurance system) that are associated
  with a codification managed by French
  Administration (cerfa code).
• Identifier for Patients, Healthcare
  Professionals, Hospitals

7
CDA R2 Body

• Body
• Different hierarchy of sections than CRS ex
• CRS Procedures (History of surgical
  procedures)
• HL7 France Personal History / Surgical
  History
• Only leaf sections can have medical content
  (narrative part and/or entries)
• Other sections are only used to describe
  hierarchical structure of leaf sections
• Mixture of the Flat approach of section of e-MS
  structure and hierarchical description of the US
  CRS to enable an interpretation of the meaning of
  entries independently of the position of a
  section in the hierarchy. We anticipate that it
  could be difficult to define a medical summary
  order that will be accepted by all medical
  specialties and that significant sections of the
  Medical Summary may be reused in other document
  models.

8
CDA R2 Body

• Section codes LOINC codes are available for
  nearly all cases (need few extensions for ex.
• Active episode of care
• Personal history )
• Specification of CDA level 3 for each section
  (like e-MS canadian project)
• Improving significantly alerts and safety of care
  (interactions, contra-indications ).
• Anticipated need for fine confidentiality
  granularity control (e.g. voluntary termination
  of pregnancy will need different confidentiality
  level than diabetes in the personal history
  section.
• Supported by association of ambulatory care
  suppliers.

9
Narrative section only

• ltcomponentgt
• ltsectiongt
• ltcode code"11348-0" codeSystem"2.16.840.1.1138
  83.6.1"
• codeSystemName"LOINC" displayName"HISTORY OF
  PAST ILLNESS"/gt
• lttitlegtAntécédents médicauxlt/titlegt
• lttextgtLe patient a été sujet dans son enfance à
  de fortes crises dasthme et a une Méningite
  bactérienne en 1979 sans séquelles.
• lt/textgt
• lt/sectiongt
• lt/componentgt
• If a sending application that is not able to
  manage level 3 data for a section than only the
  narrative part should be used.
• Instances will be not extracted from the text by
  receiving systems.

10
Level 3

• ltentry typeCode"DRIV"gt
• ltobservation classCode"OBS" moodCode"EVN"gt
• ltcode nullFlavor"NA"/gt
• lttextgtAsthme lors de lenfancelt/textgt
• lteffectiveTimegt
• ltlow value"1950"/gt
• lthigh value"1955"/gt
• lt/effectiveTimegt
• ltvalue xsitype"ST"gtFortes crises.lt/valuegt
• lt/observationgt
• lt/entrygt
• Narrative part is fully derived from level 3.
• Structured Instances without codes.

11
Level 3

• ltentry typeCode"DRIV"gt
• ltobservation classCode"OBS" moodCode"EVN"gt
• ltcode code"H26.8" codeSystem"2.16.840.1.113883
  .6.5"
• codeSystemName"CISP"
• displayName"Méningite bactérienne, sans
  précision"gt
• lttranslation code"G00.9"
• codeSystem"2.16.840.1.113883.6.3"
• codeSystemName"ICD10"/gt
• lttranslation code"H00.10"
• codeSystem"2.16.840.1.113883.6.3"
• codeSystemName"ICD10"/gt lt/codegt
• lttextgtMéningitelt/textgt (if synonym used by HCP
  )
• lteffectiveTime value"1979"/gt
• ltvalue xsitype"ST"gtPas de séquelles.lt/valuegt
• lt/observationgt
• lt/entrygt
• Narrative part is fully derived from level 3.
• Structured Instances with codes