CCR … I’m sure there are days for those who work in Health IT and with the various health standards when it would be a nice, mental break if those three letters represented what many recognize it as – Creedence Clearwater Revival. We could all take it easy like Jeff “The Dude” Lebowski, roll down the windows, blast “Down on the Corner” on the radio, and just go bowling.
But, if you’re like most other healthcare standards experts, you probably wouldn’t get past the fourth frame before your mind wanders to that one interface that needs close monitoring or the steps you need to take to hit your ambitious Q1 goal of meeting Meaningful Use requirements.
You don’t visit this blog for music or movie suggestions, so I’ll quickly transition from The Dude to Meaningful Use, particularly the Transfer of Care initiative.
In a recent presentation hosted by the NeHC University, Jitin Asnaani, Initiative Coordinator for the Office of Interoperability & Standards at the ONC, revealed insight to the future of the CCR and the C32 (CCD) documents related to Meaningful Use. He addressed progress that had been made by one of the key initiatives within the Standards & Interoperability (S&I) Office, the Transfer of Care (ToC) initiative.
The mission of the ToC initiative is to improve the electronic exchange of core clinical information among providers, patients and others while focusing on improvement in the quality of care. He cited the Meaningful Use Stage 1 short-comings:
- Ambiguous definitions for data.
- Multiple existing standards.
- Insufficient implementation tools.
For Meaningful Use Stage 1, there were multiple document standards: CCR and C32. While CCR was much more defined than C32, its flexibility was limited. But implementing C32 required sifting through numerous implementation guides to understand the data definitions and the structure. Mr. Asnaani indicated that the S&I ToC Community of 150 members reached consensus for a single standard for clinical summary documents for Meaningful Use Stage 2: Consolidated CDA.
Just like Creedence, the CCR healthcare document standard seems set to become a distant memory. But that’s not to say that Consolidated CDA is a “Bad Moon Rising,” or even (thankfully) a Creedence Clearwater Revisited.
Consolidated CDA is a streamlined version of CDA which is based on HL7 CDA Release 2. However, all of the various implementation guides of the original CDA are combined into a single library of CDA Templates. Combined with the implementation guide cleanup, the C32 (which is a type of CDA) was updated and harmonized and known issues concerning ambiguity and gaps were addressed. Figure 1 illustrates the relationship between previous Meaningful Use documents used for Stage 1, as compared to the new templated version.
In a recent a blog, I talked about the positive impact that streamlining the vocabularies utilized for Meaningful Use would have on the interoperability of clinical documents. While it is sad to see the simplicity of CCR no longer supported, moving toward a single standard document is yet another step in the right direction. Moving towards a single clinical document, organizing the definitions of that document better, and updating it to correct issues will go a long way to help providers move from “demonstrating” that ability to transfer clinical documents to “utilizing” the data contained in the clinical documents for a better quality of care.
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