The need for clinical data transformation present EMRs with a myriad of challenges in passing real-time information back and forth within an HIE or during direct point-to-point communication of data.
With CCDA, we can do point-to-point direct delivery of information, sending critical and real-time patient information to remote data warehouses for use by Big Data analytics, as well as HIE.
What is CCDA?
Consolidated Clinical Document Architecture (CCDA) is a complete architecture used to create documents and template methodologies for those documents. Primary function of the CCDA is to standardize the content and structure for clinical care summaries. CCDA documents are coded in XML and XHTML (a combination where HTML describes presentation and XML describes content) and are made of these parts:
- Header – (enables exchange of clinical documents within and across institutions)
- Body – (contains the clinical report and can contain an unstructured “blob”, or structured content, in one or more Sections)
2.1. Section(s) – (may contain Allergies, Meds, Problems, Immunizations, Vital Signs, etc)
2.1.1. Narrative block – (“human-readable” part of a CDA document).
2.1.2. Entries (0 to maximum) – (structured “machine-readable” content for further computer processing).
History Summation of CCDA
Starting December 2011, the CCDA has been focused on making CDA Templates (CCD being one of its templates).
It is being adopted by the United States through Meaningful Use efforts, and will make it incrementally easier to achieve international interoperability, and deliver on the promise of persistence, stewardship, potential authentication, context, wholeness and human readability, as originally promised by CDA in 1999.
It is the product of a prodigious effort of the Office of the National Coordinator’s (ONC) Standards and Interoperability (S&I) Framework.
It is a single standard for communicating summary of care records, enabling the sharing of clinical care information in the most common care scenarios: inpatient-to-outpatient, primary care physician (PCP)-to-specialist, provider-to-patient and provider-to-ACO. CCDA also facilitates easier EHR-to-EHR transition of clinical data.
Benefits of CCDA
- Supports the exchange of clinical documents between those involved in the care of a patient
- Supports the re-use of clinical data for public health reporting, quality monitoring, patient safety and clinical trials
- Can be reused in multiple applications
- CCDA is a full-blown CDA, providing methodology for templates
- Accommodates all medical documents, and may include binary data and other document types
- Allows for user-defined fields
- Is built in HL7 RIM standard
- Enables global inter-operability
The most important benefit of CCDA is its ability for human consumption. The idea of templates, which aides in human consumption, allows caregivers to know where to go for the information they are specifically looking for. The Clinical Document Architecture gives context by providing a clinical document that tells a specific story about the care provided to the patient for diagnosis and treatment of their problem.
The CDA also promotes a more complete understanding between the data it provides, and the statements contained in the document. The CDA supports human readability too, for both patient and provider, and it supports video and audio interoperability between systems.
Application of CCDA
CCDA accommodates more than just summaries and snapshot stories for patients. It provides a methodology for all types of medical documents. It is based on the HL7 Reference Information Model (RIM), but is flexible enough to accommodate user-defined fields (typical HL7), and can store complete documents, binary data, and multimedia as well in its body. It’s been approved by ANSI in 2010. CDA introduces the concept of incremental semantic interoperability, which allows tracking of relationships between elements of care.
The minimal CDA is a small number of XML-encoded metadata fields (such as provider name, document type, document identifier, and so on) and a body which can be any commonly-used MIME type such as pdf or .doc (Microsoft Word) or even a scanned image file. CCDA has two separate components:
- Human readable components found in section/text
- Machine readable components found in section/entry
CCDA is the Consolidation of CDA Templates to become the Single Source for clinical documents. CDA is in use world-wide. The most popular use is for inter-enterprise information exchange (aka XDS.b and XDR), in such countries as Finland, Greece and Germany and in pilot use in Canada, Japan, Korea, Mexico, Argentina and elsewhere.
CDA is firmly in the plans for many of the nascent US Regional Health Information Organizations and the US Military Health System. The largest single producer of CCDA documents is the Mayo Clinic, which is producing thousands of CDAs every week and when in full production will reach 50,000 notes/week. Mayo sees CDA as a strategic investment in information that will increase in value over time and which can be reused in multiple applications.
CCDA to the Rescue
Before CCDA, providers trying to implement a specific clinical document were faced with a “rabbit hole” of cross-referenced materials creating an ever growing, complex web of documentation. CDA, which was until recently known as the Patient Record Architecture (PRA), provides an exchange model for clinical documents (such as discharge summaries and progress notes) – and brings the healthcare industry closer to the realization of an electronic medical record.
CDA documents can be encoded with the full power of the HL7 Reference Information Model (RIM, see below) and controlled vocabulary such as LOINC, SNOMED, ICD, CPT etc. CCDA is clearly the next step in the evolution of interoperability because it allows substantially easier point to point connection, IE: you don’t have to go through a post office model like HIE, and it allows for much better patient engagement with human readability of complex data and patterns of data.
Is it a perfect standard? Probably not, but it doesn’t advance the cause and it will, if executed properly, save money in the implementation of a fully integrated and organized data model. It will cause the transformation of HIE and integration strategies just at a time when many are getting those models completed for full scale operations.
Orchestrate Healthcare can help you with strategy, implementation, and maintenance of these new models with our expert consultants and many years of experience in integration. There is a reason we are a top ranked KLAS firm, and it starts with having great people and by maintaining or knowledge set on the leading edge of healthcare IT.
For more information, see the S&I Framework Wiki for the latest version of the Companion Guide to Consolidated-CDA for Meaningful Use Stage 2 and HL7 CDA Release 2