There has been a great deal of discussion on what is happening – and will happen – with the two continuity of care standards. As a refresher, the two are:
- ASTM Continuity of Care Record (CCR): an XML-based standard for the movement of “documents” between clinical applications. Furthermore, it responds to the need to organize and make transportable a set of basic information about a patient’s health care that is accessible to clinicians and patients.
- Continuity of Care Document (CCD): the result of a collaborative effort between the Health Level Seven (HL7) and American Society for Testing Materials (ASTM) to “harmonize” the data format between ASTM’s Continuity of Care Record (CCR) and HL7’s Clinical Document Architecture (CDA) specifications.
We ran a poll asking “if you could just vote for one, which would it be?” The results are outlined below.
- For CCD: 70%
- For CCR: 30%
We also wrote a post about Chilmark Research’s blog on the two patient care summary standards. Recently, I discovered a response to the Chilmark post, and it was by the e-CareManagement blog entitled Chilmark Needs to Chill Out on CCR/CCD Findings. From the post:
“Here’s another metaphor: asking a HIE whether they prefer CCR or CCD is like asking an ancient Roman whether they would prefer to converse in Latin or Swahili. The obvious answer will be “Latin” — not because Latin is a better language, but because they already have sunk costs into learning Latin. If you already speak Latin, it won’t bother you that Latin is complex, archaic and difficult to learn.”
Take a few minutes to read the blog post, and be sure to read all the comments below his post, including one from Chilmark Research.
Vince Kuraitis from e-CareManagement blog responded to one of our earlier posts with a similar argument. The argument is that CCR is more usable and appropriate for the ambulatory setting while CCD is geared more towards HIEs and larger health care institutions. The discussion is healthy. A few other highlights from others include:
- David C. Kibbe, MD MBA: “This isn’t really a standards problem at all. It’s a business model problem. Businesses that want to exchange data have always found a means of doing so, and now, in health care, it’s gotten much, much easier to do so. It helps that the feds are behind this movement.”
- John at Chilmark: “The issue is not Linux or .Net, Latin or Swahli, that is too simplistic. What is at issue is what standard will help an organization do the work they need to do. CCR may be fine in a small ambulatory practice with limited IT resources and simple data mgmt requirements/workflow. CCR though is not flexible enough to allow larger practices, clinics and hospitals to create document structures, add data types, etc. to meet their internal operational needs. As David rightly pointed out, it is a business issue.”
- John D. Halamka, MD, MS: “We noted that CCR is a fine patient summary standard, but for other uses such as reporting the actors/actions/events in clinical workflow needed for quality measurement, CCD is preferred over CCR.”
In the Healthcare Standards IFR, it states that both CCR and CCD are allowed initially, but the direction needs to be move to one continuity of care “standard.” This consolidation needs to occur by 2013.
The arguments are correct – one is more heavy duty and the other easier to work with; one is for HIEs and large organizations, and the other is for ambulatory settings. In fact, the poll we conducted may reflect this sentiment. Thirty percent in favor of CCR may reflect more ambulatory responses than others, or it may be the people who have tried to work with the existing CCD standard!
At some point, CCD and CCR need to come together more closely. It will assist in the exchange of patient data between smaller ambulatory, larger care delivery organizations, and HIEs. These type of exchanges will ensure really meaningful use, not just hype or getting half-way there. Green CDA may be the approach that resolves the discussion.
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