The Continuity of Care Document

Changing the landscape of healthcare information exchange

Electronic clinical document exchange

Prior to the approval of the Continuity of Care Document (CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More) as an ANSI Standard in 2007, electronic data exchange of clinical data could utilize one of two formats: HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More Clinical Document Architecture (CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More) or ASTM Continuity of Care Record (CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More). Both formats allow providers to share clinical summary information about patients to referring physicians, pharmacies, EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More systems and other providers.

Both formats also have the ultimate goal of improving patient care. But although they are similar in this way, they are not compatible with each other.

In an effort to combine the two closely related formats, the CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More was created. CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More provides a consolidated, single standard for clinical documents in the healthcare community. It harmonizes the two separate standards by using CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More within the broader context of CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More.

The goal of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is to increase the quality and efficacy of patient transfer between points of care. Its use is also instrumental in driving the increased adoption of EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More systems and electronic health records (EHRs), and the move towards more modern communication methods for patient data exchange.

Two competing standards

What is HL7 Clinical Document Architecture (CDA)?

CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More is an XML-based, electronic standard used for clinical document exchange that was developed by Health Level 7. CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More conforms to the HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More V3 Implementation Technology Specification (ITS), is based on the HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More Reference Information Model (RIM), and uses HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More V3 data types. It was known earlier as the Patient Record Architecture (PRA).

CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More is a flexible standard and is unique in that it can be read by the human eye or processed by a machine. This is due to its use of XML language, which also allows the standard to be broken into two different parts. A mandatory free-form portion enables human interpretation of the document, while an optional structured part enables electronic processing (like with an EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More system). Text, images and even multimedia can be included in the document.

CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More does not specify a transport mechanism and can be utilized within a messaging environment or independently of it. Transport methods can include HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More V2, HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More V3, DICOMDigital Imaging and Communications in Medicine (DICOM) is a common format for image storage. It allo... More, MIME-encoded attachments, HTTPHTTP (Hypertext Transfer Protocol) is the foundation for application-level communication on the inte... More, or FTP. CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More is flexible enough to be compatible in a wide range of environments.

What is the ASTM Continuity of Care Record (CCR)?

CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More is also an XML-based standard used for clinical data exchange, but was developed by ASTM International. CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More provides a “snapshot” of treatment and basic patient information—it is not comprehensive like an EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More. Its primary function is to ease the transition of a patient from one provider to the next.

The information included in the record focuses on the diagnosis and reason for referral rather than symptoms and treatment chronology. It may include information from only a single provider visit or may be more extensive to include data from multiple visits. The amount of information included varies by provider and patient.

CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More is a concise standard that uses a defined set of core data and is based on XML. However an important distinction between CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More and CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More is that CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More uses only specified XML code. It does not have a free-text section which is rendered and authenticated as the CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More requires. However it does have Description.Text XML elements which allow for text to be stored, although these elements will not be rendered with the standard CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More style sheet

Who uses these standards?

In current practice, very few providers or vendors in the United States actually utilize these clinical document standards. Resistance to adoption is due to the relative newness of the standards and historically the lack of a mandate to utilize them. However, in July 2010 the ONCOffice of the National Coordinator for Health Information Technology (ONC) – Located within the Of... More published its Final Rule for EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More Certification requirements which are tied to Meaningful Use funds. Both CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More and CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More are called out as standards for EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More Certification. As of 2011 there seems to be more momentum towards using these standards, although actual utilization still remains low.

Harmonizing historically divided standards

How did the Continuity of Care Document (CCD) develop?

The CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More was formed through a joint collaboration between Health Level 7 and ASTM International. It was created to address the divide between those who have adopted HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More and those who have adopted the ASTM CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More, and to drive the use of electronic exchange for clinical data.

The collaboration between the two organizations makes the resulting standard widely compatible with existing systems as well as with other similarly formatted standards. The hope is that the introduction of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More will encourage the growth of EHRs and the use of electronic exchange of information among physicians, leading to better patient care, safety, quality and efficiency.

Components of CCD

CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is built on CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More elements, but the data itself is defined by CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More.

To form the standard, CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More uses a detailed set of constraints (or templates) for CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More elements. The templates define how to use CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More elements to communicate clinical data. The scope of the clinical data itself, within the templates, is set by CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More. Each template may have further supporting templates, as required.

Elements of a CCD Template

Keeping pace with technology

Most professionals in the healthcare industry would agree that the future of care lies in the use of electronic documents, personal health records, and EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More systems. But those who have implemented CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More or some other data exchange method for their clinical documents may wonder—what makes CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More a better solution?

A universal standard

As more and more providers move towards electronic data exchange, a universal standard for clinical documents is needed to assure connectivity regardless of location. This means finding a standard that can be widely implemented, universally accepted, and that allows the increasingly widespread use of electronic exchange to continue to march forward.

Implementing CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More addresses this need by allowing for broad compatibility and easy assimilation into new and existing technology or standards. Because it is a blend of HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More and ASTM standards—two very prominent standards organizations in healthcare—CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is potentially compatible throughout multiple levels of the healthcare community. CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is also a true document, not just a record, and is congruently designed for the same type of exchanges as those performed in an EMR—including import, management, and export of XML data.

Easy integration

The HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More RIM-based specifications that form the base of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More are widely compatible with existing applications, browsers, EMRs and legacy systems. Any document or standard that uses the same patterns is also plug-and-play compatible with CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More. These include new versions of HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More, new types of public safety reports that use RIM-based messages, IHEIntegrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industr... More specifications, HITSPHealthcare Information Technology Standards Panel (HITSP) serves as a cooperative partnership betwee... More specifications and CDISC.

