CDA Quick Start Guide (v1.5)   DOWNLOAD

A Quick Start Guide for implementers working with simple CDA documents. This guide covers requirements in the CDA header and body and explains fundamental concepts, e.g., the approach to identifiers, vocabulary, and data types.

Trifolia 4.0.0 Release Notes     View Notes

This is the second major open source release of Trifolia. The update simplifies the installation process for users who wish to install Trifolia on their own systems, and improves support for the latest release of FHIR. It also includes an upgrade so that users in China can log in without using Google Captcha . Finally, it allows users to import data from other Trifolia installations, making it easier to share data between instances of Trifolia.

FHIR CDA Position Statement and Roadmap View Position Statement (Updated April, 2015)            View Original Position Statement

This position statement addresses the relationship between HL7’s Clinical Document Architecture (CDA) product line and the Fast Health Interoperability Resource (FHIR) product line. It was prepared jointly by Lantana Consulting Group—a recognized leader in the CDA community—and Grahame Grieve, Health Intersections, the FHIR project lead. This statement is not official policy. It is our hope that it will stimulate discussion and possibly guide policy makers, architects, and implementers as well as standards developers. The  statement was updated on April 10, 2015 to report on progress made since the original position statement.

Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization, JAMIA January 2015 View Article

Authors: Jeremy L. Warner, Suzanne E. Maddux, Kevin S. Hughes, John C. Krauss, Peter Paul Yu, Lawrence N. Shulman, Deborah K. Mayer, Mike Hogarth , Mark Shafarman , Allison Stover Fiscalini, Laura Esserman, Liora Alschuler , George Augustine Koromia, Zabrina Gonzaga, Edward P. Ambinder

The objective of this article was to develop and evaluate a foundational oncology-specific standard for the communication and coordination of care throughout the cancer journey, with early-stage breast cancer as the use case. The team developed an implementation guide in congruence with C-CDA which was balloted through the HL7 process and implemented by the Health Story Project and Athena Breast Health Network. The HL7 Implementation Guide for CDA, Release 2: Clinical Oncology Treatment Plan and Summary, DSTU Release 1 (eCOTPS) was successfully balloted and published as a Draft Standard for Trial Use (DSTU) in October 2013.

Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative View Article

Upgrades to electronic health record (EHR) systems scheduled to be introduced in the USA in 2014 will advance document interoperability between care providers. Specifically, the second stage of the federal incentive program for EHR adoption, known as Meaningful Use, requires use of the Consolidated Clinical Document Architecture (C-CDA) for document exchange. In an effort to examine and improve C-CDA based exchange, the SMART (Substitutable Medical Applications and Reusable Technology) C-CDA Collaborative brought together a group of certified EHR and other health information technology vendors to examine the machine-readable content of collected samples for semantic correctness and consistency. This article outlines the finding.

SMART Platforms Project is an ONC-funded research project at Harvard Medical School/Boston Children’s Hospital. SMART and Lantana Consulting Group collaborated with EMR/HIE vendors to perform a detailed review of vendors’ Meaningful Use Stage 2 Consolidated-CDA documents. More at “C-CDA Endoscopy, or Improving Clinical Document Exchange” by David Kreda and Joshua Mandel  view article

In 2014, the industry will see wide-scale production and exchange of Consolidated CDA documents among healthcare providers. Indeed, live production of C-CDAs is already underway for anyone using a Meaningful Use 2014 certified EHR. C-CDA documents fuel several aspects of meaningful use, including transitions of care and patient-facing download and transmission.

SMART Platforms Project is an ONC-funded research project at Harvard Medical School/Boston Children’s Hospital. SMART and Lantana Consulting Group collaborated with EMR/HIE vendors to perform a detailed review of vendors’ Meaningful Use Stage 2 Consolidated-CDA documents. More at

Setting the Standard: EHR Quality Reporting Rises in Prominence Due to Meaningful Use view article

In this article, published in the January 2014 Journal of AHIMA, thought leaders from Lantana Consulting Group and HHS’s Centers for Medicaid & Medicare (CMS) discuss the industry mandate to measure the quality of care provided to patients. The ability to measure healthcare relies upon standard data and data formats for electronic health records (EHRs) under the “Meaningful Use” EHR Incentive Program.

2013 WEDI Report View Report 

Lantana President & CEO, Liora Alschuler contributed to the 2013 WEDI Report as a Work Group Co Chair. The objective is to provide a roadmap for industry action by focusing attention on identifying business model attributes in the following four areas:

  • Enabling patient engagement through improved access to pertinent data
  • Evaluating alternative payment models and requisite business, information, and exchange requirements
  • Reviewing existing standards for exploring ways to better align administrative and clinical information capture, linkage, and exchange
  • Evaluating business cases for innovative encounter models using existing and emergent technologies

greenData BIG DataDownload

Lantana Group published this white paper for HIMSS12, highlighting how the Lantana Trifolia Toolkit uses the greenCDA methodology to open up the flow of Big Data within the enterprise and onto our health information networks. The Trifolia Toolkit was used in the HIMSS12 Health Story Showcase demonstration to enrich source data provided through dictated and a semi-structured notes and created coded, validated CDA documents ready for exchange.

