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CCD Standard Gaining Traction, CCR Fading

In a number of interviews with leading HIE vendors, it is becoming clear that the clinical standard, Continuity of Care Document (CCD) will be the dominant standard in the future.  The leading competing standard, Continuity of Care Record (CCR) appears to be fading with one vendor stating that virtually no client is asking for CCR today.  This HIE vendor did state that one client did ask for CCR, but only to enable data transfer to Google Health.

CCR was created by ASTM with major involvement by AAFP wih the objective to create a standard that would be far easier to deploy and use by smaller physician practices.  At the time of CCR formation, the dominant standard was HL7’s CDA, a beast of a standard that was structured to serve large hospitals and based on some fairly old technology and architectural constructs.  With competing CDA and CCR standards in the market, there was a need for some rationalization which led to the development of CCD, a standard that combined some of the best features of CCR and CDA.

Today, CCD is seen as a more flexible standard that is not nearly as prescriptive as CCR. This allows IT staff to structure and customize their internal HIT architecture and features therein for their users and not be confind to a strict architectural definition such as that found in CCR.  (Note: such strict definitions are not always a bad thing as they can greatly simplify deployment and use, but such simplicity comes at a price, flexibility.)

Unfortunately for Google Health, who has built its system on top of a modified version of CCR, this trend   likely lead to increasingly difficulty in convincing healthcare providers to provide patient health records in a CCR format.  Google would be wise to immediately begin the work necessary to bring CCD documents into their system as the writing on the wall is getting clearer by the day.  CCR is a standard that will fade away.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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MohanPingalaThe EHR GuyDavid C. Kibbe, MD MBASherry Reynolds Recent comment authors
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Pingala
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Pingala

I am looking for a sample CCD for bulk-loading demograhics. Can someone send or point me to a link where I can get the document? Thanks in advance.

Mohan
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Mohan

Hi,

I have provided Sample CCD with good data with covering C32 and MU standards. For your request of bulk loading process, if you require I can put some time of creating it.

If interested send an email to this ID : Mohan_raj_3000@yahoo.co.in

The EHR Guy
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One of the most asked questions I have been receiving these last few months from companies, developers and physicians alike is: “What standard should I use, CCD or CCR?”. I respond: “Both!”. Why? Well, we never know what the customer wants until they have made their choice. Microsoft also decided to do this as well, obviously for some reason. Now, I’m sure that the one to take off will be the most documented one so that people can refer to for learning. As far as I know, and I learned this at HIMSS 10 yesterday, a CDA book is being… Read more »

David C. Kibbe, MD MBA
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David C. Kibbe, MD MBA

Hurray! We’re discussing the actual use of health data exchange standards that use XML (extensible markup language, the lingua franca of the Web). This was a major purpose of creating the CCR standard in 2004-05, as a means of enabling movement of health data over the Web and Internet, you know, as other industries have done to share data and make it computable using web services. So, simply having the choice of two XML clinical summary standards that can be computably exchanged is real progress. But there’s still a long way to go until any EHR technology can reliably and… Read more »

Sherry Reynolds
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Sherry Reynolds

FYI – In ONC’s presentation today at the National eHealth Collaborative – the NHIN Limited Production Implementation uses a limited C32 Continuity of Care Document (CCD)
• Demographics
• Allergies
• Medications
• Problem List
and by July 31, 2010 they expect to use
– HITSP C32 subset
– Add’l ICIB-Defined/HEC Approved Data
Sherry – Alliance4Health

Margalit Gur-Arie
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Margalit Gur-Arie

I don’t know what the exact situation on the ground is, but ONC is allowing for both standards to coexist in Stage 1 of MU, with the caveat that the choices will be narrowed. If you look at the Standards Committee proposals, there is no mention of CCR.
Is it possible that the regulatory choice was already made in DC?

Steven Waldren MD, MS
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Steven Waldren MD, MS

Disclaimer: I was a co-developer of the ASTM CCR (I was also an editor on the CCD), therefore I am biased toward the CCR. Although I am an advocate for discrete data exchange that improves quality, safety, and efficiency regardless of the standard used. My first comment is that many vendors like the CCD because they can produce Level I and Level II CCDs and not have to worry about highly structuring clinical data (this requires a Level III CCD through the use of clinical statements). If you are only going to wrap HTML with a CDA header and section… Read more »

Vince Kuraitis
Guest

John, “I Love You, Man” but you missed the boat on this one.
1.It’s no news that HIEs prefer CCD.
2.HIEs are not representative of the broader health IT market.
3.The narrow findings don’t justify the broad conclusion.
4.The CCD and CCR standards are more complementary than competitive
at
http://e-caremanagement.com/chilmark-needs-to-chill-out-on-ccrccd-findings/

Shahid N. Shah
Guest

John, it’s odd but from my anecdotal discussions I’m not seeing this trend (but am glad it’s occuring if is). If you’re interested, we could get a survey started at HITSphere.com to get some objective evidence from the vendor community. Or, perhaps as you ask around more vendors next week at HIMSS we might get some additional information. Thanks for posting this article.

inchoate but earnest
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inchoate but earnest

John,
Are there any handy metrics that we non-HIT followers might reference re: the adoption shift you have identified? I’ve no reason to doubt you, but without evidence, it looks like you’re merely editorializing here, with an n of one vendor providing support for your assertion.