Journal of Software Engineering and Applications, 2013, 6, 78-81
doi:10.4236/jsea.2013.63b017 Published Online March 2013 (
Copyright © 2013 SciRes. JSEA
Based on the Complete CDA Standard Clinical Document
Editor Research and Development
Jun He, Liang Xiao
School of Computer Science, Hubei University of Technology, Wuhan, China.
Received 2013
The design and development of a kind of fully comply with an HL7 standard clinical CDA document editor for gener-
ating standard CDA standard XML file, and can extract the other clinical commercial software generating clinical
document XML- related content, and modified into standard CDA XML documents, used for data exchange, data min-
ing and clinical d ecision support.
Keywords: The HL7; The HL7 CDA; Clinical Document
1. Introduction
Because the traditional paper clinical documents (in-
cluding course records, discharge summary, etc.) have
the problems in the writing norms, preservation, re-
source sharing, as well as the high speed development of
informatization for medical institutio ns to bring fast, safe,
advanced management, clinical application, electronic
clinical document arises at the historic moment. Elec-
tronic clinical document first purpose is to resource
standard and safety preservation, but as the electronic
clinical document data is unceasingly rich, and the clini-
cal staff, and the researchers of potential rich clinical
data in the clinical research of great value, in urgent need
of these rich data to exchange and share. But many do-
mestics and international relevant software developers in
the beginning of software architecture did not form a
unified and standard data exchange standard, make
clinical data transmission and exchange exist some diffi-
The HL7 established conveniently. The HL7 is a after
the American national standards institute approved stan-
dards development organizations, it has made a number
of information exchange protocols, and get international
recognition and extensive practice. It has gathered
through different manufacturers, medical institutions,
organizations, establishing of the standardization of the
health information transmission protocol, make each
hospital in heterogeneous system can make data interac-
tion. And CDA (Clinical Document Architecture) as the
HL7 standard set, as a part of the clinical document in
exchange for the purpose is to describe the clinical
document structure and semantic document marking
standard1. It details the clinical document structure and
semantic, is also a clear, complete object, can contain
text, images, audio and other multimedia content. But, so
far, both at home and abroad such as electronic medical
records related to the clinical document design exists
some insufficient and defect:
1) Do not completely comply with the HL7 standard,
especially in the design of electronic medical records, do
not completely comply with the standard of CDA, gener-
ate XML file cannot be through the HL7 CDA syntax
and semantic the authentication, in the isomerism cases,
clinical data exchange and sharing idea is just stay on
2 No software can extract other clinical software
developers generating XML document, so can't for re-
lated data extraction, analysis and higher level of utility
This research mainly include 1) design and develop
fully comply with the HL7 CDA standard based on web
clinical document editor, and can extract the other soft-
ware developers generating XML documents 2) extract-
ing clinical expert knowledge and clinical document
content and changed into computer can identify language,
form a maintainable clinical knowledge base 3) in this
clinical knowledge base, when the clinical medical
staff use the program to make order, write disease, the
system will give the clinical guidance and the decision
support, and finally form a maintainab le, knowledg e base
is unceasingly rich medical decision support system. This
paper firstly introduced the HL7 related content, then
detailed illustrate the CDA tech nical details, and th e third
part, we will describe development and function display
of the clinical document editor base on Web, finally we
Based on the Complete CDA Standard Clinical Document Editor Research and Development
Copyright © 2013 SciRes. JSEA
will summarize our research work, and introduce the
follow-up research direction and contents.
2. Project Overview
Clinical decision support systems (CDSSs) have been
hailed for their potential to reduce medical errors and
increase health care quality and efficiency. At the same
time, evidence-based medicine has been widely pro-
moted as a means of improving clinical outcomes, where
evidence-based medicine refers to the practice of medi-
cine based on the best available scientific evidence. The
use of CDSSs to facilitate evidence-based medicine
therefore promises to substantially improve health care
quality [1]. The proj ect mainly through the establishment
of clinical knowledge base for clinical decision support
provides a strong backgroun d support, and overall vision
as shown in Figure 1: design a clinical document editor
for clinical staff to complete the document editing, and in
full compliance with t the CDA standard of XML docu-
ment on the one hand, on the other hand extracts XML
format generated by other software vendors clinical
specify the content of the document, and save it as a le-
gitimate CDA document; through more than two parts of
the data acquisition and the use of natural language
processing, data mining technology, the formation of
new clinical guidelines.(Extract data for a variety of dis-
eases, and also make a number of clinical guidelines);
Transform the existing clinical guidelines, and own clini-
cal guidelines to clinical data that the computer can be
Figure 1.
identified, as well as develop a graphical tool for clinical
experts to edit and maintain clinical expertise knowledg e,
and ultimately form a continuously maintainable ,data
continuously enriched ,and accurate clinical knowledge
base to provide accurate, efficient clinical decision sup-
port for a variety of clinical practice.
