This is your Questionaire submitted by on Tuesday September 9, 2008, 14:48:53

Show Me Your CDA! My questionnaire

A. Basics

---

1. CDA Project Name:   Transforming TR's NHIS Messages to CDA
   
2. Project Web Site:      http://www.srdc.metu.edu.tr
   
3. Contact Name:           Mustafa Yuksel
   
4. Contact E-mail*:         mustafa@srdc.metu.edu.tr
   *Primary contact for information about the project; one or more
   
5. Geographic location:Ankara, Turkey
   
6. Summary description: (Please write a paragraph describing your project. Include installation sites, demonstrations, and primary purpose 250 words)
   Turkey’s National Health Information System (NHIS) aims to provide a nation-wide infrastructure for sharing the Electronic Health Records (EHRs). The current implementation supports the transfer of EHRs, called the “Transmission Schema” instances from the Hospital Information Systems (HIS), the Family Medicine Information Systems (FMIS) and the Laboratory Information Systems (LIS) to the NHIS servers at the Ministry of Health (MoH). During the localization of the “Transmission Schemas”, the rules which are set in the “Health Level 7 (HL7) Refinement, Constraint and Localization” are applied. In other words, the Clinical Document Architecture (CDA) RMIM is edited and then converted to HMD and XSD, respectively. The “Transmission Schemas” are based on the national Minimum Health Data Sets (MHDS). The MHDSs use the data elements from the National Health Data Dictionary (NHDD). The data elements are coded with coding systems which are available from the Health Coding Reference Server (HCRS). HL7 Web service Profile is used for the transportation of “Transmission Schema” instances. However, the “Transmission Schemas” are not HL7 CDA conformant although they stem from the CDA RMIM, because substantial editing has been done by the responsible implementers and as a result, the instances cannot be validated against CDA XSD. In this project, the differences between the “Transmission Schemas” and the HL7 CDA R2 conformant EHRs are identified and an “Adaptor” is developed to convert the “Transmission Schema” instances to the HL7 CDA R2 conformant EHRs, and vice versa. This will enable automatic transformation of local instances to conformant CDA documents for international EHR exchange.
   
   

B. Business Case

---

1. What are the exchange sites? [choose multiple]
   Primary care provider (i.e. General Practice)
   Emergency
   Hospital
   Tetriary care
   Document repository (not affiliated with a single provider)
   Internally within an enterprise (provider))
   
2. What were the reasons for beginning your CDA exchange? [choose multiple]
   Improve the delivery of care
   Government mandate
   Business drivers (cost effectiveness)
   Public health reporting
   Quality Reporting
   Standardizing clinical reporting
   

   C. CDA Usage

   ---

   1. What document types do you use? [choose multiple]
      Discharge summary (inpatient or outpatient)
      Transfer of Care, Referral or Medical Summary (e.g. U.S. CCD)
      Operative Note
      History and Physical
      Consultation Note
      Progress Note
      Admission Note
      Nursing Assessment
      Public Health Reports
      
   2. Do you use an implementation guide? [choose multiple]
      HL7 Implementation Guide
      HL7 Affiliate Implementation Guide
      IHE Implementation Guide
      Other: NHIS of Turkey Integration Guide
      
      
   3. What level of coding do you use?
      Level 0 (non-XML)
      Level 2 (coded sections)
      Level 3 (some coded entries)
      Mixture or unsure
      
      
   4. Did your initial exchange begin at a lower level of coding?
      Yes
      No
      If yes, please describe:
      
      
   5. How are your CDA documents generated: [choose multiple]
      Electronic Medical Record export
      Scanning
      Word processing (converted to XML or left as non-XML)
      Dictation
      Conversion from alternative standard (HL7 V2, DICOM SR, other)
      Natural Language Processing
      Speech recognition
      Other: XSL based transformation techniques
      
      
   6. Please describe your CDA volume:
      Number of CDA documents exchanged over the last year:
      Number of CDA documents exchanged last month:            
      If other, please describe:
      The National Health Information System of Turkey is still at its testing phase, currently the vendors are trying to integrate their Health Information Systems to NHIS centralized servers providing HL7 v3 Web Services. The deadline for integration is September 30, 2008. After that, it is projected that about 145 million documents will be exchanged in the year 2008 and 400 million documents in 2009 from all over Turkey.
      
   7. Do you make your CDAs available to patients through a Personal Health Record system
      or provider portal?
      Yes
      No
      
      
   8. Did you extend CDA to fulfill your use case? Have you submitted requirements for consideration in CDA R3?
      Yes
      No
      If yes, please describe:
      In the original National Health Information System of Turkey, the "Transmission Schema"s are not CDA conformant because refinement had begun from the RMIM level. However, unfortunately it is not possible to name this process as extension. In our project, we have developed an adapter to transform NHIS messages of Turkey to conformant CDA documents.
      
   9. Have you carried out educational seminars on CDA use?
      Yes
      No
      
      
   10. Have you used terminology for...
       10.1 clinical document types: [choose multiple]:
       Local Vocabulary
       LOINC
       SNOMED
       If other, please describe:
       
       
       
   10.2 Section Codes [choose multiple]:
   Local Vocabulary
   LOINC
   SNOMED
   If other, please describe:
   
   
   10.3 Clinical Information [choose multiple]:
   Local Vocabulary
   LOINC
   SNOMED
   ICD
   If other, please describe:
   
   
   

   D. Health Information Exchange Methodology

   ---

   1. How many sites are involved in exchanging CDA in this project?
      
      
   2. How do you exchange/transport your CDA documents? [choose multiple]:
      Web Services
      ebXML
      SOAP (Simple Object Access Protocol)
      SOA (Service Oriented Architecture mechanism)
      CD/DVD
      Memory stick/Thumb drives
      HL7 v2x MDM
      HL7 v3 RCMR
      IHE XDR/XDS
      If other, please describe:
      National Health Information System of Turkey uses HL7 v3 Web Services Profile and our adapter provides Web Services acting as a proxy for transformation
      
      
      

   E. Vendor Applications

   ---

   Please share some information about the applications in use:

   Vendor/In-house	Product Name	Functionality	Product Status

   Vendor or In House development: Name of vendor or in-house development
   Supported Functions: Authoring, Distribution, Display, EMPI, Enrichment (Natural Language Processing, coding, etc), Management, Electronic Medical Record (EMR)
   Product Status: pre-released, released (Note: applies to the version of the product with the CDA capabilities you are using. If released, but the CDA capability is in beta, indicate pre-release)

   F. Bibliography

   ---

   Please list any existing bibliographic references to your work including scientific papers, articles in your own language, implementation guides, etc.) Kabak Y., Dogac A., Kose I., Akpinar N., Gurel M., Arslan Y., Ozer H., Yurt N., Ozcam A., Kirici S., Yuksel M., Sabur E., The Use of HL7 CDA in the National Health Information System (NHIS) of Turkey, 9th International HL7 Interoperability Conference (IHIC) 2008, Crete, Greece, October, 2008.