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  • 10.0 CDA Exchange Plus Import Planning
    • Table of Contents

    CDA Exchange Plus Import Planning

    10.0.1Considerations to make before implementing CDA Exchange Plus

     

    Prior to starting the ingestion of CDA Documents, the following topics should be considered as they will affect how the data is ingested into your system.

    10.0.1.0.1Data Samples

    In order to make a successful Go-Live possible, it’s recommended to have a sample dataset containing CCDs that mimic production data as closely as possible for testing in lower environments. If this is not possible, synthetic sample data will do as well, however, in the higher environments prior to production it is recommended to allow production data into a lower environment to test with live data before committing it to prod.
    It is recommended to at least test with production-like data once in a lower environment before going to production in earnest to avoid any surprises in the production database.

    10.0.1.0.2Data quality of the CDA documents

    CDA Exchange Plus does not do any kind of IG validation, therefore if CCDs come in with bad formatting i.e. mismatching references, duplicate identifiers, non-decimal entries in decimal fields. It will impact the ingestion of these documents.

    Case example: US CCDs often include an SSN containing a placeholder value or other placeholder values. The placeholders do not hold any information, but may cause conflicts if the database performs lookups on identifiers and may match resources with the same placeholder together. In order to determine how the CDA module interacts with the various identifiers it’s recommended to gather a representative test load of data and load the test into the repository in a lower environment in order to determine if the default behaviour of the CDA Exchange Plus module is suitable for use. Both the rate of ingestion success/failure and the outcome of successful ingestion should be compared against expected outcomes in order to properly understand what customizations may need to be applied.

    10.0.1.0.3Other modules with ingestion methods

    Other ingestion methods and data within the same SmileCDR database can impact ingestion. Evaluating how CDA ingestion affects the rest of the ingestion methods already in the system is important for successful ingestion of the CDA documents.

    Case example: Hl7v2 ingestion uses the first identifier in order to make conditional create or conditional updates to the database. Therefore, this first identifier must remain unique within the database, otherwise a merge conflict will occur as SmileCDR can no longer determine which resource needs updating if there are two resources with the same identifier in the repository. The CDA Exchange Plus module by default does not check on the first identifier and so, if an identifier comes in that already exists in the database it can cause a duplicate. In order to resolve this, the two ingestion methods should be tested alongside each other to determine what conflicts may arise and what search parameters and customizations may need to be implemented to prevent ingestion failure.

    10.0.1.0.4Overall infrastructure

    Depending on the method of ingestion (Kafka + channel import, camel, $import-cda) speed and message size may factor in some configurations. The size of a CCD may vary from <5mb to >200MB. Accounting for this during the configuration of the kafka message broker is important to ensure the messages make it into SmileCDR.

    10.0.1.1Best Practices

    10.0.1.1.1CDA Exchange Plus implementation with existing ingestion methods from other modules

    In a new installation of 2025.02.R01 or later, it is recommended to use the new document bundle persistence mode and store the FHIR bundle as a single monolithic entity. This prevents issues with deduplication at ingestion. A batch job should be created in the background to extract the bundle and convert them to top-level entities in a more robust and flexible way.
    This decouples the ingestion from the normalising step and allows for more flexibility and robustness of the system.

    10.0.1.1.2Java vs Javascript processors

    The JavaScript processor is meant for minor point changes in the CCD or the resulting transaction bundle. Unlike the Java Interceptor, the JavaScript pointcut is limited to what can be accessed in the JavaScript Execution Environment.
    It is not suitable for big changes such as: reordering of elements of an incoming or outgoing CCD, removal of multiple nodes at once of an incoming or outgoing CCD, precise insertion of new elements of an incoming or outgoing CCD, or changing of references within the transaction bundle.

    Bundle editing and complex changes to the CCD such as restructuring the order of elements or precision insertion of elements should be done via the Java Interceptor. The Java Interceptor has access to the complete library of Java APIs including those used for XML and Transaction Bundle editing allowing more flexibility and testing capabilities.

    10.0.1.1.3Troubleshooting logs

    It’s recommended to have troubleshooting logs enabled in lower environments but not Production as it can expose PHI/PII. It also puts a considerable strain on the system to have to constantly produce the additional logs which may slow down performance. This is why proper testing in lower environments with production data is of utmost importance when implementing CDA ingestion as the troubleshooting log along with the smile-error.log and smile.log will provide more information in lower environments with the settings enabled.

    10.0.1.1.4Version control of scripts

    It is recommended version control of the CDA ingestion scripts in JavaScript as well as any subsequent Java Interceptor is maintained for traceability and to prevent script loss if rollbacks must occur. This can be done by using Git repositories such as GitLab or GitHub.

    10.0.1.1.5Sample Data recommendations

    Below are a few questions to ask yourself while preparing your test data:
  • Planning
  • 10.0 CDA Exchange Plus Import Planning