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Continuity of Care Document

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    • 1. © 2002-2005 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document Liora AlschulerLiora Alschuler Alschuler Associates, LLCAlschuler Associates, LLC February 2006, HIMSSFebruary 2006, HIMSS
    • 2. 02/14/200 2© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Liora AlschulerLiora Alschuler  Principal, Alschuler Associates, LLCPrincipal, Alschuler Associates, LLC  CDA design, implementation, supportCDA design, implementation, support  Tricare Management Activity, Department of Defense, Enterprise WideTricare Management Activity, Department of Defense, Enterprise Wide Referrals & AuthorizationsReferrals & Authorizations  Subcontractor, HITSPSubcontractor, HITSP  Project Springfield: document-based personal health accountsProject Springfield: document-based personal health accounts  Co-author, CDA & CRS Quick Start GuidesCo-author, CDA & CRS Quick Start Guides  Member, HL7 Board of DirectorsMember, HL7 Board of Directors  Co-editor, CDACo-editor, CDA  Co-chair HL7 Structured Documents TCCo-chair HL7 Structured Documents TC  HL7 IHE LiaisonHL7 IHE Liaison  past Chair, KEG & XML SIG & HL7 Marketing Committeepast Chair, KEG & XML SIG & HL7 Marketing Committee  liora@alschulerassociates.comliora@alschulerassociates.com
    • 3. 02/14/200 3© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Consult HL7’s CDAHL7’s CDA  Clinical Document ArchitectureClinical Document Architecture  ANSI/HL7 R1-2000, R2-2005ANSI/HL7 R1-2000, R2-2005  eDocuments for InteroperabilityeDocuments for Interoperability  Key component for local, regional,Key component for local, regional, national electronic health recordsnational electronic health records  Gentle on-ramp to informationGentle on-ramp to information exchangeexchange o Everyone uses documentsEveryone uses documents o EMR compatible, no EMR requiredEMR compatible, no EMR required o All types of clinical documentsAll types of clinical documents CDA Health chart Summary Path Radiology Discharge
    • 4. 02/14/200 4© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off ASTM’s CCRASTM’s CCR  Standard SpecificationStandard Specification for Continuity of Carefor Continuity of Care Record (CCR)Record (CCR)  a core data set of the most relevant administrative, demographic, and clinical information facts about a patient’s healthcare, covering one or more healthcare encounters.  Released January, 2006
    • 5. 02/14/200 5© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off ASTM CCR vs. HL7 CDAASTM CCR vs. HL7 CDA  Conflicting?Conflicting?  Overlapping?Overlapping?  What if you could have both!#*?IWhat if you could have both!#*?I!!!!  What if you could have your data elementsWhat if you could have your data elements  And send them in a common exchange framework?And send them in a common exchange framework?
    • 6. 02/14/200 6© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off ASTM CCR + HL7 CDA = CCDASTM CCR + HL7 CDA = CCD  CDA is designed to support professional societyCDA is designed to support professional society recommendations, national clinical practice guidelines,recommendations, national clinical practice guidelines, standardized data sets, etc.standardized data sets, etc.  From the perspective of CDA, the ASTM CCR is aFrom the perspective of CDA, the ASTM CCR is a standardized data set that can be used to constrain CDAstandardized data set that can be used to constrain CDA specifically for summary documents.specifically for summary documents.  The resulting specification, known as the Continuity ofThe resulting specification, known as the Continuity of Care Document (CCD), is being developed as aCare Document (CCD), is being developed as a collaborative effort between ASTM and HL7.collaborative effort between ASTM and HL7.
