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Thursday, May 5, 2011

IHE PCC Reconciliation

IHE PCC just finished a week full of meetings in Oak Brook to complete development of its profiles and white papers for public comment. One of the profiles we are working on this year is Reconciliation of Diagnoses, Allergies and Medications, or RECON for short.

The RECON profile has one actor, the reconciiation agent. Usually this would be implemented by an EHR system. The actor has functional and technical requirements.

Functionally the actor is required to access clinical information about problems, medications and allergies. That information must be able to come from clinical documents, and may also come from queries using the IHE QED profile, or using data from other unprofiled sources.

The actor must then determine which of the various diagnoses, allergies and medications reported from the various information sources are in agreement, and which are different. It must then suggest changes to make to a final list. IHE doesn't say how those changes are suggested, but does offer some guidance in this profile on what information might be used to help make those decisions.

The healthcare provider using the system that supports this actor will then be able to make any corrections, additions, or updates to the lists.

Finally, the system must be able to report the reconciled results. The results reported include what was accepted by the healthcare provider during the reconciliation process, of course. But they also identify the healthcare provider(s) who reconciled the data, and the information sources that were used during reconciliation.

This profile will enable systems to take advantage of information communicated in, for example multiple CCD documents, and to coordinate it with information stored within an EHR. One benefit of this profile that because it also records the sources of information which have already been reconciled, a receiving system can also avoid work by taking advantage of that fact. Thus, if a system receives information in document C which contained information reconciled from document A and B, then it could avoid reconciling against document A and B again.

It will soon be published for public comment and I look forward to your feedback.


  1. Thanks Keith. Looking forward to it. Do you know by what means the reconciled list will be communicated (e.g. will it be a CCD)?

  2. No, a CDA. After all, not everything is a CCD.

  3. Actually, the more I think about this, I wonder why you'd not want to make the reconciliation objects available as optional components within a CCD.

  4. They certainly could be optional components within a CDA (including CCD). The IHE RECON profile requires them to be present in CDA documents conforming to a particular document template. The entries wrap problem, medication and allergy entries inside the sections. BTW: This means that requiring direct containment in a specification is a problem.