Analysis of Clinical Document Architecture (CDA) Levels & R1 vs R2

This essay provides a detailed explanation of the three levels of Clinical Document Architecture (CDA), highlighting their hierarchical structure and functionalities. It begins by describing CDA level one as a detailed representation of a clinical note, emphasizing its aim to reduce technical barriers during standard adoption. The essay then discusses CDA level two, which involves a set of templates layered on top of CDA Level One, requiring domain knowledge and professional society participation for development. Lastly, CDA level three is explained as an addition to the RIM-derived mark-up, enabling message extraction from clinical documents and detailed representation of findings and symptoms. Furthermore, the essay contrasts CDA R1 and CDA R2, noting that CDA R2 derives both the header and body from the RIM, enabling formal expression of clinical document content. It also highlights the evolution of these standards and the driving forces behind the development of CDA R2, including the expectation to further encode narrative clinical statements in clinical reports. Desklib provides access to this and many other solved assignments for students.

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1. The three levels of CDA are as follows:
CDA or clinical document architecture consists of hierarchical set that mainly consists
of two levels. The level one consists of a detailed representation of an elaborately narrative
clinical note. The aim of the level one is to reduce the technical barriers during the standard
adoption along with which there is provision of a gentle introduction of the RIM. This
however lacks the presence of the complex semantics which were implemented in the HL7
version 3 messaging. This type of architecture will be able to provide a pathway of migration
for the people who are the implementers of the clinical documents. The level two is
considered as a set of templates that be put as layers on the top of the CDA Level One
specification. The development of this type of template requires the knowledge of the domain
in considerable amount along with the participation from the individuals belonging to the
professional societies. This is in order to create the templates which can be witnessed and
embraced. Additionally the level three of the CDA will be able to add to the RIM derived
mark-up to the CDA Level One specification. This is able to order message to be to be
extracted from a clinical document. This allows the detailed representation of the findings
and the symptoms which allows for the billing of the codes to be extracted automatically
(Dolin et al., 2001).
2.
The differences that exists between CDA R1 and CDA R2 involves that the CDA R1
is able to derive the header from the RIM whereas in CDA R2 there is derivation of both the
header and the body. This CDA R2 is able to enable the content of the clinical document
body to be expressed in a formal manner which is able to express the extent that is modelled
in the RIM, which in turn is coupled with terminology. The Clinical Document Architecture,
Release One (CDA R1) has become an American National Standards Institute (ANSI)–

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approved HL7 Standard in November 2000, that is involved in the representation of the first
provided specification which is derived from the Health Level 7 (HL7) Reference
Information Model (RIM). On the other hand the release 2 of the CDA R2 has become and
became an ANSI-approved HL7 Standard in May 2005. The model developed for R2 was
significantly unchanged from the one developed in CDA R1. This CDA R1 is used on a
worldwide basis, however recently there are several sites that are able to make transitions to
the CDA R2. With the CDA R1 there is possibility of developing the decision support for the
applications using the local extensions. However in respect to CDA R2 there are changes are
already outlived with respect to the communication along with the accession to the
methodology. The driving force which is overriding in nature is at the back of this
development of CDA R2, for which has been the expectation to further encode the narrative
clinical statements found in clinical reports (Dolin et al., 2006).

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References
Dolin, R. H., Alschuler, L., Beebe, C., Biron, P. V., Boyer, S. L., Essin, D., ... & Mattison, J.
E. (2001). The HL7 clinical document architecture. Journal of the American Medical
Informatics Association, 8(6), 552-569.
Dolin, R. H., Alschuler, L., Boyer, S., Beebe, C., Behlen, F. M., Biron, P. V., & Shabo, A.
(2006). HL7 clinical document architecture, release 2. Journal of the American
Medical Informatics Association, 13(1), 30-39.