    • 7. 02/14/200 7© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document  CCD maps the CCRCCD maps the CCR elements into a CDAelements into a CDA representation.representation. CCR data elementCCR data element CDA R2 correspondenceCDA R2 correspondence ResultsResults SectionSection ResultResult ObservationObservation DateTimeDateTime Observation.effectiveTimeObservation.effectiveTime IDsIDs Observation.idObservation.id Type:Type: Values include:Values include: Hematology, Chemistry,Hematology, Chemistry, Serology, Virology,Serology, Virology, Toxicology, Microbiology,Toxicology, Microbiology, Imaging - X-ray,Imaging - X-ray, Ultrasound, CT, MRI,Ultrasound, CT, MRI, Angiography, CardiacAngiography, Cardiac Echo, Nuclear Medicine,Echo, Nuclear Medicine, Pathology, ProcedurePathology, Procedure DrawDraw values from observation.codevalues from observation.code (e.g. by looking at the LOINC class(e.g. by looking at the LOINC class for a LOINC code).for a LOINC code). DescriptionDescription Observation.codeObservation.code StatusStatus Observation.statusCodeObservation.statusCode ProcedureProcedure Observation.methodCode;Observation.methodCode; ProcedureProcedure TestTest ObservationObservation
    • 8. 02/14/200 8© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off <Results> <Result> <CCRDataObjectID> 2.16.840.1.113883.19.1 </CCRDataObjectID> <DateTime> <Type> <Text>Assessment Time</Text> </Type> <ExactDateTime> 200004071430 </ExactDateTime> </DateTime> <Type> <Text>Hematology</Text> </Type> <Description> <Text>CBC WO DIFFERENTIAL</Text> <Code> <Value>43789009</Value> <CodingSystem>SNOMED CT</CodingSystem> </Code> </Description> <Status><Text>Final Results</Text></Status> <section> <code code="30954-2“ codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <title>Laboratory results</title> <text> CBC (04/07/2000): HGB 13.2; WBC 6.7; PLT 123* </text> <entry> <observation classCode="OBS" moodCode="EVN"> <id root="2.16.840.1.113883.19" extension=" <code code="43789009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="CBC WO DIFFERENTIAL"/> <statusCode code="completed"/> <effectiveTime value="200004071430"/> Continuity of Care DocumentContinuity of Care Document Project will develop basis for automated translationProject will develop basis for automated translation
    • 9. 02/14/200 9© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Sample sectionSample section  11 INTRODUCTIONINTRODUCTION  22 (PROTOTYPE) LAB RESULTS(PROTOTYPE) LAB RESULTS  2.12.1 IntroductionIntroduction  2.22.2 Section conformanceSection conformance  2.32.3 Clinical statement conformanceClinical statement conformance  2.42.4 ExtensionsExtensions  2.52.5 Rendered exampleRendered example  2.62.6 Encoded exampleEncoded example  2.72.7 ASTM CCR MappingASTM CCR Mapping  2.82.8 Appendix - CCR exampleAppendix - CCR example  Sample section developed by Dr. Bob Dolin, KaiserSample section developed by Dr. Bob Dolin, Kaiser PermanentePermanente
    • 10. 02/14/200 10© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off CCR CDA correspondanceCCR CDA correspondance <observation classCode="OBS" moodCode="EVN"> <id root="2.16.840.1.113883.19" extension="1"/> <code code="43789009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="CBC WO DIFFERENTIAL"/> <Description> <Text>CBC WO DIFFERENTIAL</Text> <Code> <Value>43789009</Value> <CodingSystem>SNOMED CT</CodingSystem> </Code> </Description>  Same Context:Same Context:  CDA: observation, code, code systemCDA: observation, code, code system  CCR: description, code, value, coding systemCCR: description, code, value, coding system  CDA: optional unique ID; code system ID; moodCDA: optional unique ID; code system ID; mood  Different approaches to human-readable textDifferent approaches to human-readable text  There are differences, but an implementation guide can supportThere are differences, but an implementation guide can support interoperabilityinteroperability
    • 11. 02/14/200 11© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document  Did this come out of the blue?Did this come out of the blue?  There is a history of collaborationThere is a history of collaboration  Many people have participated in both effortsMany people have participated in both efforts  Presentation on CDA for continuity of care at ASTM CCR meeting,Presentation on CDA for continuity of care at ASTM CCR meeting, August, 2003August, 2003  Memorandum of Understanding, 2004Memorandum of Understanding, 2004  Acapulco demo: CDA for CCR, October, 2004Acapulco demo: CDA for CCR, October, 2004 o HL7 partnered with Massachusetts Medical Society, Microsoft,HL7 partnered with Massachusetts Medical Society, Microsoft, Ramsey Systems (UK)Ramsey Systems (UK)  Initial HL7 Care Record Summary ballot, April, 2005:Initial HL7 Care Record Summary ballot, April, 2005: o Limited to CDA header, no detailed section codingLimited to CDA header, no detailed section coding o Anticipated: “Development of detailed (CDA Level 3)Anticipated: “Development of detailed (CDA Level 3) Implementation Guides for “continuity of care” (CCR) inImplementation Guides for “continuity of care” (CCR) in collaboration with the ASTM E31 under the 2004 Memorandum ofcollaboration with the ASTM E31 under the 2004 Memorandum of Understanding”Understanding”  HL7 ballot on CCR, Spring 2005: incorporated changes required for bi-HL7 ballot on CCR, Spring 2005: incorporated changes required for bi- directional exchange and semantic interoperabilitydirectional exchange and semantic interoperability
