Model-based Analysis of HL7 CDA R2 Conformance and Requirements Coverage

Numerous national and regional projects around the world [23] are developing specifications for sharing electronic medical records. Many of them are basing their specifications on the HL7 CDA standard, extending it in order to meet the local requirements or medical practice. Many of these projects are illustrating the specifications with sample CDA documents and provide in addition tools [13] [14] [24] to check the conformance of CDA documents with their extensions. In this paper we provide the outcome of an evaluation of both the samples and the tools provided by these projects. We looked at the conformance of the provided samples with the basic HL7 CDA requirements as specified within the "Clinical Document Architecture, R2 Normative Edition", and we looked at the capability of the tools provided to check those requirements. The outcome of the study shows that a large portion of the requirements specified by the standard are neither tested nor respected by the provided validation tools and samples.