title: Health level seven interoperability strategy: big data, incrementally structured.
abstract: OBJECTIVE
  Describe how the HL7 Clinical Document Architecture (CDA), a foundational standard in US Meaningful Use, contributes to a "big data, incrementally structured" interoperability strategy, whereby data structured incrementally gets large amounts of data flowing faster. We present cases showing how this approach is leveraged for big data analysis.
  
  
  METHODS
  To support the assertion that semi-structured narrative in CDA format can be a useful adjunct in an overall big data analytic approach, we present two case studies. The first assesses an organization's ability to generate clinical quality reports using coded data alone vs. coded data supplemented by CDA narrative. The second leverages CDA to construct a network model for referral management, from which additional observations can be gleaned.
  
  
  RESULTS
  The first case shows that coded data supplemented by CDA narrative resulted in significant variances in calculated performance scores. In the second case, we found that the constructed network model enables the identification of differences in patient characteristics among different referral work flows.
  
  
  CONCLUSIONS
  The CDA approach goes after data indirectly, by focusing first on the flow of narrative, which is then incrementally structured. A quantitative assessment of whether this approach will lead to a greater flow of data and ultimately a greater flow of structured data vs. other approaches is planned as a future exercise.
  
  
  CONCLUSIONS
  Along with growing adoption of CDA, we are now seeing the big data community explore the standard, particularly given its potential to supply analytic en- gines with volumes of data previously not possible.
authors.affiliation: Robert H Dolin, MD, 1368 N Stallion St Orange, CA 92869, USA, E-mail: BobDolin@gmail.com.
authors.forename: R H
authors.initials: RH
authors.lastname: Dolin
authors.forename: B
authors.initials: B
authors.lastname: Rogers
authors.forename: C
authors.initials: C
authors.lastname: Jaffe
mesh_terms: D059019:Clinical Coding; D057286:Electronic Health Records / Q000458:organization & administration*; D057208:Health Level Seven; D062527:Meaningful Use; D008498:Medical Record Linkage; D014481:United States
keywords: Big data; CDA; HL7; Semantic Interoperability