HSX Aligns with MU Stage 2 Guidelines and Promotes Consolidated CDA for Its Exchanges

CCD By Any Other Name . . . is Still About Continuity of Care

HSX Aligns with MU Stage 2 Guidelines and Promotes Consolidated CDA for Its Exchanges

The Centers for Medicare & Medicaid designated the CCD (Continuity of Care Document) as one of the standard document formats permitted for clinical patient-information exchange in satisfying Meaningful Use (MU) Stage 1, which had the basic objective of moving the healthcare industry from paper exchange to electronic exchange of such information.  The CCD was not a document that existed as such in the paper-based medical record environment, instead having its roots in the harmonization of much-needed content-standards work from two organizations regarding patient care summaries: ASTM (ASTM  International) and HL7 (Health Level Seven International).  

The CCD document included in the MU Stage 1 specification was, in essence, the CCD as described in the ONC’s (Office of the National Coordinator for Health Information Technology) Health IT Standards Panel (HITSP) interoperability specification C32.  HITSP C32 is a constraining set of rules required by ONC on top of the original implementation guide published by HL7 for this type of clinical data exchange document.  However, the panel’s specifications included an underlying set of additional requirements published in other HITSP guides for data templates and clinical terminology. This created a complicated set of interconnected specifications leading to ambiguous interpretations and implementations by health information technology vendors.  

This guidance confusion led ONC to revisit the clinical care summary topic for its primary use case, Transition of Care, in MU Stage 2.  The major improvement was to consolidate all of the various documentation for CCD, as well as other document types, into one implementation guide, the Consolidated Clinical Document Architecture implementation guide (C-CDA IG).

This guide is a library of templates that provide specifications for nine document types within the CDA family:

  1. CCD
  2. Consultation Note
  3. Diagnostic Imaging Report
  4. Discharge Summary
  5. History & Physical
  6. Operative Note
  7. Procedure Note
  8. Progress Note
  9. Unstructured Document (basically any scanned or pdf document in a CDA envelope)

The basic clinical document architecture dictates that an electronic health information exchange document will comprise a Header and a Body part.  The Header is largely the same as previously, and identifies specific information regarding the patient, the source of the information, the event for which this document was created, and the document type.  The Body sections adhere to the other specifications/entry templates defined by the C-CDA.

This allows applications to more easily move to support more than just one document listed in the CDA family.  The industry anticipates that ONC (and the CMS MU initiative) as well as other government healthcare agencies will continue to leverage these guidelines, in order to streamline exchange between healthcare organizations and to generate standardized data for population health initiatives.