Interoperability and EHR, New trends: The CCD

A recent development to further interoperability is the Continuity of Care Document (CCD). The continuity of care document is the tool that allows for interoperability between clinicians and EHR systems. The CCD was created and defined to allow for a common platform primarily for health care providers to exchange patient information accurately and improve patient care¹. 

The clinical care document is the file set of patient summary information, designed to be exported from a provider’s EHR system and delivered to the patient or another health care provider. The CCD is normally created by an EHR or other system used by a health care provider, and is a single standalone representation of the patient health history and medical record that can be viewed on a common platform. The development of the CCD also establishes a baseline for recommendations from the health care profession, a standard for data, and guidelines for clinical practices².

The Continuity of Care document follows the guidelines of the Clinical Document Architecture (CDA) standard, which uses Extensible Markup Language (XML). The XML format is a self contained data structure that defines the content, and this is paired with a standard HTML code to establish the display to render the document readable from a web browser.  The XML structure defines the standard groupings by clinical content, and makes use of common classes and associations. The CDA format offers a flexible approach where the data segments can be moved or re-used allowing for many combinations but still using the same data structure. The XML data starts with a header, defining the elements and then contains a body section, which is further divided into Sections, each with provisions for narratives and specific procedure entries. The Body section starts off with the clinical report and at least one section. Each section must contain one narrative block for human readability and is populated by the end user. There may also be zero or more specific entries, such as allergies, prescription drugs, problems, vital signs. These are coded for machine readability by a decision support system or another EHR system².

References:

1 HealthIT.gov (2013). Implementing Consolidated-Clinical Document Architecture (C-CDA) for Meaningful Use Stage 2 .Clinical Document Architecture Overview.  Retrieved 4/6/15 from http://www.healthit.gov/sites/default/files/c-cda_and_meaningfulusecertification.pdf

2 Health Level 7 (2015). HL7/ASTM Implementation Guide for CDA R2 Continuity of Care document, Release 1. Health Level Seven International. Retrieve 2/3/15 from: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=6