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Thursday, October 14, 2010

Customer service--call holding on line 2

One of my job functions is to promote the use of standards, and as an expert on CDA, CCD and the HITSP C32, as well as someone who frequently writes on these and other standards, you can imagine that I get a lot of questions.  They come from a variety of sources.  Some of them arrive via the contact me link on this blog, others through comments.  Others arrive through various mailing lists where I'm engaged, and some come directly to my inbox, and some are phone calls.

I encourage people to contact me with their questions, internally or externally.  But I also encourage them to take advantage of the rest of the standards community.  I'm only one person, and my opinions, while highly informed, are not always the right answer, nor are my responses always speedy.  Some questions take months to answer, such as my recent post on use of translation with medications in the C32.

So what can you do?  There are a number of mailing lists that you can join, free of charge that will provide you with access to a great deal of expertise.
  • HL7 List Services (too many to count)
    • CCD Discussions about the HL7 CCD Specification, including some discussions about C32
    • Strucdoc Discussions about the Structured Documents Workgroup, including questions and interpretations of standards and guids (e.g., CDA, CCD)
  • IHE Google Groups (approximately 40 groups)
    • IHE XDS Implementors This discussion group is for implementors of the IHE XDS.b, XDM, XDR, and XCA Integration profiles
    • IHE PCC Technical Committee  IHE Patient Care Coordination Technical Committee list serve.  Discussion of current work.
    • IHE PCC Implementors   Technical discussion for people implementing IHE PCC integration profiles.
There are a couple of benefits to using these resources:  You get access to other experts.  You get faster responses.  The only problem is that you won't always get agreement.  That is an answer in and of itself.  When the experts don't agree, you've hit on something that hasn't been considered and may require some thought.  The mailing lists are one of the places where that thinking goes on.  Usually we will converge on a single solution, but it may take some time.  This is just another aspect of the process, and I ask that you be patient with us.  It could be worse, at least the number of opinions expressed in the list is usually less than the number of participants.  That's not true of other venues where I've been involved.

I don't think there will ever be "one place to go" for everything, but I do think that there needs to be a better way organize our national program.  I have some hope that as the S&I framework progresses, there will become a place where we can begin to centrally access some of the knowledge that is generated in these great venues.  We need a centrally located FAQ where people can post questions to and get authoritative responses on nationally recognized standards.  We also need a place where someone can report bugs or enhancements to the testing tools or processes that are being Federally developed.   I'm not holding my breath because progress there is painfully slow right now.  It is happening, but only a few of us are even close enough to see movement.

In the meantime:

TW wants to know the relationship between CCR, CCD and HITSP C32:

The CCR is the Continutity of Care Record, a standard from ASTM.  This is a data set of relevant information needed for transfers of care.

The CCD is the Continutity of Care Document, an implementation of the CCR standard in the HL7 Clinical Document Architecture.  This was developed in close coordination between HL7 and ASTM.

Vassil Peychev further clarified the relationship between C32, CCD and CDA really well in a recent post on the HL7 Structured Documents list:
As the name describes, the CDA standard is an “architecture” and as such can be implementing following specific implementation guides. One such implementation guide is the CCD, which describes how to present the ASTM CCR content specification in a CDA document.

In other words, the CCD is a CDA document, which follows the constraints in the CCD specification. The HITSP C32 implementation guide then further constrains the CCD specification for the particular use in the US.
JM wants to know whether the recent interim rule on Syndomic Surveillance still has the same objective but removes implementation guidance, or whether the objective is also removed.  He thinks (correctly) that the objective is still applicable but that there is no implementation guidance, which he points out makes it very difficult to validate (also correct).

From my reading, the objective is still present, the requirement to us a particular implementation guide has been removed.  The HITSP C39 Specification is purpose designed for biosurviellance and can now be used after the change just made in the rules by ONC.


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