HL7v2 to CCD

Confused? Start with What You Know

CCD-HL7-get-startedOver the past few months, we’ve heard a lot from our hospital-based customers about CCD and C-CDA readiness. There’s more urgency with Meaningful Use Stage 2 deadlines, even with the extension.

But the funny thing is: hardly anyone ever says, darn, but this is confusing.

Sometimes people express their frustration. “What the heck are those regulators doing? Why are they pushing more stuff at us, when we’re barely able to keep up as it is?”

Others bury their heads in the sand. “We’ll get to it. It can’t be that hard. Just go download a few Implementation Guides and we’ll get it done.”

And few and far between, there are the rare people who say, “This is hard. This is confusing. How do we start?” This post is for those folks who find it confusing. Here are some suggestions for getting started.

For starters, you’re an interface expert – either an analyst or developer. You’ve already got an extensive body of knowledge in HL7 v2.x messaging.

How do you add CCD to your toolkit? Simple. Start with what you know: HL7 v2.x. Here are some answers to the questions we’ve often come across.

With HL7 2.x interfacing, scoping and validation is a big part of the work. Will this volume of work be reduced with CCD?

No. And here’s why. CCD, which is based on Clinical Document Architecture (CDA), is an evolving standard and it parses a number of discrete elements. And as an implementer (either as a vendor or a provider), you can define or tweak your own templates.

Sure, there are specific templates that are prescribed by Meaningful Use. And these are publicly available, with a full set of schemas (which define the structure or format), content, and of course use cases.

The validation or conformance templates are also available, so it’s easy to define the rules they have to conform to.

The danger here is that implementers still have to meet their organization’s own needs, therefore they will need to define custom formats – similar to z-segment in HL7 v2.x. They’ll meet their immediate needs.

If the CCD spec or schema is more constrained, shouldn’t the interoperability work be easier?

You would expect that to be the case. The CCD specification is more constrained than the HL7 v2.x standard from a structure or format point of view. But keep in mind that the CCD spec (because it is based on on XML) is huge. And the content is varied. One analyst said, “it’s all over the map. I have no idea where to start.” So the idea of creating profiles – what Caristix Workgroup software enables — is attractive, since it facilitates the gap analysis process. (More on gap analysis and CCD next week.)

How do I manage custom elements and variations?

Documentation is important. An XML schema, while complete, is hard to read and represent easily. They are self-referring. You’re going to scroll a lot. Our goal, with our profile approach, is to makes this process easier. Coming soon: another article on the biggest roadblock with CCD: gap analysis.

Stay tuned. Tell us: What else would you like us to cover? Leave a comment.