HData Template Sub Project – HL7Wiki – A new data standard that appears lightweight and open source. I don’t know how it compares to CCR so if someone else wants to take a look and post a comment, go for it.
Posts Tagged ‘standards’
Microsyntax.org : Transmitting meaningful information in small character streams
December 1st, 2009 | Popularity: 3% 2 commentsMicrosyntax.org – Microsyntax.org is a non-profit focused on identifying, researching and finding consensus on information syntax in real-time streams. A bit of translation – developing a way for people (including patients and doctors) to communicate meaningful data in small bits, over things like cell phones and Twitter. Open source, come on in.
The Health Care Blog: Should Health Care Standards be Open Source?
May 15th, 2009 | Popularity: 25% 2 commentsThe Health Care Blog: Should Health Care Standards be Open Source?
Is a $100 per license a significant hurdle in the use of open standards? Guest writer Alan Viars fleshes out a conversation he and I had on Twitter recently, related to some thinking about the open sourceness of open standards. Applause to Alan for putting the information out there for public comment and review, in the interest of making health care data easier to move around.
A Web Services based Electronic Health Record, OnCall, from the Laboratory of Computer Science
July 2nd, 2008 | Popularity: 40% 1 commentWhile at Massachusetts General Hospital last week, as a guest of The Stoeckle Center for Primary Care Improvement, I was invited to meet the team at the Laboratory of Computer Science based at MGH. The Lab of Computer Science produces the OnCall series of clinical web portals, which are a front end to the Computer Stored Ambulatory Record medical record system.
The reason it is a “series” and not “a front end” is because this system actually has brands that are specific to the specialties and care that it supports. Here’s a picture from a computer screen that shows them:
Why is this interesting? Because it’s doable – this ambulatory record system communicates using an XML platform, and has been doing so since 1996. XML, as I mentioned in a previous post, is an uber-industry standard for moving data across systems outside of health care, and is now getting traction in health care. Having it as a foundation for an electronic health record system back to 1996 has some advantages, like the one you can see above. Different types of care can access the same data differently.
In my usual LEAN way, I asked if I could see OnCall in action, and so I shadowed Henry Chueh, MD during his clinic day (with each patient being asked for their consent before I entered the room). I found the interface to be very user centric, with lots of modern AJAX-y touches, as one would expect for an EHR that is being continually improved by a team of physicians that practice medicine regularly. Back to the XML though, the happiness is not that the user experience is good, it’s that it can be improved perhaps easier than another system because the data is moved around in standard ways. It’s almost like the team could create a patient version of the same record using a style sheet – which is something of a holy grail in patient access, in my opinion.
OnCall is going to be used as the basis for the Ambulatory Practice of the Future, also being designed at MGH. The idea is that a practice that can continuously improve will do best with an electronic system that can do the same, quickly.
There isn’t yet a patient portal attached to OnCall, but one is being worked on under the leadership of Henry and JeanHee Chung, MD, MS, a practicing internist and member of the LCS team. They showed me an early prototype of a patient front end and system named “ACCORD” (Ambulatory Care Compact to Organize Risk and Decision-making) which takes a personal health record one step farther than I have seen, by connecting patients and physicians to agreements around treatment plans. There’s a short summary of the project here at the AHRQ Web Site. I think this would be an exciting development for an electronic system and I was delighted to meet the parents of the OnCall system and get a glimpse into the future of a personal health record that uses data to model patient-centeredness.
Thanks to MGH and the Lab of Computer Science team for the warm welcome. LCS is sort of legendary in Informatics circles in terms of the vision it brought to medicine around the use of computers, and it was good to see in the flesh.
What I learned about CCR, Part I
June 27th, 2008 | Popularity: 33% 11 commentsThis is a bit overdue for me given that I learned what I learned about CCR at the ASTM Workshop in May, 2008, conducted by David Kibbe, MD, MBA, and Steven Waldren, MD. I think what I learned is important for supporting patient-centered HIT, so I’m putting my summary here. A reminder that the beauty of Web 2.0 is that nothing is ever finished – feel free to clarify or correct anything I’ve gotten wrong.
The seminar itself was very enjoyable, nicely paced, and I learned as much from the students (including fellow blogger Vince Kuraitis and Sam Faus from Sujansky and Associates) as from the teachers – that’s always the right combination.
Why was CCR created?
CCR stands for “Continuity of Care Record. (link to official site here) ” I think the “why?” of anything is the most important – knowing where things come from tells us where they’re going…
In 2003, there was a desire to figure out a way to take the “green form,” which health care providers used to transmit a patient’s medical record summary to the nursing home, digital.
