The CCD is another evolution of healthcare messaging, released by the HL7 organization. It is an XML based document that was designed to contain large amounts of data about a patient (see example below), whereas the original HL7 standard focused on individual transactions (i.e. Admit a Patient, Order some Lab work, Prescribe a Medication). The default usage of a CCD is a “Summary of Care”, in which a healthcare provider describes everything known about the patient for a given visit all in a single document (i.e. Known Allergies, Performed Procedures, Medications Prescribed).

We first encountered the CCD standard with our Electronic Health Record application, EXR, being able to generate a CCD document as described above. Soon after, we partnered with SEMHIE to work on the Social Security Administration’s E-Disability CCD Exchange. We then decided to turn it around, and added the ability to ingest a CCD and its contents into our Patient Health Record software, PhysBee, which in turn, spawned the creation of our Alchemy service, and our work with MiHIN and the Medication Reconciliation service.

<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 CDA/infrastructure/cda/CDA_SDTC.xsd" xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:sdtc="urn:hl7-org:sdtc">
  <realmCode code="US" />
  <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040" />
  <templateId root="2.16.840.1.113883.10.20.1" />
  <templateId root="2.16.840.1.113883.3.88.11.32.1" />
  <templateId root="2.16.840.1.113883.10.20.3" />
  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1" />
  <id root="6858a017-39c1-4153-bbd4-eaedac72a0e7" />
  <code code="34133-9" displayName="Summarization of episode note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOIVA" />
  <title>Continuity of Care Document</title>
  <effectiveTime value="20091206130000+1400" />
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" />
  <languageCode code="en-US" />
  <recordTarget>
    <patientRole>
      <!--1.02 - Person ID (SSN)-->
      <id root="2.16.840.1.113883.4.1" extension="999-99-9999" />
      <!--1.03 - Person Address (Home Address)-->
      <addr use="HP">