Moving Forward

Those who cannot learn from history are condemned to repeat it.  -- George Santayana

The resurrection of the debate between "CCR" and "CDA" of four years seems to ignore all that has occured since then.  If we are not careful, we are doomed to repeat our mistakes, and even if we are, it would appear that we are at least condemned to repeat the labor leading from our successes.

Do you remember all the hullaballo in early 2007 celebrating the harmonization of the CCR and CDA into CCD?  As one of the 14 editors of that specification who worked on it with members of HL7 and ASTM for more than I year, I certainly do.  At the time, it was celebrated as being one of the great successes of harmonization.  Most of us, having achieved the success of CCD moved on.  We built on that information model to support a truly interoperable exchange for healthcare.  Only now there are some who wish to see that work discarded because "it's not internet friendly".

Lest we forget, there's a lot more to agreeing on CCD that was needed to ensure interoperability.  There are some 80 different value sets from more than 25 different vocabularies that have been incorporated into the standards for the selected use cases.  There's also the necessity to secure the transport of that information through at variety of different topologies.

That took some three years of effort AFTER we resolved the CDA vs. CCR debate with the "both AND" of CCD.  If your definition of BOTH AND has changed, (and apparently it has for some), then more work is needed on the CCR half.  We would need to bring CCR up to the same level of interoperability that we did with CCD, and that will require yet more effort.  Frankly, I'd rather spend that time working on making the existing standards better by taking the learnings from the internet crowd and the health informatics crowd back into the healthcare standards organzations.  That's a BOTH AND that is a step in the right direction, instead of a step backwards.