(In the clinical arena, the transfer to a nursing home is one of the most delicate times for a patient and their family. Inaccurate or missing information can have an enormous impact when the receiving institution is not staffed to reconcile and adjust therapy the same way a hospital is.)
In their discussions, David told us, they began asking about making this XML-based standard “a record for the patient” that could be used for all kinds of care transitions, not just to the nursing home. And so, CCR was born.
(Comment from me – (a) yet another innovation from those in our profession who care for our geriatric peers (b) CCR is fairly new on the scene, 2003 is recent in Informatics history)
CCR was vetted through ASTM International, which from my understanding, is atypical for this organization, which now has a very small focus on Health Informatics. There are other standards bodies, most notably HL7, that have traditionally working in health information.
What exactly is CCR?
Note: The paragraph below is superceded by the comment attached to this post by David Kibbe, MD, which more accurately explains the content and licensing of CCR. Thanks, David!
CCR is two basic things – a “Schema Definition” that resides an a fairly easy to read spreadsheet. And an implementation guide, which provides the “how to” of every element. Both are licensed under the Apache GNU License. This is not 100% the same as open source – but I think it does mean anyone writing software can use this standard to move data around.
CCR uses eXtensible Markup Language, or XML. XML is very standard in modern Web applications. For example, the piece of software that I am writing this blog post on is going to send my words via XML to my blog, and my blog doesn’t really care what software I used to send it my words from, as long as it uses the right XML code to contain it in. This is important in a standard – it’s connected in a logical way to standards already used by other industries to move data (getting us away from the “health care is different” model).
Is CCR supposed to help with portability and interoperability?
As David explained to us. These are two different things. Portability means you can move the information to another place, via paper, fax, or digitally. Interoperability is the ability of “XHR” software (“X” can mean “P” or “E” for EHR or PHR – get it?) to communicate and exchange data so it can be used for its intended purpose, for example to trend with data like it, or to be used to support population health.
CCR is supposed to help with both, using an approach that is not based on a paper chart – it is concerned with vendor-neutral, human and machine-readable structured data.
Why isn’t CCR based on the concept of a medical chart?
I have worked in large systems that computerize medical charts using state of the art software. This part took me some time to understand. A medical chart is divided into various sections, organized a certain way (depending the doctor/hospital where it’s used unfortunately), and serves various clinical and legal functions. It’s a lot of things to a lot of people.
CCR on the other hand, is more like, “What do I need to know about you (and what do you, the patient need to know about you) for you and I to take care of you right now.” It’s a summary of the most important things, but not necessarily everything. At the same time, it can have multiple observations, like a list of past blood pressures for example. It can be a summary of just one outpatient visit, or of 10 years in a healthcare system. It’s flexible that way. We learned that MinuteClinic, Inc. uses it in the former way, to “summarize” one visit to a practitioner and transmit it as needed by the patient.
Part II coming soon: More of What I Learned about CCR
Health Management Rx: Good News/Bad News – CCHIT To Certify PHRs
June 23rd, 2008 | Popularity: 17% 0 comments | Leave a reply- Health Management Rx: Good News/Bad News – CCHIT To Certify PHRs – Helpful guidance as PHRs enters the realm of CCHIT
CCHIT Goes After PHRs « Chilmark Research
June 17th, 2008 | Popularity: 17% 0 comments | Leave a reply- CCHIT Goes After PHRs « Chilmark Research – commentary on PHR certification process
Serving on the Personal Health Records Work Group – Certification Commission for Healthcare Information Technology
June 10th, 2008 | Popularity: 21% 10 commentsThe members of Personal Health Records PHR Work Group Members – CCHIT Certification Commission for Healthcare Information Technology were announced today, click on the link to see the list.
It’s a pretty impressive group, myself excluded 
, and I look forward to participating. Because CCHIT handles proprietary information, I won’t be blogging about my volunteer position with this group here.
CCHIT operates its own web site which includes opportunities for public commentary, and it also operates the EHRDecisions Blog, which I subscribe to.
The Health 2.0 Blog: Google Health beta — What's really new and different?
June 2nd, 2008 | Popularity: 24% 0 comments | Leave a reply- The Health 2.0 Blog: Google Health beta — What’s really new and different? – Nice commentary from David Kibbe – looking at the advantage to all of health care (and health) that come from moving to standardized movement of data. I agree.
