Introducing the Green CDA

I regularly write about the need to converge CCR and CCD into a common, simple to use, XML construct that incorporates structured and unstructured clinical summary information.

CCD itself would be a good endpoint if the XML were more readable and the overhead of the CDA was reduced. The other option is for CCR to be expanded to include more metadata and support unstructured documents such as discharge summaries and operative notes. The CCR folks have been working on PDF for healthcare to support document capability.

Simpler but full featured is exactly what Green CDA tries to do.

It's a streamlined, human readable and computable lighter version of CDA that includes just the data and metadata necessary to do the job of representing a clinical summary.

Here's an example of the Problems section and Patient data section in Green CDA.

There are tools available to convert green CDA into a full CDA document

There are also tools available to convert CDA into Green CDA

Additional tools are are being developed to enable easy creation of Green CDA constructs by navigating the RIM, selecting attributes, and selecting associations to consolidate to make the XML flatter.

When I first saw the Green CDA XML, I was so impressed that I asked the question - why not use Green CDA as CDA, getting rid of MoodCode, many of the OIDs and other overhead in the CDA?

In the past, the idea was that the CDA was capable of representing any aspect of the medical record for any purpose. That sounds like a noble idea but in practice it creates a fixed overhead for even the simplest data exchange.

Folks at HL7 are working hard on CDA templates, tools for creating CDA documents and simplifying the CDA (and the XML used in CDA).

The Green CDA initiative is a great start. I look forward to watching its development and the industry reaction.

The Interim Final Rule supports both CCR and CCD for 2011, but recommends convergence by 2013. Over the next 24 months, we'll see what convergence of XML standards for structured and unstructured data is technically and politically possible.