The Clinical Document Editor – a Powerful Tool for CDA Implementation

Background: Documents constructed according to the HL7 Clinical Document Architecture (CDA) need to be reviewed, edited and approved by an author, who is usually a clinician. The CDA specification does not require any particular editing tool to be used in creating CDAs. The tools used to edit CDAs have typically been specific to a particular profile of CDA, and even to the application using that profile. There are widely used style sheets to render and view CDA documents, but there are no comparable widely deployed tools for creating the CDA itself. Objectives: This paper describes an open source toolset to create productionquality, clinician-oriented, web-based editors and viewers for any profile of CDA. Methods: We illustrate the process of developing and deploying a clinical document editor using the example of the Consent Directive CDA. We introduce the Clinical Document Constructor Architecture. Results: The Clinical Document Editor toolset allows fully-functioning, clinician-ready editors to be rapidly developed and deployed for any CDA profile. Conclusions: The emphasis hitherto has been on the structure and computability of CDA documents, but the lack of tools to produce and edit the CDA format is now a significant constraint on its adoption. Tools to efficiently create and edit CDA documents are an essential step in making CDA applications acceptable to practicing clinicians, and thus in realizing the potential of CDA for healthcare interoperability.