The Continuity of Care Document (CCD) was approved earlier this week. The CCD is a collaborative effort between the HL7 standards and ASTM International organizations. To add to confusion, there are multiple standards for electronic patient record (EMR / EHR) integration. They are:
- Continuity of Care Record (CCR) – authored by ASTM
- HL7 Clinical Document Architecture (CDA) – authored by HL7
- Care Record Summary (CRS) – original HL7 attempt at patient care integration standard, later incorporated into HL7 CDA
- Continuity of Care Document (CCD) – jointly agreed to by ASTM and HL7 and endorsed by the Healthcare Information Technology Standards Panel (HITSP)
CCD is a part of the healthcare interface standards “harmonization” effort, which is worthwhile and needed. Regardless, it creates confusion in the marketplace as to which standard to use or ask for when evaluating EMR and EHR systems as well as in determining the overall connected healthcare community strategy for a hospital, lab, clinic, or imaging center. Which one? CCR, CDA, or CCD?
In a Modern Healthcare article entitled CCD Standard Up for a Vote, there is a quote from the American Academy of Family Physician’s Center for Health Information Technology as to why the different standards.
“There isn’t really a rift between ASTM and HL7. I think where the rift starts to come is between legacy vendors and some of the Internet-technology-based vendors. You have the large hospital vendors (more or less in the HL7 camp) and the smaller physician office system vendors (using CCR). That’s where the controversy starts to explode.”
Peter Waegemann, chief executive officer of the Medical Records Institute, adds to this in a subsequent Modern Healthcare article entitled Standards Rivals’ Collaboration Could Have Major Impact:
“Vendors and users of large IT “legacy” systems that are backers of HL7’s Clinical Document Architecture will gain the most benefit from the CCD because they will be able to use the CCR format in their systems, Waegemann said. But the collaboration with HL7 on the CCD further establishes the CCR, he said.”
Both are valid points. The good news in this announcement is that CCR and CCD will work well together. This will facilitate a more integrated healthcare environment. As clinics, hospitals, labs, and imaging centers move forward, they will need to continue to be adaptive in their integration approach. Flexibility is essential in the near term.
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