In a number of interviews with leading HIE vendors, it is becoming clear that the clinical standard, Continuity of Care Document (CCD) will be the dominant standard in the future. The leading competing standard, Continuity of Care Record (CCR) appears to be fading with one vendor stating that virtually no client is asking for CCR today. This HIE vendor did state that one client did ask for CCR, but only to enable data transfer to Google Health.
CCR was created by ASTM with major involvement by AAFP wih the objective to create a standard that would be far easier to deploy and use by smaller physician practices. At the time of CCR formation, the dominant standard was HL7’s CDA, a beast of a standard that was structured to serve large hospitals and based on some fairly old technology and architectural constructs. With competing CDA and CCR standards in the market, there was a need for some rationalization which led to the development of CCD, a standard that combined some of the best features of CCR and CDA.
Today, CCD is seen as a more flexible standard that is not nearly as prescriptive as CCR. This allows IT staff to structure and customize their internal HIT architecture and features therein for their users and not be confind to a strict architectural definition such as that found in CCR. (Note: such strict definitions are not always a bad thing as they can greatly simplify deployment and use, but such simplicity comes at a price, flexibility.)
Unfortunately for Google Health, who has built its system on top of a modified version of CCR, this trend likely lead to increasingly difficulty in convincing healthcare providers to provide patient health records in a CCR format. Google would be wise to immediately begin the work necessary to bring CCD documents into their system as the writing on the wall is getting clearer by the day. CCR is a standard that will fade away.
[…] today I was really interested to read Chilmark essentially declaring CCD the winner in the EMR interoperability battle. Officially he says that CCD is gaining traction and CCR is fading, but if you read his post […]
[…] Article John Moore, Chilmark Research, 17 February 2010 SHARETHIS.addEntry({ title: "CCD Standard Gaining Traction, CCR Fading", url: "http://articles.icmcc.org/2010/02/18/ccd-standard-gaining-traction-ccr-fading/" }); […]
[…] CCD (HL7 Continuity of Care Document) vs. CCR (Continuity of Care Record). Their post is entitled CCD Standard Gaining Traction, CCR Fading. Other than Google Health, HL7 CCD seems to be the most request […]
Interesting and timely discussion. Given CCD’s traction, it is interesting that the healthcare standards IFR calls for both in Stage 1. We are having a similar discussion on these healthcare standards.
Saying that CCR is fading away is not factual.
CCD will have more momentum among HIEs, RHIOs, and federated healthcare organizations (e.g., IDNs).
Big vendors such as: GE, McKesson, Epic, etc. will favor CCD since they are the ones that have been promoting it in HL7 for many years.
CCR will be favored by many EMR vendors that would like their products to feed the consumer (e.g., patient, custodian).
I believe each one has their place in the healthcare market albeit in different segments.
And yes, both Google and Microsoft will offer CCR for their health repositories.
Thanks,
The EHR Guy
Maybe to say it will completely fade is too bold a statement after all it does take a lot for standard to go away. That being said, do believe that th market will not support two separate standards, that a rationalization will occur and not convinced that CCR will be around several years from now.
That being said, will CCD be around? More than likely yes, as it has the large institutions and their vendors to support it, though also believe that it will go through a major rework to further simplify while maintaining the attributes that larger enterprises appreciate, flexibility.
As for Google Health, they’ve been supporting a modified (even simpler) version of CCR since go live. MSFT’s HealthVault has supported both CCR and CCD since go live.
This post was looking longer term where in over time, CCR will indeed fade, CCD will still have prominence and there will likely be a further melding of the lightweight capabilities that CCR provides in a new standard such as “green CDA” see: http://motorcycleguy.blogspot.com/2010/02/birthing-of-new-standard.html
Just do not believe that the industry will indeed support both CCR & CCD, there will be a rationalization.
When Google Health went GA, they supported (and continue to) a modified, striped-down version of CCR. The PHR company, NoMoreClipBoard has built functionality for Google Health that now allows Google to accept CCD formatted data sets.
From the beginning, HealthVault has supported buth CCR and CCD. HealthVault’s support of both standards has been itrumental in its ability to attract and on-ramp far more data providers than Google to date.
[…] for rewarding people for their work, but charging this much for a standard a little insulting. Some people are positing that this standard is on its way out. I guess that’s what happens when you charge for […]
John, I spoke with a Google engineer at HIMSS and he told me that they were going to support the entire CCR and will be adding the CCD.
HITSP promotes the CCD has added CCR as a secondary document for legacy systems
If we do not support the CCR many EHR and almost all PHR will not be compatible and will not be able to share data. Hospital systems are the most likely candidate for CCD implementation. It is the smaller health systems and PHRs that would suffer by CCD mandate.
I spoke with Dick Taylor, CMIO of Providence Health at Oregon HIMSS a few weeks ago and he told me that CCR data had no value to him and went on to explain that the data can be ambiguous. I agreed with his point but there is still a lot of hand written notes in the system and will be for a long time to come
I feel that CCD will be the end goal but legacy system including CCR data will be around for a long time.
Jeff Brandt
http://www.hieconnect.net