Delaware’s Journey

STATE CDA PILOT PROJECTS

1. Two Projects Not One2. What is CDA3. Template Development4. Execution5. Conclusion

STATE CDA PILOT PROJECTS

• Template Development Project• Execute Data Exchange Project

TWO PROJECTS NOT ONE

• Project Teams Make-Up– Project Executive Team– State Pilot Team• State Personnel• Vendors

– Template Team• Modelers

TWO PROJECTS NOT ONE

• Delaware was unique– There were participants on both Template

Development and the State Pilot teams– Other participating jurisdictions only had

representation on the state pilot team• As a dual participant there were approximately

12 additional hours of conference calls added to our calendars each month

TWO PROJECTS NOT ONE

• CDA(Clinical Document Architecture) by definition isWHAT IS CDA?

an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange. (fancy webpage)

Author

Raw CDA XML

Author Rendered CDA

• Reportable Conditions – Determine reportable conditions – Who are they reportable to?• Reportable to the State Health Offices• Reportable to the CDC• Reportable to both• Do you share this data with other states?

TEMPLATE DEVELOPMENT

– Similarities• Naming conventions• Formats• Medication

recommendations• Treatment

recommendations• Demographics

Gather reportable condition forms from multiple sourcesLA-County, New York City, Massachusetts ,Michigan

TEMPLATE DEVELOPMENT

– Differences• Naming conventions• Formats• Medication

recommendations• Treatment

recommendations• Demographics

• Implementation guidelines– If published guidelines exists then you can

follow the guidelines– If there are no published guidelines then you

have to look at developing vocabulary and submitting to PHIN VADS(PHIN Vocabulary Access & Distribution System)

TEMPLATE DEVELOPMENT

• What is MDHT– MDHT is a JAVA based application, built on the

open source application Eclipse maintained by The Eclipse Foundation

• Who do you need?– CDA Expert• Templates / Constraints• Background

– Understand both business and technical sides of project – Does not need to be technical but it helps

• There is technical language that may get mixed in

LEARNING MODEL DRIVEN HEALTH TOOL(MDHT)

Place Holder for MDHT screenshot

MDHT Screen Shot

MDHT was the most time consuming part of the project

– Learn a new tool– Technical issues• Network issues• Firewalls• Permission issues

– Time constraints– Competing priorities

LEARNING MODEL DRIVEN HEALTH TOOL(MDHT)

• Learning a new tool– Different than other development tools– Even with a technical background the

learning curve proved difficult at times because there were a lot of manual steps that could have been automated.

LEARNING MODEL DRIVEN HEALTH TOOL(MDHT)

• Weekly conference calls• Conference calls 2x a week• Extra Conference calls a week when

needed

Modeling DONE

NEAR THE END OF MODELING

• State Pilot Project Team– Business Analysts • EMR, DERSS (NEDDS based system), and DPHL(Lab)

– Vendors• Core Solutions, Labware, Orion Systems

EXECUTE THE MODEL

• Delaware’s initial CDA execution planEXECUTE THE MODEL

EMR/EHR

EMR DERSSDHIN

Lab Instruments

Lab RequestCD

A La

b Re

sult

Set

CDA Lab Result Set

Lab Request

Rhapsody

LIMS Lab Result

Lab

Requ

est

• Delaware’s actual CDA execution planEXECUTE THE MODEL

EMR/EHR

DERSS

DHINCDA Result Set

Rhapsody

CDA Result Set

• Why change the execution plan?

– Time• Vendor Business Model was not flexible enough to

dynamically deliver resources in 30 days or less• LIMS vendor could not perform the work needed in

the required time frame

EXECUTE THE MODEL

• Resource intensive project– States participating at all levels will need

additional resources– Template development is time consuming

and public private partnership is worth considering

– Forces you to think about your entire data sharing model

– Opens up new opportunities for collaboration– Allows you to better plan your funding for

data integration

CONCLUSION

Pilot Participants– Marcy Parykaza, Delaware– Jean Collison, Delaware– Patricia Burke, Delaware– Barry Borden, Delaware– Andrew Rentschler, Delaware– Kendall Patterson, Delaware– Core Solutions(EMR Vendor)

Template Team– Anna Orlova, PHDSC– Maiko Minami, PHDSC– Alla Fridman, PHDSC– Lisa Nelson, PHDSC– Sarah Quaynor, PHDSC– Kendall Patterson, Delaware– Sondra Renly, IBM Research– Lori Reed-Fourquet, eHealthSign– Nikolay Lipskiy, CDC

PARTICIPANTS