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The Development of a National Approach to CDA: Successes, Challenges and Lessons Learned in Australia

Author(s): Williams PAH, Gaunt S, Grieve G, McCauley V, Leslie H

Background: Australia has been in the process of designing and implementing a national ehealth system for a number of years. A core component of this design has been the selection of HL7's CDA as the basis of the Australian EHR. This incorporates CDA into both the shared Personally Controlled Electronic Health Record and for document exchange point-to-point.

Objectives: CDA was chosen partly for its ability to address issues of governance and consistency in a national environment that does not have definitive oversight or a single decision making body.

Methods: Developing long and complex implementation guides has been assisted by good design of a 'super-schema' to include the Australian extensions, together with a framework for extensive conformance checking. Australia has created a multi-level conformance framework which currently supports a mainly Level 2 CDA architecture yet provides a transition pathway to future full interoperability.

Results: One area of contention around the Australian solution, however, is debate over content presentation and data content using CDA. The Australian implementation has had considerable debate around the technical and governance infrastructure for controlling the rendering of the documents. Other challenges have arisen in the selection of transport standards, sourcing of CDA expertise and in relation to the need for local extensions to CDA. Local extensions to CDA have been modelled using the HL7 development paradigm (based on the HL7 RIM) as permitted by the CDA standard, and submitted for inclusion in HL7 CDA Release 3.

Conclusions: This paper illustrates the Australian approach to the development of CDA for the National EHR and ehealth point-to-point communications, and provides an insight for other countries considering similar implementations.