Consolidated CDA: Promising Approach to Structured Surgical Report

mTuitive's contribution to the SMART C-CDA Collaborative is published on GitHub at  You can view some of the sample XML documents and a write-up of our work.

mTuitive contributed operative reports in CCDA format to the SMART C-CDA Collaborative as part of their effort to "ensure that real-world Health IT software can consistently produce and consume C-CDA documents."

We extended OpNote with the ability to generate a CCDA-flavored XML document on demand. This feature is not yet in production but we will likely add it and offer it as an option for future integration opportunities.

What's CCDA?

CDA itself is an HL7 specification for how to structure clinical documents as XML with varying levels of structured data. Consolidated CDA (CCDA) is an implementation guide from HL7 which provides templates or constraints for implementing various specific types of clinical documents as CDA documents. These include H&P, operative notes, discharge summaries, progress notes, and more.

CCDA is a way to represent actual data as structured clinical documents, not the templates used to create that data. (There are other standards emerging to standardize template definitions, like MRRT for radiology reporting and HeD for decision support and documentation templates.)  It is not the only standard for structured clinical documents, but it's the best one ready for widespread adoption right now.

So What?

We are all familiar with the question of "how can you send us the discrete data?"  This standard has the potential to be a ubiquitous solution to that problem.  If CDA/CCDA adoption takes off (or even becomes part of meaningful use), then it will be far easier to exchange structured clinical data between systems, and every structured clinical documentation integration won't be a custom, blank-slate project.

Going forward, we will continue to participate in this workgroup and hopefully help make CCDA more readily viable for real-world scenarios. We plan to suggest the addition of pathology reports to the suite of documents covered by CCDA for its next version, and we are going to do some internal exploration of formatting pathology reports with CCDA.

I should mention that we had the option to make our contributions private, such that they could not be viewed on the Web by other vendors. All contributors were encouraged to make their CCDA documents public, and that is what we chose to do.  John Murphy (mTuitive CEO) and I both agreed that if we are working to help evolve a standard, there is more to be gained from an open approach. 

For what it's worth, we've already been mentioned on twitter by the National Coordinator for Health IT, and on the SMART website alongside giants like Cerner, Greenway, and Epic.  Also, developers and vendors working with the SMART C-CDA Scorecard are offered some of our documents for learning more about CCDA (see the dropdown "Show Me an Example").  The nice thing about open standards is how they level the playing field among vendors big and small.

A Nerdy (or Not-So-Nerdy) Aside -- What's GitHub?

As an interesting aside, the CCDA samples project is hosted on github.

The way this works is that anyone can "fork" or copy a project, make their own changes.  The original project owner can "pull" those changes back if they like them, or not.  For example, the official repository for this project is maintained by Children's Hospital at You will see our documents in there too.   We "fork" their repository, make changes to it, and they "pull" our changes back in when they are ready.  Though that is pretty much normal source control behavior, github has made this work on a massive scale in a far more user-friendly manner than ever before.

A pull request is a formal request, using software, for someone to merge your modifications into their project.  Github more than anyone is refining how coders collaborate online. Their tools are really interesting, and in my opinion point the way toward how medical standards such as CAP and CPAC should be developed. In fact, I would imagine some are already being developed this way.

For non-nerdy examples, there are legal documents, US government policies, and Gregorian chants being created and edited using github.