How Do CCR and CDA Compare?

October 18th, 2006 by Dave Shaver Print Friendly

HL7′s Clinical Document Architecture (CDA) stores or moves clinical documents between medical systems. Documents are things like discharge summaries, progress notes, history and physical reports, prior lab results, etc. The CDA uses XML for encoding of the documents and breaks down the document in generic, unnamed, and non-templated sections.

HL7′s CDA defines a very generic structure for delivering “any document” between systems. What is missing in the CDA standard proper is a listing of the sections of that document. That is, a template of the expected sections that will appear in a given type of document. For example, on a history and physical document, sections could be named Current Medications, Prior Immunizations, Social History, etc.

Ignoring the political or technical motivation, an independent group at the ASTM was formed and worked to define an XML standard for moving documents between systems. Initially, this standard was unrelated to HL7′s CDA standard. It is fair to say the standards competed for mind share and each expressed a different integration philosophy.

In later efforts, the two standards groups agreed to effectively make the standards compatible with each other. The Memorandum of Understanding (MOU) between HL7 and ASTM says that they will “harmonize” the two competing standards. That’s a fancy way of saying they will play nicely.

In short, although not 100% technically correct, in HL7 training I like to describe the CCR as a specialization of the CDA. That is, the CCR provides a template of the expected sections that will be provided in CDA format. This CCR “content profile” is a tightly controlled list of document sections answering the “What major bits of data will be sent?” question. The CDA, then, is the structure of how the document will be formatted in XML.

There is a good overview of CDA and CCR over at the American Academy of Family Physicians web site.

There are also several related postings on this blog site:

Posted in CCR, CDA

http://hl7standards.com/blog/2006/10/22/formal-article-publication-comparing-cda-and-ccr/ Dave Shaver

[...] While I posted a short description comparing CDA and CCR, there is a formal article written by Ed Hammond et al and is titled, The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis. This article was published in the Journal of the American Medical Informatics Association (JAMIA). Later in the month, I’ll summarize this article. For now, here is the abstract: The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis [...]
http://hl7standards.com/blog/2007/02/15/what-is-hl7-continuity-of-care-document/ What Is the HL7 Continuity of Care Document?

[...] The HL7 Continuity of Care Document (CDD) is the result of a collaborative effort between the Health Level Seven and ASTM organizations to “harmonize” the data format between ASTM’s Continuity of Care Record (CCR) and HL7’s Clinical Document Architecture (CDA) specifications.� [...]
http://hl7standards.com/blog/2007/02/15/emr-standards-c-change/ EMR Standards – A “C” Change

[...] HL7 Clinical Document Architecture (CDA) – authored by HL7 [...]
http://hl7standards.com/blog/2007/02/01/who-uses-hl7/ Who Uses HL7?

[...] read about how the HL7standard relates to various healthcare IT initiatives like ELINCS, CCR, and HL7 CDA. You may also be aware of the�sea-tide change among clinics and their EMR systems as they�now are [...]
http://hl7standards.com/blog/2007/10/10/preparing-for-hl7-v3/ Preparing for HL7 V3

[...] standards (e.g., Inpatient Encounter, Ambulatory Encounter, etc.) and V3 Documents standards (e.g., CDA, CCD, etc.) are all based on the [...]
http://hl7standards.com/blog/2008/05/15/cda-the-american-bridge-from-hl7-v2-to-v3/ CDA – The American Bridge from HL7 V2.X to V3?

[...] that US adoption of the HL7 Version 3 Standard is still years away, with one lone exception:� Clinical Document Architecture [...]
http://www.hl7standards.com/blog/2006/10/18/how-do-ccr-and-cda-compare/ How Do CCR and CDA Compare?

[...] What is the Continuity of Care Record (CCR)? [...]
http://www.hl7standards.com/blog/2008/07/29/continuity-of-care-document-for-clinical-data-exchange/ Continuity of Care Document for Clinical Data Exchange

[...] an ANSI Standard in 2007, electronic clinical document exchange could utilize one of two formats: HL7 Clinical Document Architecture (CDA) or ASTM Continuity of Care Record (CCR). In an effort to combine the two closely related formats, the Continuity of Care Document was [...]
http://www.hl7standards.com/blog/2008/01/25/comparing-hl7-messages-to-hl7-documents/ Comparing HL7 Messages to HL7 Documents

[...] do the healthcare standards apply?�In HL7 messaging, HL7 V2.X and HL7 V3 apply. In HL7 documents, HL7 Clinical Document Architecture (CDA) and ASTM Continuity of Care Record (CCR) standards apply. Both approaches deliver value to [...]
http://www.hl7standards.com/blog/2007/02/15/emr-standards-c-change/ EMR Standards – A “C” Change | HL7 Standards

[...] Clinical Document Architecture (CDA) – authored by [...]
http://www.hl7standards.com/blog/2006/11/28/interoperability-rsna-standards/ Interoperability, RSNA, and Standards – What Do They Have in Common? | HL7 Standards

[...] IT published an article entitled New Standards to Help with Interoperability about how DICOM and HL7 Clinical Document Architecture (CDA) work together to solve healthcare integration issues.�As the article states, “Since [...]
http://www.hl7standards.com/blog/2007/02/15/what-is-hl7-continuity-of-care-document/ What Is the HL7 Continuity of Care Document? | HL7 Standards

[...] ASTM’s Continuity of Care Record (CCR) and HL7′s Clinical Document Architecture (CDA) [...]

How Do CCR and CDA Compare?

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