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Co-creating Value in Healthcare with Interoperability

Jul 26 2010   2:41AM GMT

CCD – Clinical Document Exchange standard in EHR:



Posted by: Nirpath
CCD, CCR, CDA, Interoperability and health information exchange

We still come across the standards such as CDA (Clinical Document Architecture), CCR (Continuity of Care Record) and CCD (Continuity of Care Document), but which one should we use for an EHR implementation.

CCD has come up in 2007, prior to which CDA and CCR were used for sharing clinical summary information about patients to referring physicians, pharmacies, EMR systems and other providers. A system using CCR is not compaitble with the same using CDA. So, buyers should know and enquire about – what kind of standard is being used by the EMR.

To solve the issues of incompatibility, CCD is created as an hybrid standard solution – using CDA elements, the data being defined by CCR.

As part of the new critera from CCHIT – 2008, all ambulatory and inpatient EHRs should be CCD compatible – which means the participating systems to send and receieve clinical documents in CCD format. CCHIT’s endorsement of CCD as part of their certification process is very good indicator for creating interoperable solution from different ISVs, paving the way for better communicating EHRs and Health exchange.

Real-world implementation of CCD is still at early stages. Labs, Clinics, imaging centers are exploring many ways on using CCD to stream line their manual processes and improving their return on investments. Few examples could be –
1. A patient performing a test at a Lab, which generates an HL7 “ORU” message and transmits to the referring physician’s office / EMR system. The EMR then generates CCD from the HL7 lab result message. This CCD can be part of the comprehensive Health Record, maintaining interoperability with other providers sharing patient information and test results in an accurate manner cutting down lots of manual work flow processes.
2. A physician can use CCD to enter free-form text about a patient visit in the standardized format, which is not possible in CCR. This specific narrative text could be very important for continued care of the patient at another provider’s place or hospital.

Advantages of CCD:
1. Shares summary of information about the patient very easily with other vital information as secondary information. The summary information may clarify some missing data about the patient, helping the other physician understandig the patient better and giving better patient care.
2. High level of compatibility and wider adaptibility makes it a better choice for the providers.
3. It’s easily understandable by Human unlike other standards like HL7 which are more of machine friendly.
4. Xml format, beign easy with machines to do faster processing and compatibility with other systems designed with Xml.

CCD’s developments make both CDA and CCR less favorable in specialized situations encouraging migrations to a single standard – making one step closer for interoperability. The end result is better – more efficient care for patients.

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