CDA Evaluator performs the following functions:
1. It extracts a summary of important information items from the CDA document. The list of items extracted is based on requests from KCR’s cancer registrars.
2. It prepares a de-identified version of the original CDA file; all identifying information about the patient has been replaced with filler text in a fashion compliant with Safe Harbor standards. Providers and payers have also been rendered anonymous since such parties often wish to be anonymous if such data are used in research. Human review is needed before the de-identified file is distributed since the anonymization process depends on correct implementation of the CDA format and will fail if PHI is included in inappropriate elements.
3. It performs validation using a slightly modified form of NIST’s official validator for cancer reporting CDA (as represented in the 2/6/2013 downloadable version, the most recent as of this writing). The modifications consist of a change in the output format for improved readability and the elimination of Web-based file lookups so that the validation will proceed correctly even on a computer with no Internet access.
4. It performs content verification to confirm the presence or correct content of items that are not checked by validation. This feature is currently at a minimum level of functionality and will be expanded in near-future releases. Content validation currently covers:
- Referring Provider present (mandated in Implementation Guide but not checked by NIST). This is specifically checked by verifying that a Referring Provider NPI number has been provided.
- Cancer Diagnosis Section not null (mandated in IG but not checked by NIST). This is specifically checked by verifying that at least one histology code is present in the Cancer Diagnosis Section.
- Cancer Diagnosis Histology Code correct format. This tests the code mentioned above for correct codesystem and format. This format check is currently over-conservative and will flag some valid codes as errors.
- NPI number present for the healthcare provider participating in the clinical encounter described by the CDA document.
- NPI number present for the healthcare provider or organization taking custodial responsibility for the CDA document.
- Patient birth time present (only the birth date portion of this timestamp is checked for valid format).
- Patient SSN present.
- Linkages given connecting treatments to diagnoses. The IG specifies optional elements for linking medications, medications administered, and procedures to the diagnoses that are the reason for providing/performing these services. Because they are optional, the NIST validator does not flag their absence as an error, but without these elements there is no way of establishing what condition the treatment is intended to treat. This check tests all the procedures described in the CDA document for diagnostic linkage, so procedures which are not treatments and require no diagnostic justification (e.g. blood pressure measurement) will be marked as linkage failures. Verification failures in this category require human review to check whether necessary information is actually missing.
5. Extracting a NAACCR record from the CDA. This feature currently implements a subset of the known CDA-to-NAACCR mappings and will be expanded in near-future releases.