    • 12. 02/14/200 12© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document  Will CCD see adoption?Will CCD see adoption?  Role of IHE (Integrating the HealthcareRole of IHE (Integrating the Healthcare Enterprise)Enterprise)  2005: Cross-enterprise document sharing (XDS) with2005: Cross-enterprise document sharing (XDS) with both CDA and CCRboth CDA and CCR  2006: XDS for Patient Care Coordination domain2006: XDS for Patient Care Coordination domain Medical SummariesMedical Summaries o CDA Care Record SummaryCDA Care Record Summary o Extend with coded content for three required sectionsExtend with coded content for three required sections  2007:2007: likely will adopt CCDlikely will adopt CCD
    • 13. 02/14/200 13© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document  Current activitiesCurrent activities  Meeting ~ weekly by webinar, teleconferenceMeeting ~ weekly by webinar, teleconference  Sample lab section developed as patternSample lab section developed as pattern  Participation by ASTM E31.28, HL7 StructuredParticipation by ASTM E31.28, HL7 Structured Documents TC andDocuments TC and o HL7 domain committees for patient care, lab, ED...HL7 domain committees for patient care, lab, ED... o Clinical societies: ACP, AAFP, ACR...Clinical societies: ACP, AAFP, ACR...  Interest in international harmonizationInterest in international harmonization o CDA summary documents in use around the worldCDA summary documents in use around the world
    • 14. 02/14/200 14© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document  TimelineTimeline  February – March: Meet by web/telconferenceFebruary – March: Meet by web/telconference o Individuals developing:Individuals developing: • HeaderHeader • List of sectionsList of sections • LabLab • Allergies/adverse reactionsAllergies/adverse reactions • Problems/conditionsProblems/conditions • MedicationsMedications  April – MayApril – May o Initial ballot: header, list of sections, detailed sectionsInitial ballot: header, list of sections, detailed sections o Ballot reconciliation: Spring HL7 Working Group MeetingBallot reconciliation: Spring HL7 Working Group Meeting  June – JulyJune – July o Develop complete draft for second ballotDevelop complete draft for second ballot  August – SeptemberAugust – September o Second ballotSecond ballot o Ballot reconciliation: Fall HL7 Working Group MeetingBallot reconciliation: Fall HL7 Working Group Meeting
    • 15. 02/14/200 15© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document  ““ASTM is dedicated and privileged to work inASTM is dedicated and privileged to work in collaboration with HL7 on the expression ofcollaboration with HL7 on the expression of ASTM's Continuity of Care Record content withinASTM's Continuity of Care Record content within HL7's CDA XML syntax and the seamlessHL7's CDA XML syntax and the seamless transformation of clinical and administrative datatransformation of clinical and administrative data between the two standards.”between the two standards.”  Rick Peters, MD, E31.28Rick Peters, MD, E31.28
    • 16. 02/14/200 16© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Continuity of Care DocumentContinuity of Care Document  BenefitsBenefits  Industry concensus on summary document contentsIndustry concensus on summary document contents and requirements through ASTM ballots (2004, 2005)and requirements through ASTM ballots (2004, 2005)  Industry concensus on document exchangeIndustry concensus on document exchange framework through HL7 ballots (1999-2005)framework through HL7 ballots (1999-2005)  Summaries for continuity of careSummaries for continuity of care o Interoperable with full range of document typesInteroperable with full range of document types o Interoperable with HL7 V3 messages, all RIM-basedInteroperable with HL7 V3 messages, all RIM-based specifications (public health reporting, clinical trials,specifications (public health reporting, clinical trials, structured product labels and more)structured product labels and more)
    • 17. 02/14/200 17© 2006 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off CCD ResourcesCCD Resources  HL7 Web site:HL7 Web site:  CDA Normative Web EditionCDA Normative Web Edition  http://www.hl7.org/Special/committees/lists.cfmhttp://www.hl7.org/Special/committees/lists.cfm o CDA: strucdoc@lists.hl7.orgCDA: strucdoc@lists.hl7.org o CCD: ccd@lists.hl7.orgCCD: ccd@lists.hl7.org  ASTM Web site:ASTM Web site: o ASTM.orgASTM.org  JAMIAJAMIA  Dolin RH, Alschuler L, Boyer S, Beebe C, Behlen FM, Biron PV, ShaboDolin RH, Alschuler L, Boyer S, Beebe C, Behlen FM, Biron PV, Shabo A. HL7 Clinical Document Architecture, Release 2. J Am Med InformA. HL7 Clinical Document Architecture, Release 2. J Am Med Inform Assoc. 2006;13:30–39.Assoc. 2006;13:30–39.  http://www.jamia.org/cgi/reprint/13/1/30http://www.jamia.org/cgi/reprint/13/1/30  Liora AlschulerLiora Alschuler - Liora@alschulerassociates.com- Liora@alschulerassociates.com

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