Because of its small fixed XML tag set, CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More can be universally rendered as HTML or PDF. No specialized communication efforts or tedious changes to existing processes are required.

XML

Healthcare continues to march steadily towards the use of XML for data communication needs. CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More follows this trend by encouraging the implementation of XML for clinical document exchange. It also keeps pace with the introduction of XML in HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More V3—the wave of the future for healthcare information exchange.

Adopting CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More ensures that your organization maintains maximum adaptability to your trading partners’ needs as more and more systems migrate to this more modern markup language standard.

CCHIT certification

In June 2008, CCHITCertification Commission for Healthcare IT (CCHIT) serves as the recognized US certification authori... More published its final approval criteria for emergency department EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More products and for EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More vendors. The new criteria require all ambulatory and inpatient EHRs to be CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More compatible in order to become CCHITCertification Commission for Healthcare IT (CCHIT) serves as the recognized US certification authori... More certified. This means being able to send and receive clinical documents in CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More format.

ONC EHR certification

In July 2010, the ONCOffice of the National Coordinator for Health Information Technology (ONC) – Located within the Of... More released the certification criteria for EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More Technology. With this, CCHITCertification Commission for Healthcare IT (CCHIT) serves as the recognized US certification authori... More became a certification body of the new criteria. The THE CONTINUITY OF CARE DOCUMENT 5 new criteria allowed for the CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More or CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More standard to be used for clinical document exchange. Because of the implication on Meaningful Use funds, this provided greater incentive for vendors to implement CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More or CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More in their EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More systems as providers demand product that is certified.

The ONCOffice of the National Coordinator for Health Information Technology (ONC) – Located within the Of... More endorsement of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More and CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More as part of their certification process is an important step in facilitating the widespread adoption of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More, CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More and XML in general. It also is instrumental in encouraging the use of an electronic personal health record.

Improving patient care

A key indicator of a progressive healthcare system is quality patient care that continues to improve over time. Persistent efforts to make care more efficient and effective are essential to continued growth as we move further into the 21st century.

CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is one step in that direction.

Quick access to key patient data

A differentiating characteristic of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is that it shares summary information about the patient, in an easy-to-read format, within the broader context of the personal health record. Its focus is on sharing the most important patient health information in a way that is easily communicated between points of care, while at the same time contributing to the patient’s overall health history.

For the patient, this means less loss of meaning and misinterpretation of data by providers. For physicians, this means easier access to vital patient health information and better patient care.

Wide accessibility

CCD’s high level of compatibility makes it easy to implement and allows a large number of providers to access vital healthcare information—with very few roadblocks along the way.

The basic elements of a patient’s health record are for the first time easily portable and do not disrupt existing data flows. In addition, a lack of electronic connectivity no longer prevents transmission of patient data because the document is readable by the human eye.

Using CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More, physicians are better able to access the information regardless of location or circumstance. The end result is improved safety for patients and a more informed level of care.

CCD in the real world

Real-world implementation of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is still in its very early stages. Hospitals, labs, clinics and imaging centers are only now discovering the many ways CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More could be implemented in their unique environments.

Here are a few of the possibilities.

How CCD is implemented

CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is best utilized within the context of a personal health record or EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More. A typical scenario of use might look something like this:

A patient has a test performed at a lab. The lab generates an HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More V3 ORU message and sends it to an EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More system. The EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More then generates a CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More for the patient, which is either sent electronically to the provider or printed out for the patient to carry to the next point of care.

In this scenario, the lab results are transferred in a way that prevents loss of meaning or errors in interpretation, while at the same time working within the context of the EHRElectronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The ... More. The CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More functions well as part of the comprehensive personal health record. At the same time, it maintains universal compatibility among providers to share vital patient information— in this instance test results—in the most accurate and efficient manner possible.

In another scenario, a physician uses CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More to enter free-form text about a patient visit alongside the standardized information such as demographics or lab results. This is an advantage over other standards—like CCR—which do not allow narrative text. In this situation, specific information that is important for continued care of the patient—and that would otherwise not be conveyed—is now available to the receiving physician.

Future possibilities

Because CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is built using both CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More and CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More, it is potentially compatible with any number of documents that use either of these standards. This flexibility allows you to work seamlessly with differing formats as needed, or to perform conversions between formats if required. So for example, doctors might be able to send a CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More and then have it converted to CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More and posted to a patient’s EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The... More.

Summary

The design and flexibility of CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More is a more usable version of two complimentary document standards. Its development makes both CDAClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More and CCRContinuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between... More less favorable in certain situations, and encourages migration to a single standard for clinical documents across the entire healthcare community.

The CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More gives providers easier access to information with less loss of meaning than with previous standards. Its use enables sustained growth of EMRs and other electronic data exchange applications even as new systems and standards develop.

With CCDContinuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the He... More, you can be prepared for future technology while simultaneously opening the doors to greater compatibility within your healthcare community. The end result is better, more efficient care for patients.

About Corepoint Health

Corepoint Health solutions deliver interoperabilityInteroperability refers to the ability of two or more systems or components to exchange information ... More for healthcare organizations and simplify the complexities of healthcare data through practical software applications, consulting and training. Our innovative and proven software solutions leverage clinical data flow efficiently for a diverse group of healthcare entities including hospitals, imaging centers, laboratories, clinics and healthcare vendors. This next generation approach to healthcare data and streamlined workflow is where Corepoint Health specializes in helping customers discover the power of integration.

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