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Continuity of Care Document for Clinical Data Exchange

Prior to the approval of the Continuity of Care Document (CCD) as 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 created.

CCD harmonizes the two separate standards by using CCR within the broader context of CDA. It shares summary information about the patient in an easy-to-read format, using CCD templates to constrain the data. The information can be read by the human eye or processed by a machine (such as an EMR system), and can be sent electronically or manually carried by the patient.

CCD is widely compatible with new and existing technology/standards because it is based on HL7 CDA – a RIM-based specification. It can work with existing applications, browsers, EMRs and even legacy systems. Because of its small fixed XML tag set, CCD can be rendered as HTML or PDF, and requires no specialized communication efforts or changes to existing processes.

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

Moving into the future

New CCHIT certification criteria require all ambulatory and inpatient EHRs to be CCD compatible, making CCD the preferred standard for clinical document exchange as we move forward into the future. The new criteria is also instrumental in encouraging the use of an electronic health record within the healthcare community.

Those implementing CCD will be readily compatible with new technology, while simultaneously opening the doors to greater compatibility and better care for patients.

Posted in CCD, CDA, HL7 Basics
  • http://www.ringholm.de/column/rs_last_en.htm Rene Spronk

    A few comments:

    The CCD is a US-specific implementation guide based on HL7′s CDA standard, just like there are many country-specific implementation guides, e.g. see http://www.ringholm.de/download/CDA_R2_examples.zip for a 60 Mb archive of CDA implementation guides and examples. Although some parts of the CCD (those parts that focus on clinical content) may be applicable outside of the US, the implementation guide as an overall specification isn’t.

    The text could be interpreted to mean that -given the existence of the CCD- there is no need anymore to use other CDA based documents. I’m not sure all e-Document use-cases can be covered by the CCD. The attempt to standardize at the national level has to be applauded however.

    Some of the IHE CDA implementation guides are making sure they’re compliant with the CCD. IHE implementation guides have an international scope, and as such this is a tough balancing act.. how to ensure that a specific e-Document will work given the requirements of the US, France, Germany and Argentina? (to just name a few countries).

    Your blog is read in many countries – please always mention whether something is country-specific or not, or some readers may attempt to implement a Brazilian standard in a US context, or a French one in Finland.

  • http://www.macadamian.com/insight/healthcare Didier Thizy

    A common concern I’ve heard from software teams is that the implementation guides for CDA and CCD are quite lengthy, without too many concrete examples of what a CDA XML file or CCD XML file should look like.

    I’ve scoured the internet finding a lot of the examples that people have posted on various blogs and newsgroups:
    http://tinyurl.com/yf6sv88

    This may be helpful to readers, and certainly if you know of other examples of CCD XML files let me know so I can add to my repository.

    Didier

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  • Nanospeck0

    Great info on CCD. I was searching all over the internet for helpful links.