HIT Standards CommitteeHIT Standards CommitteeClinical Operations Work GroupClinical Operations Work Group

Workgroup UpdateWorkgroup Update

Jamie FergusonKaiser Permanente

John HalamkaHarvard University

30 June, 2010

Problem Statement

• Implementers of CCR and CCD for transfers of care also need other standard document types, e.g.,: – Inpatient Discharge Summary– ED Discharge Summary

• These documents may contain specialized content not found in CCR or CCD, e.g.,:– Discharge Diet– Surgery Description– Surgical Operation Note Findings– Estimated Blood Loss – Chief Complaint

Review: CCR and CCD

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A CCD based document

CCD: A collection of templates representing core content for healthcare summary documents with template content from CCR

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CDA: A foundation standard enabling the definition of templates for a broad range of healthcare documents

Extending And Reusing Existing Templates In Other Documents

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A CCD based document

A CDA based documentcompatible with CCD

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Template content from CCRFam

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CDA

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Identified by the CCD document ID number

Identified by another identifier, e.g., anED Discharge document ID number

Discussion points

• We plan to make recommendations to the Standards Harmonization entity as outlined in the Concept of Operations plan

• General direction of WG: Recommend that the process should standardize templated CDA sections to build upon and extend what was done in CCR and CCD

• WG direction is consistent with NIST direction for testing

Discussion points, continued

• Must enable more documents and reuse existing work

• May also recommend this direction for attachments

• Identification of complete documents assembled from templates: – A few complete documents might have complete document IDs, e.g., discharge

summaries, ambulance services, etc.– Otherwise, a general method for identification should be devised

• Embedded or concatenated identifiers would avoid enumerating a combinatorial explosion of complete documents assembled from templates

• Coordination of templates with value set standards– E.g.,: value sets for hospital readmission measures could be coordinated with

discharge summary template standards

• Next Steps

– Seek HIT Standards Committee input

– Continue Workgroup discussions to create future recommendations to the full Committee