Continuity of Care Document

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The Continuity of Care Document (CCD) specification is an XML-based markup standard intended to specify the encoding, structure, and semantics of a patient summary clinical document for exchange.[1]

Structure[edit]

The CCD specification is a constraint on the HL7 Clinical Document Architecture (CDA) standard. The CDA specifies that the content of the document consists of a mandatory textual part (which ensures human interpretation of the document contents) and optional structured parts (for software processing). The structured part is based on the HL7 Reference Information Model (RIM) and provides a framework for referring to concepts from coding systems, such as the SNOMED or the LOINC.[citation needed]

The patient summary contains a core data set of the most relevant administrative, demographic, and clinical information facts about a patient's healthcare, covering one or more healthcare encounters. It provides a means for one healthcare practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another practitioner, system, or setting to support the continuity of care. Its primary use case is to provide a snapshot in time containing the pertinent clinical, demographic, and administrative data for a specific patient.[1]

The CCD specification contains U.S. specific requirements; its use is therefore limited to the U.S. The U.S. Healthcare Information Technology Standards Panel has selected the CCD as one of its standards. CCDs are quickly becoming one of the most ubiquitous and thorough means of transferring health data on patients as each can contain vast amounts of data based on the standard format, in a relatively easy to use and portable file.[2]

Development history[edit]

CCD was developed by HL7 with consultation and advice from several members of ASTM E31, the technical committee responsible for development and maintenance of the Continuity of Care Record (CCR) standard. In the opinion of HL7 and its members, the CDA CCD combines the benefits of ASTMs Continuity of Care Record (CCR) and the HL7 Clinical Document Architecture (CDA) specifications. It is intended as an alternate implementation to the one specified in ASTM ADJE2369 for those institutions or organizations committed to implementation of the HL7 Clinical Document Architecture.[3][not in citation given]

The public library is relatively limited of reference CCDs available for developers to examine how to encode medical data using the structure and format of the CCD. Not surprisingly, different Electronic Health Record vendors have implemented the CCD standard in different and often incompatible ways.[4] The National Institute of Standards and Technology (NIST) has produced a sample CCD with valid data that is available for public download.[5]

CCD and Meaningful Use[edit]

As part of U.S. federal incentives for the adoption of electronic health records, known as Meaningful Use, the CCD and Continuity of Care Record (CCR) were both selected as acceptable extract formats for clinical care summaries in the program's first stage. To be certified for this federal program, an Electronic Health Record must be able to generate a CCD (or equivalent CCR) that has the sections of allergies, medications, problems, and laboratory results, in addition to patient header information.[6] Several of these sections also have mandated vocabularies, such as LOINC for laboratory results, according to the federal program.[citation needed]

When ambulatory and inpatient care providers attest that they have achieved the first stage of Meaningful Use, they document that they have tested their capability to "exchange clinical information and patient summary record," which is a core objective of the program.[7] Most Electronic Health Record vendors have adopted the CCD rather than the Continuity of Care Record since it is a newer format that harmonizes the Continuity of Care Record and the HL7 Clinical Document Architecture (CDA) specifications. For the proposed second stage of Meaningful Use, the CCD is planned to become the primary extract format for clinical care summaries as part of the Consolidated Clinical Document Architecture.[8]

Competition and Internet Health Industry Standards[edit]

CCD and Continuity of Care Record (CCR) are often seen as competing standards.[9] The now-defunct Google Health supported a subset of CCR,[10] while Microsoft HealthVault claims to support a subset of both CCR and CCD.[11]

See also[edit]

References[edit]

  1. ^ a b ANSI (2010). "Introduction". Implementation Guide for CDA R2 HITSP C32, C83, and C80 Summary Documents. Model-Driven Health Tools (MDHT) for CDA. 
  2. ^ D'Amore, JD; Sittig, DF; Ness, RB (May 2012). "How the continuity of care document can advance medical research and public health". American journal of public health 102 (5): e1–4. doi:10.2105/AJPH.2011.300640. PMID 22420795. 
  3. ^ Ferranti, Jeffrey M.; Musser, R. Clayton; Kawamoto, Kensaku; Hammond, W. Ed (May–Jun 2006). "The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis". Journal of the American Medical Informatics Association 13 (3): 245–252. doi:10.1197/jamia.M1963. PMC 1513652. PMID 16501180. 
  4. ^ D'Amore, John D.; Sittig, Dean F.; Wright, Adam; Iyengar, M. Sriram; Ness, Roberta B. (2011). "The Promise of the CCD: Challenges and Opportunity for Quality Improvement and Population Health". AMIA Annual Symposium Proceedings: 285–294. PMC 3243208. PMID 22195080. 
  5. ^ http://xreg2.nist.gov/cda-validation/downloads/HITSP_C32_Examples_Jan2010.zip
  6. ^ http://healthcare.nist.gov/docs/170.304.i_ExchangeClinicalinfoPatientSummaryRecordAmb_v1.1.pdf
  7. ^ Blumenthal, David; Tavenner, Marilyn (August 2010). "The “Meaningful Use” Regulation for Electronic Health Records". New England Journal of Medicine 363: 501–504. doi:10.1056/NEJMp1006114. PMID 20647183. 
  8. ^ http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4430.pdf
  9. ^ Kibbe, David C. (19 June 2008). "Untangling the Electronic Health Data Exchange". e-CareManagement blog. Better Health Technologies, LLC. 
  10. ^ http://code.google.com/apis/health/ccrg_reference.html[dead link]
  11. ^ Nolan, Sean (13 July 2008). "Again with the Standards Thing". Family Health Guy. MSDN Blogs. 

Bibliography[edit]

External links[edit]