Safe Exchange of CCDA

In teaching CCDA yesterday, we talked about how to move from CCD/HITSP C32 to CCDA.  The question came up of what to do with a CCDA document that isn't valid or is poorly structured.  I recommend two things:

1. When Exchanging CCDA Documents for the first time with any partner, ALWAYS validate the content conforms, and if it doesn't, don't import the machine readable data into your CDR.  
2. Quarantine the content, but make it accessible to clinicians as text.  In other words, if it's valid CDA, but not valid CCDA, transform it to a human readable (e.g., HTML) using YOUR OWN TRANSFORM, and allow that to be displayed.  Note that clinical data in this document hasn't been imported (incorporate is the word used in MU Stage 2) to the CDR to the reader.

These recommendations do two things:

1. The validation step is a prophylactic, preventing dirty data from infecting the CDR
2. Putting "dirty" content into a quarantine makes sure that the clinical data that someone took the trouble to communicate to a provide is still available for clinical care (as human readable content), even if not in the most accessible way.

The latter part is simply an appropriate application of both Postel's law, and the principle that the patient comes first.