3. Introduction of HL7
Health Level Seven organization was founded in 1987 by
dr. SamSchultz in Pennsylvania university hospital
hosted a meeting con tributed to an HL7 organization and
communication standard was born. With many users,
manufacturers, consultant organization to join, the HL7
team is growing, and estab lished the HL7 working group
finally. Health information exchange standards in HL7
(Health Level 7) is a health information transfer protocol,
standardized electronic transfer agreement between the
different applications in the medical field. A collection of
different vendors HL7 standard format used to interface
between the design of application software, which will
allow data interaction between heterogeneous systems,
various medical institutions.HL7’s main application ar-
eas is HIS / RIS, communication between the specifica-
tion HIS / RIS system and its equipment, it is involved in
all aspects of the wards and patient information man-
agement, laboratory, pharmacy, radiology systems, toll
collection system. HL7’s aim is the development of the
hospital data transfer protocols and standards, to stan-
dardize clinical medicine and management information
format, reducing the cost of the hospital information sys-
tem interconnection, to improve the level of information
sharing of data between the hospital information system.
Health Level 7 Level 7 "is the highest layer in the OSI
seven-layer model, the seventh floor. But this is not to
say that it follows the seventh layer of the OSI definition
of data elements, it is only used to constitute its own ab-
stract data types and encoding rules. It also does not re-
quire the specification of how to support the first to sixth
layers of the OSI data. As standard, the HL7’s goal is:
1) HL7 standard should support the exchange of data
in different technological environments, should also
support a variety of programming languages and operat-
ing systems, as well as support a variety of communica-
tions environments.
2) Support both single stream and multiple data stream
two means of communication.
3) T he max imum c ompa tibi lit y, reserved special table,
encoding defined for different users, and news segments
(such as: HL7’s Z-segments).
4) The standards must have the scalability to support
new requirements, which include the extension of the
agreement itself and is compatible with the existing sys-
tem and the new system.
5) The standards shou ld be in full reference to existing
Based on the Complete CDA Standard Clinical Document Editor Research and Development
Copyright © 2013 SciRes. JSEA
communication protocols based on widely accepted in-
dustry standard.
6) HL7 long-term goal is to develop a method for
medical institutions, electronic data interchange stan-
dards or protoc ol s.
4. HL7 CDA Technology
Clinical documentation is a completely object, including
text, images, sound and other multimedia content, it has
sustained, operability, can be identified, integrity, read-
ability. CDA have the following characteristics [2]: 1)
marked the CDA with XML language. 2) CDA inherit
the data type of the first edition of HL7RIM3 and HL7 3
release.3) complete CDA will include a set of hierarchi-
cal document specifications, this level formed structure
of the document. "
A CDA document by document type definition, com-
position head (CDA Header), body (CDA Body). Docu-
ment Type Definition norms and constraints of the
document, and the way to use the CDA version is the
DTD that the document type definition; the CDA Header
determine the classification of the document, provide the
identification information, respondents data, patient in-
formation, provider information; CDA Body is composed
of a nested set, a total of four content sets: section, para-
graph, lists, tables. The content sets contain content and
optional title, including plain text, links or multimedia
data. CDA Header and the CDA Body are defined using
the HL7 RIM data type [3].
5. Clinical Editor Development and Function
The document editor using JSP development, and using
DOM (Document Object Model) to process and read the
XML documents. JSP development is conducive to dis-
tributed deployment; DOM parsing an XML document
mechanism biggest feature is that the entire XML data as
a one-time loaded into system memory object parsed into
a tree, and can make use of the parent-child relationship
between the mark throughout XML data structure on the
high-speed browsing. Editor function is mainly divided
into two blocks: using th e editor to save the editor's con-
tent into fully compliance with the CDA standard of
XML document and can pass the official CDA’s valida-
tor ; reading XML documents generated by other vendors,
to extract critical information to for clinical guide data
studies; and save it as compliant XML documents, Fig-
ure 2 is the clinical document design diagram, Figure 3
is illustrating classes and functions:
6. Summary
Clinical document editor design complete marks the
whole project studies have been done to the first part,
Figure 2.
Figure 3.
Figure 4.
Based on the Complete CDA Standard Clinical Document Editor Research and Development
Copyright © 2013 SciRes. JSEA
Figure 5.
next we will set the editor into specific clinical practice,
further improve the clinical document editor fu nction and
technical details, make its are on the function more rich,
more flexible architecture, and using it to extract other
software company generate XML document, extraction
rich, precise and effective use of clinical data, for the
development of new clinical guidelines lay a solid data
support. Guidelines are not integrated into an electronic
patient record [4,5]. In a follow-up research work, clini-
cal guidelines for the structural expression and clinical
practice of decision support would be our research focus.
7. Acknowledgment
This work is supported by National Natural Science
Foundation of C hi na u nder Grant Num ber 6115 10 0 1.
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dards-a brief overview”,2006,PP.1-6
[4] Xiao L., Cousins G., Courtney B., Hederman L., Fahey T.,
Dimitrov B.D., “Developing an Electronic Health Record
(EHR) for Methadone Treatment Recording and Decision
Support”, BMC Medical Informatics and Decision Mak-
ing 11:5, 2011.
[5] Xiao, L., Cousins, G., Fahey, T., Dimitrov, B., Hederman,
L., “Developing a rule-driven clinical decision support
system with an extensive and adaptive architecture”, Pro-
ceedings of the 14th International Conference on E-health
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