It's common knowledge that the Continuity of Care Document (CCD) specification is a healthcare standard EHRs will use to exchange data, based on requirements outlined in meaningful use. But Rob Brull, product manager at Corepoint Health, says there's more to know about the spec, and how it will impact organizations' MU efforts in the months ahead.
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Brull outlines five things to know about CCD.
1. What exactly is a CCD document? CCD stands for Continuity of Care Document and is based on the HL7 CDA architecture, said Brull. CDA, or Clinical Document Architecture, is a "document standard," governed by the HL7 organization. "HL7 is the leader in healthcare IT standards, with its v2 and v3 standards," Brull said. "The HL7 v3 standards include messaging and document standards. The document standards for HL7 v3 is CDA, and one of the documents within the CDA architecture is CCD."
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2. What is the difference between a CCD document and a CCR document? Brull said in a class he teaches, the "three C's of healthcare" are discussed: CCD, CDA and CCR, or Continuity of Care Record. "The CCD owes its existence to CCR and CDA," he said. "The CCR started out as a three-page paper document, which was used in patient care referrals." Additionally, the CCR was created by the Massachusetts Department of Public Health and included information necessary for providers to effectively continue care. "Since it was a very successful document in the transfer of care scenario, the Massachusetts Department of Public Health teamed up with ASTM and the Massachusetts Medical Society to create an electronic version of CCR," said Brull. Eventually, he continued, ASTM combined efforts with HL7 to construct the CCD document, which includes all the same content of the CCR, but under the architecture of the CDA.
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3. Does a CCD offer the complete medical record? A CCD document isn't intended to be a complete medical history for a given patient, said Brull. "Instead, it's intended to include only the information [that's] critical to effectively continue care. This snapshot of information is broken across 17 different sections, which include the clinical content as defined originally by the CCR." Some sections, such as Family History, could include information from outside of the defined snapshot of time, "but the general intent of the document is to only include information necessary for the continuation of care," he said.
4. What is the main purpose of a CCD? HL7 defines CDA as a "standard that specifies the structure and semantics of 'clinical documents' for the purpose of exchange," said Brull. "With CCD being a type of CDA document, its primary purpose is for exchange — specifically in he content of a patient being transferred from one care setting to another." Guiding policies are emerging in health IT, he continued, to ensure this exchange takes place in a secure and efficient way. "The Direct Project and NwHIN Exchange provide rules for exchanging CCD's, by either pushing the document ot the next provider, or requesting the document from the previous provider," said Brull. "Rules from both of these organizations are based on profiles defined by IHE, or Integrating the Healthcare Enterprise."
5. Can a provider or patient use or view a CCD document without special software? "One of the most important characteristics of a CCD is that it must be human-readable using any standard Web browser," said Brull. "This is a requirement of any CDA document." The patient data within a CCD document is encoded using XML, he said, which can be displayed on a Web browser using a style sheet. "If the creator of the CCD document created the document in a user-friendly fashion, the style sheet will be available via the Internet," he said. "Thus, any clinician, or even just the patient, can open the CCD document and view the patient health data with just an online Web browser."