Part 1 of this series laid out the challenges of CCDA Integration and working with
various electronic health record (eHR) formats and Part 2 described how to use the InterSystems HealthShare framework to transform CCDA documents into SDA, the canonical data format used by HealthShare Unified Care Record (UCR).
Now that the groundwork has been laid out, we can discuss approaches for how to make the process more efficient.
The punchline? The first CCDA interface is always the most challenging, but if you spend time organizing the integration framework and development environment with an eye toward the future, subsequent integrations will be completed much faster.
Initial Setup
The design of your CCDA transformation framework is key to organizing and streamlining the development process. Even though there is a provided framework with HealthShare, it is worth the time and effort to establish how the base code should be used, where custom code and libraries should be stored, and the overall methodology for approaching each new integration. Ideally, with these key decisions made and the framework laid out, development can then occur in well-established, modularized components.
Part of the initial setup involves establishing the IHE pipelines, which this series has only touched upon briefly since we are focusing on the CCDA transformations themselves. But the IHE pipelines are a requirement for ingesting the CCDA into HealthShare and, once again, a well-designed, well-documented infrastructure makes downstream development and troubleshooting more efficient.
Data Visibility and Data Quality
One of the most significant barriers to integrating CCDA is navigating its complex format which presents a high barrier to entry. Tools that enhance data visibility and simplify CCDA document review can significantly reduce the learning curve and accelerate integration delivery.
Without visibility into the data, discovery is often done by the developer who is handed sample CCDA messages and no specifications. Thorough data profiling and quality reviews at the outset of the development cycle can reduce costs by minimizing iterations—from mapping to unit testing to validation. Identifying issues early allows data analysts to either resolve problems with the vendor or determine necessary mappings before involving developers.
Reusable Solutions
There was a time when CCDA transformation was the Wild West; multiple document versions, vendor-specific document formats, and site-specific data standards. These challenges still exist, but experienced implementors have compiled libraries and templates they keep in their back pocket.
Developing solutions with reusability in mind and consistently leveraging them is a significant time-saver. Many organizations implementing integration at scale find themselves trapped in an endless loop of non-code reuse and costly resourcing. It’s crucial to ensure these solutions align with future development projects to avoid this cycle of continual reinvention, searching for previous examples, and excessive copying and pasting.
Development Tools and Tips
Here are some additional items you'll want to make sure you have in place:
Integrated Development Environments: An IDE that supports XSL syntax and testing streamlines the development process and decreases the time required to reach proficiency. IRIS Caché Studio has little support for XSL, whereas Visual Studio Code (VSCode) has XML formatting, XSL syntax recognition, and downloadable XPath and XSLT extensions.
Testing Utilities: A testing utility built on top of HealthShare to expose and validate the XSLT process. XPath and XSLT syntax and behavior will vary depending on the version of XSLT being used. Although HealthShare provides a basic XSLT tester, our team has discovered that investing in more robust testing utilities and harnesses significantly accelerates development and is well worth the effort.
Development Tools: Tailored tools specific to the implementation which facilitate the ability to look up reusable XSLT templates and add new templates in a simpler way. These tailored tools are suited specifically for CCDA transformation in HealthShare and lower the learning curve for learning XSLT.
Generative AI: An AI "co-pilot" for CCDA transformation can be extremely effective for identifying patterns in XML and also for generating XSLT templates. With a little training and prompting practice, an XPath/XSLT novice can quickly come up to speed on CCDA transformations.
Knowledge Transfer and Collaboration
As long as CCDA transformation remains a niche skill, the cost of development will depend on a few experienced resources that are often stretched thin. Just as HL7 v2 transformation has become a widely adopted skill with mature toolsets that enable rapid development, CCDA integration has the potential to follow the same path, lowering the cost of integration on a large scale.
The key is a vibrant developer community. There is no silver bullet solution to the many variations and idiosyncrasies of different eHR vendors, but with well-documented repeatable solutions, improved troubleshooting tools, and knowledge sharing, the ability to quickly diagnose issues and leverage previous experience is the key to making IHE implementations more efficient and cost-effective.
To build a team capable of handling any challenge, partnering with the right firm is crucial. If you aim to enhance your team's self-sufficiency and reduce integration costs, consider partnering with LEAD North. Our mission is to educate and simplify complex processes, such as CCDA integration in HealthShare. Whether you are new to this field, seeking to optimize your existing framework or simply have questions on anything that was included in this series, we invite you to reach out through our contact page for consultation. Also, check out our upcoming training courses here!
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