CDA in the Wild – Introduction




…beyond the bushes ahead you will see the Wild CDA in its natural habitat…


Lantana Consulting Group presents the first installment of CDA in the Wild by Rick Geimer, a blog series that identifies top errors found in CDAs (and how to fix them).


Contrary to popular belief, wild CDAs are not typically the proud, majestic specimens pictured in the marketing brochures of certified EHRs. Most are messy, unclean beasts – stalking unsuspecting information, tearing their prey apart, and devouring demographics, narrative, and coded data before slowly hauling their bloated frames through the morass of healthcare information exchanges – leaving acrid waste and little else in their wake.


Maybe that’s a bit harsh…


Still, most CDAs exchanged today leave much to be desired. I’ve been working with CDA R2 since 2005, and have seen a decade of production CDAs, CCDs, C32s, C-CDAs, QRDAs, HAIs, and so on. They rarely fail to disappoint.


For EHR customers seeking a solution to their information exchange needs, this may come as a surprise. Many assume that, because an EHR is certified, then it must follow Meaningful Use guidelines and produce valid, usable C-CDA documents. Sadly, that is not the case out in the bush.


From what crossed my desk, I have to conclude that many EHRs only produce valid CDA documents during certification tests. From a technical standpoint, documents they produce in the field, in the wild, may not even be a CDA. Hint: if a CDA does not validate against the CDA schema, then there’s a problem calling it a “CDA”.


This series will highlight the top 10 issues I’ve identified with CDAs in the wild:

  1. Basic XML Issues
  2. Validation Issues
  3. Narrative Issues
  4. Identifier Issues
  5. Terminology Issues
  6. Null Flavor Issues
  7. OID Issues
  8. Date/Time Issues
  9. Document Type and Template Issues
  10. Kitchen Sink Issues


Seems like I need a tissue to clean up all those issues.


Oohhkaaay. In this series, I’ll describe each issue, give you some examples, and easy ways to fix it. My hope is that vendors will read these suggestions and clean up their CDAs. If not, then at least you will know what to look for when you shop and what to fix when your interoperability is not interoperating.


Read Installment #2: Rick takes on Basic XML Issues.


To see the full series click #CDAinthewild


#CDAintheWild; #CDA; #HIT