Coming together is a beginning; keeping together is progress; and working together is success.  – Henry Ford

Since the launch of the Stage 2 Certification program, ONC has been actively listening to the buzz among implementers as EHR vendors strive to update their systems to conform to the Consolidated Clinical Document Architecture (Consolidated CDA) standard in order to meet the transition of care objective.

The ability of EHR systems to generate and use the Consolidated CDA standard is critical in supporting seamless electronic exchange of health information among various health care providers, helping to reduce medical errors and the overall costs of healthcare.

The Standards and Interoperability Framework has provided a great platform for the standards community to come together and agree on standards before taking them to the HL7 Standards Organization for balloting. However, up to this point, there has been no centralized venue for implementers to participate directly in this activity.

Typically, implementers get involved much later in the standards cycle, during the implementation phase, when they have to convert the standard into software code!

The standards community recognizes the challenges implementers face

To its credit, the standards community is not only aware of this problem, but has tried to address it through blog postings, providing clarifications via Errata Documents and answering specific implementation questions on email groups.

But it takes significant time for implementers to collate all the relevant information to ask the right questions, and when responses are provided via emails, they are not easily accessible to other developers that may be having same issue. There is often more than one response to a question, and the implementer must then choose which one to pick, often with little practical experience.

As a result, despite using the same standard, this often means these implementations are not interoperable, requiring costly workarounds. And it generally slows the uptake of the standard in the industry.

A Solution: the Standards Implementation and Testing Platform

Knowing this lack of implementation support was a challenge for the industry, the HL7 Structured Document Working Group established the Consolidated CDA task force in January 2013 to address the issue. The Consolidated CDA task force met over two months, and came up with the final report that was approved by the HL7 Structured Document Working Group.

ONC was actively monitoring the important effort by the Consolidated CDA task force, and on April 4, 2013, announced the launch of the Standards Implementation and Testing Platform.

The SIT Platform supports many of the recommendations made in the Consolidated CDA task force report, including:

1. An Issue Tracker to formalize, triage, route, and track issues related to Consolidated CDA. ONC technical staff will bring standard related issues to the HL7 Structured Documents Working Group to get them resolved quickly and make the solutions available to everyone via SIT Platform.
2. A moderated discussion Forum to facilitate dialogue between those seeking answers to questions about standards. Implementers can post questions, experts in the standards community can respond to questions, and moderators monitor the forum to help assure that questions are addressed in a timely fashion.
3. A Knowledge Base to aggregate information important to implementers, including reference materials and topic-specific Frequently Asked Questions. It will serve as a starting point for software developers to support their efforts to develop systems that utilize the Consolidated CDA.
4. A public Sample Data Repository where implementers can find samples of Consolidated CDA data contributed by community.

I am excited about the progress we’ve made to support implementers, but my team and I know there is still much work to be done to encourage broad implementation support and standards uptake.

We hope that the SIT Platform provides a useful tool to the implementers and the standards community to engage even more closely with each other, in support of our overall goal of establishing high quality standards that are ready for implementation!

Please share your feedback with us

I would greatly appreciate your feedback on our approach to supporting health information technology standards implementation. Please feel free to participate in this new community endeavor, share this new resource broadly, and share your thoughts below. We hope you will find it useful.