An Electronic Health Record Based on Structured Narrative Download

A JAMIA article on work done at New York Presbyterian/Columbia University Medical Center on structured narrative. We think this article really speaks to the value of the full patient record and how narrative documents complement the EHR. A great read!

Making use of electronic data: The National Healthcare Safety Network eSurveillance InitiativeDownload

The Center for Disease Control and Prevention (CDC), as part of National Healthcare Safety Network (NHSN), is developing a standard framework to support the electronic submission of health care-associated infections (HAIs) and antimicrobial use and resistance (AUR).

The article outlines three key challenges to collecting this data electronically and shares background and success stories on the sharing of Lab, ADT and pharmacy data. Future exchanges, currently under development, will utilize the Clinical Document Architecture (CDA). One reason for choosing CDA is its ability to provide semantic interoperability.

Lantana Consulting Group provided expertise on the use of CDA and supported development of the HL7 Healthcare Associated Infections CDA Implementation Guide, which includes guidance on electronic reporting of Bloodstream Infections Reports, Surgical Site Infection Reports, Procedure Denominator Reports and the ICU Denominator Report.

Quality Reporting Document Architecture (QRDA) Initiative
Phase I Final ReportDownload

The Quality Reporting Document Architecture (QRDA) initiative results from a private collaboration sponsored by the Alliance for Pediatric Quality (Alliance), a joint effort of the American Academy of Pediatrics, The American Board of Pediatrics, Child Health Corporation of America, and the National Association of Children’s Hospitals and Related Institutions. Its goal is to develop an electronic data standard for exchange of patient-level quality measurement data between healthcare information systems.

APIC Announces New CDC Approach to HAI Reporting using CDADownload

The Centers for Disease Control and Prevention (CDC)…is developing a standards-based solution for transmission of health care-associated infection (HAI) data from existing commercial software systems to the agency’s National Healthcare Safety Network (NHSN). … CDC’s pilot project of the new solution in July and August, 2007 was the first field test of the Health Level Seven Clinical Document Architecture Release 2 (HL7 CDA R2) for public health reporting purposes.

Implementing Single Source: The STARBRITE Proof-of-Concept StudyDownload

The “Single Source” concept applies the write-once, use-many principle to data gathering for clinical trials using CDA as the key to interoperability in this case study.

The article reports on a pilot implementation done at the Duke Clinical Research Institute that radically streamlined the data-gathering process by eliminating redundant data entry.

On a side note, the authors observed that the highest degree of reuse was not between the clinical trial and the patient chart, but between previous notes in the chart and the note documenting the current encounter. “HL7’s first ballot in expected series under way”
by Joe ConnView Article

“Implementation guides for documents containing ‘history and physical reports’ were submitted Monday to Ann Arbor, Mich.-based HL7. It is the first ballot in what is expected to be a series of interoperability specifications under a project called Clinical Document Architecture for Common Document Types, or CDA4CDT.

Standards development expert Liora Alschuler, the CDA4CDT project leader, said balloting is the least of the worries ahead.

“The first challenge is to get this adopted,” Alschuler said. “We have high hopes that this will see relatively rapid, widespread adoption because it has a really minimal impact on workflow.

“So what does that do for humanity? If we look at building interoperability and patient-centered records, this is the largest single gain in interoperability that the industry could see,” Alschuler said.

Healthcare Informatics: “Guidelines Will Standardize Dictated Documents”
by Brian AlbrightView Article

“Dictated medical notes and other types of transcribed patient records are usually available in electronic form, but have traditionally not been very useful in the context of an electronic medical record (EMR) system. Transcribed records follow a variety of formats depending on the clinical setting and type of transcription service used, making them difficult to search.

“There’s no real structure to the narrative that’s being inserted into the EMR,” says Jay Cannon, president of the Medical Transcription Industry Association (MTIA), Chicago. “The information is visibly accessible, but within the system it’s just a text blob.”

Now, a new standard based on the Health Level Seven (HL7) Clinical Document Architecture (CDA), could help improve the utilization of these types of documents.

HL7 Clinical Document Architecture, Release 2, JAMIA PaperView Article

Release 2 (CDA R2) became an ANSI-approved HL7 Standard in May 2005 and is the subject of this article, where the focus is primarily on how the standard has evolved since CDA R1, particularly in the area of semantic representation of clinical events.

The Clinical Document Architecture (CDA), Release 1.0, JAMIA PaperDownload

This was our debut to the informatics community in 2000.

Mt. Washington RevisitedDownload

This paper examines changes in the health care industry since a contrarian proposal was submitted to CMS in January 2005.  That proposal focused on CMS exercising its commercial power as the market master in the purchase of healthcare in the U.S. to catalyze the emergence of a commercial heath record banking industry as an alternative to building a National Health Information Network (NHIN).

Mt. Washington Vision: A Response to ONCHIT’s Request for InformationDownload

The Mt. Washington Vision was created in response to the ONCHIT RFI

HL7 NLM Interoperability SurveyDownload

HL7 commissioned this survey under its EHR contract with the National Library of Medicine (NLM). The objective was to identify areas for leadership in standards and tool development that would accelerate adoption of exchange networks in the U.S.