Recently, Rob Brull, product manager at Corepoint Health, outlined five things to know about CCD, the standard for Stage 1 Meaningful Use. And now, we looked to Brull to explore Consolidated CDA, a type of CCD document in the proposed Meaningful Use Stage 2 guidelines for the exchange of clinical health data.
Brull answers five questions about Consolidated CDA.
1. Why Consolidated CDA? With CDA and, specifically, CCD, a specific document within the CDA standard, there were "many sources of truth," said Brull. "For example, in meaningful use Stage 1 rules, the document standard referenced was C32, which is a constraint of the CCD document defined by Health Information Technology Standards Panel (HITSP)," he said. Essentially, this was HITSP's version of CCD. "So, to understand the full meaning of C32, a user would have to traverse documentation from HL7 and HITSP," said Brull. He added there were other organizations with constraints too, like Health Story for Integrating the Healthcare Enterprise (IHE). "Consolidated CDA aims to organize all the documentation in one place."
[See also: Meaningful use final rule to see 'minor revisions'.]
2. What is the ‘Consolidated’ part of Consolidated CDA? According to Brull, "consolidated" refers to the development of a single implementation guide that he says can be the single source of truth. "It represents harmonization of Health Story guides, HITSP C32, part of the IHE Patient Care Coordination, and the original CCD by HL7," he said. "The Consolidated CDA implementation guide defines templates used to structure the document." With one implementation guide – and all the templates – defined in one place, the standard becomes easier to analyze and implement, he added.
3. How are templates used in the Consolidated CDA standard? The Consolidated CDA implementation guide contains a library of CDA templates, said Brull. "These templates originate from HL7, IHE and HITSP. The templates are defined at three levels: document, section and entry," he said. The document level templates define the type of CDA document, like CCD. The section level templates define how data within specific sections will be structured, like vital signs. "Thus, vital signs will be structured the same in a CCD document as compared to a History and Physical document, with no need to recreate the wheel for different documents," he added. "Entry-level templates define how specific observations, procedures, etc. will be structured, making entries appear the same no matter what document or section they are a part of."
[See also: Meaningful use letters pour in.]
4. How many different types of documents are included in Consolidated CDA? The Consolidated CDA implementation guide defines nine different types of commonly used CDA documents, said Brull, including:
- Continuity of Care Document
- Consultation Notes
- Discharge Summary
- Imaging Integration, and DICOM Diagnostic Imaging Reports
- History and Physical
- Operative Note
- Progress Note
- Procedure Note
- Unstructured Documents
"Each of these nine documents has a document template defined in the Consolidated CDA implementation guide, which will now be the single source of truth for implementing these CDA documents," he said.
5. What specifically did the proposed rule for Meaningful Use Stage 2 refer to? "The proposed rule for Meaningful Use Stage 2 referred to the, 'adoption of solely the Consolidated CDA standard for summary care records,'” said Brull. "The proposed rule did not specifically mention the CCD document template within the Consolidated CDA standard." However, he added, since the proposed rule refers to a “summary care record,” it's safe to assume the CCD document will be the specific standard among the nine Consolidated CDA document types that will be utilized for Meaningful Use Stage 2.
6. Is Consolidated CDA really new? "From a content perspective, my answer would be, 'only slightly,'" said Brull. "Ambiguities existed between the many sources of truth for C32, and those ambiguities will be fixed, since now there will be only one implementation guide." Other tweaks have been made to the content as well, he continued, but for the most part, CDA document types, including CCD, will remain largely the same in the new Consolidated implementation guide. "However from a documentation standpoint, my answer would be yes; the CCD document in particular is now much easier to understand, implement, and analyze," said Brull.