The ABCs of the CCD – Part I of III

CCD is an acronym that stands for “Continuity of Care Document”. The CCD is a file that uses Extensible Markup Language (XML) format, which could have one of 3 different structure levels. I will explain the various structure levels in Part III of this blog series. A CCD contains patient related information that could be electronically exchanged between healthcare providers, as well as, shared with the patients themselves.

The CCD template, derived from the American Society for Testing and Materials (ASTM) Continuity of Care Record template or ASTM E2369-05 Standard Specification, or simply stated the CCR. The CCD is constrained by the HL7 (Health Level Seven) Clinical Document Architecture (CDA). The CDA adheres to the HL7 V3.0 Reference Information Model or RIM.

The ASTM CCR was created to provide a snapshot in time that contains a summary of relevant and pertinent encounters information (e.g., demographic, clinical, financial) of a patient.

Health Level Seven International partnered with ASTM to create an HL7 version of the CCR for institutions that preferred using the CDA model, hence the birth of the CCD. The CCD maps the CCR elements into the CDA structure.

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The CCD is a template based on the principles of the HL7 CDA. The characteristics of a clinical document based on the CDA are the following:

• Persistent
• Authenticable
• Human readable
• Self-context
• Thorough and complete
• Stewarding

Although one of the characteristics of a CCD is to be human-readable this does not mean that there isn’t a tool involved for the readability. A CCD could be rendered with a simple web browser in order to comply with the human-readability qualification.

The CCD is structured as a CDA document. For those of you familiar with XML documents the following line-by-line depiction will be easily understood:

• Document
  • Header
    • Body
      • Sections
        • Optional narrative block
          • Entries

A CCD includes the following 16 sections:

1. Family history
2. Social history
3. Functional status
4. Allergies
5. Immunizations
6. Medications
7. Vital signs
8. Medical equipment
9. Support
10. Encounters
11. Problems
12. Procedures
13. Results
14. Plan of care
15. Payers
16. Advance directives

Many Electronic Health Record (EHR) vendors are starting to implement the CCD to share patient information across Health Information Exchanges(HIEs), outpatient centers and other clinical providers.

The CCD is not alone. There are many other CDA based templates:

• Discharge summaries,
• History and Physical (H&P)
• Procedure Note
• Progress Note
• Operative Note
• Consultation Note
• Diagnostic Imaging Report

In the next Part II of this series we will explore a “real-world” example of a CCD.