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Thursday, December 1, 2011

Into the CDA Acronym Soup

Acronyms are a way of life for a Standards Geek.  These "short-form" names are an insider's code, almost as incomprehensible as 1337.  CDA, CCR, CCD, XDS-MS, C32, C48, C80, C83, XPHR, GreenCDA, CCDA (an Acronym first coined here by Wes Rishel), et cetera. For the average implementer, lack of knowledge about acronyms leads to miscommunication of requirements, subsequently resulting in incorrect implementation and later rework.  It gets even more challenging because many of these have several meanings.  The CCR is a data set and an XML Schema.  A CCR is an XML document that conforms to the XML Schema, but it can also be an implementation that conforms to the data set (e.g., The CCD is a CCR).

I spend a good deal of time with implementers who ask questions about CCD trying to be sure what they really mean, because I'm aware that most people in the US who are asking questions about "CCD" are really asking questions about the Meaningful Use requirements laid on top of the HITSP C32.  Sometimes the question really does get back to the HL7 CCD specification, but more often than not, it doesn't.

This post from mid-2010 shows 50 different specifications.  Each one has it's own acronym and has several different kinds of relationships with at least two or more others with only ONE exception (CDA).  I won't go into why we (geeks) use acronyms.  Tone Southerland (a standards geek colleague in IHE PCC) already explains that in this blog post.  What I'm going to try to address in this post is how an implementer is to cope.

So, here are the cliff notes.  If you are an implementer, you should study this, as there will be a test.

CDA - Clinical Document Architecture.  An HL7 standard describing the XML format of clinical documents.  It has also been approved by ANSI and ISO.  Currently in release 2.0, with work on release 3.0.

CCDA - CDA Consolidation Guide.  An HL7 Draft Standard for Trial Use consolidating the past work of HL7, Health Story, IHE, and HITSP into one consolidated guide.  The acronym was first coined by Wes Rishel.  Most participants call it the "Consolidation Guide".

CCR - Continuity of Care Record.  An ASTM standard data-set for information to exchange between systems supporting to support continuity of care.  It is published with an accompanying adjunct that is the XML Schema created by ASTM that conforms to that standard.  The format specified in the adjunct competes with the HL7 CDA.

CCD - Continuity of Care Document (Release 1.0).  An HL7 Informative document harmonizing the ASTM CCR and the HL7 CDA. A CCD is a CCR, but uses the HL7 CDA standard to represent the data.  It has now been superseded by the CCD 1.1 found in CCDA.

XDS-MS - Cross Enterprise Sharing of Medical Summaries.  An IHE profile (implementation guide) from the IHE Patient Care Coordination domain and is part of the PCC Technical Framework. It was originally based on the CRS 1.0, but was later changed to use the CCD.

CRS - Care Record Summary (Release 1.0).  An informative document from HL7 based on the CDA, and one of the intellectual ancestors of the CCD.  In competition with the CCR at the time of publication, but now superseded by release 2.0, and the CCDA.

XPHR - Exchange of Personal Health Records.  An IHE profile (implementation guide) from the IHE Patient Care Coordination Technical Framework.  It describes and further specifies how to use the CCD to exchnage information between PHR systems and EHR systems.

C32 - Summary Documents Using HL7 Continuity of Care Document.  A specification published by ANSI/HITSP that further codifies how to use the CCD for the US. Originally based directly on the HL7 CCD, it was later adapted to use the IHE XPHR profile.  However, confusion in interpretation of this specification by industry certifiers has led to conformance to the IHE PCC Technical Framework, but not necessarily XPHR directly.  The C32 makes use of the HITSP C80 and C83 specifications.

MU Stage 1 - Meaningful Use Stage 1.  A set of regulatory requirements for certification of EHR Systems that enable providers to obtain incentive payments from the federal government.  In addition to requiring support for both the CCR and CCD, it provides additional requirements over and above the HITSP C32 which result in yet further confusion about what a C32 is.

C48 - Encounter Document Using IHE Medical Summary.  A HITSP specification for encounter summaries based on the IHE XDS-MS.

C83 - CDA Content Modules Component.  A HITSP specification containing almost all CDA Section and Entry templates used in HITSP CDA based implementation guides.  The only real exception is the HITSP C37 Lab Report document based on the IHE XD-LAB profile.

C80 - Clinical Document and Message Terminology.  A HITSP specification containing vocabulary requirements for almost all HITSP specifications.  These are referenced by C83.

C37 - Lab Report Document.  A HITSP specification for lab reports using CDA, based on the IHE XD-LAB profile.

XD-LAB - Sharing Laboratory Reports. An IHE Profile from the IHE Laboratory Technical Framework for laboratory reports represented using CDA.

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