NAHIT Releases HIT Definitions | News | Healthcare Informatics
May 28th, 2008 | Popularity: 25% 0 comments | Leave a reply- NAHIT Releases HIT Definitions | News | Healthcare Informatics – Long awaited, and helpful. The difference between "P" and "E"HR appears just to be control. "P"HR is controlled by the patient. I still believe that the customer of both is the patient, and these definitions are consistent with that idea.
McCain Makes Health Records Public – Could he do it using CCR?
May 24th, 2008 | Popularity: 24% 0 comments | Leave a reply- McCain Makes Health Records Public – Could he do it using CCR? – Without commenting on the content of Senator McCain's health care record, wouldn't it be cool (if he approves) to release it in CCR format to show the promise of the standard? Same for all the candidates?
Re: Where is the Best Discussion of Google Health happening?
May 22nd, 2008 | Popularity: 32% 3 commentsColleague in patient empowerment Susannah Fox e-mailed me this question and so we thought we’d start one.
Jay Parkinson, MD, linked to a discussion happening on Digg in his blog. E-patients is also hosting an informed discussion on their blog.
Is it cliche to say that this is evolutionary, not revolutionary? I think it’s of benefit to patients and our profession that a dialogue has started around moving health care data in a standardized way to a place where people can aggregate and do things with it to improve their health. A year or two ago, it was hard to think about a standardized extract of a medical record that you could send from an EHR system except in very specialized situations. Now you can do with several partners, Google being the most recently announced option.
I didn’t even think about writing a special post about it, even though I thought, “Cool, this work will support the ideas I am exploring with the California Healthcare Foundation, that patients can be involved and active in their care, across health environments (health system, work, play).” So rather than writing about it, I just incorporated the possibility into the work we’re already doing, which is great.
I think of privacy as a state of being that allows a person to feel comfortable seeking health care regardless of the issue. This is a good place to be, and when that state of being doesn’t exist, people will seek it out, even if it means not seeking needed care, which could be devastating both to patient and health system. At the same time they seek comfort, they also want to build confidence in their ability to manage their health by having as much information their care as possible. In systems where patients have good access and trust, the care is better, and it feels great (and is great) to provide and receive care in that setting. Both things are important, we should not sacrifice one for the other; every patient deserves to achieve their life goals through optimal health.
NCPDP Standard for Encoded SIGs
May 22nd, 2008 | Popularity: 47% 0 comments | Leave a replyI learned about this at the CCR workshop. The CCR accomodates elements of this, but CMS has not endorsed it yet as a standard.
AMCP.org – Comments on Standard SIG – The NCPDP was working on the standard for Med Sigs – a little background
A Few Links Regarding the Continuity of Care Record (CCR) Standard
May 22nd, 2008 | Popularity: 80% 3 commentsMay 15th through May 18th:
- CCR Product Compatibility List — AAFP Center for Health Information Technology – Adoption list of CCR – not up to date, but gives a glimpse of who has been involved.
- Montana Healthshare – Montana organization to use CCR to improve population health
- Solventus CEND/PHR – A reference implementation of a PHR using CCD, developed by Stephen Waldren, MD and David Kibbe, MD
- PDF Healthcare – A technology platform for enclosing historical documents – can contain a CCR
- SourceForge.net: CCR Acceleration Resources Project – The XSLT transofrm from XML -> HTML for CCR
- www.ccrstandard.com – Continuity of Care Record (CCR)Standard — Resource Site _uacct = “UA-2242673-1″; urchinTracker(); – Home base for CCR
- “I hope that some day you get your wish” – "Medicine has a 100% failure rate" – a discussion of physicians in information technology.
- The WETA Guide to Fine Dining | WETA TV 26 – A nice series on DC treasures
- The Health Care Blog: PODCAST/CONSUMERS/TECH: Interview with Joseph Kvedar, Partners’ Connected Health guru – Information about ConnectedHealth and the EMC pilot they are doing
“Why Don’t We Make This a Record for the Patient” – Learning about CCR at TEPR
May 18th, 2008 | Popularity: 25% 0 comments | Leave a replyThe quote in the title of the post is from David Kibbe, MD, MBA, who co-taught a workshop on the ASTM Continuity of Care Record Standard with Steven Waldren, MD, MS, in conjunction with the TEPR Conference in Fort Lauderdale, Florida.
I took the workshop on behalf of my work with the Calfornia Healthcare Foundation to look at creating a connectivity ecosystem for patients, families, and health stakeholders in a community, which I’ve started to blog about here.
It was a good workshop, with a nice step-through of the CCR standard, which for me was fairly straightforward to follow. Here’s a screenshot of the XML schema of a sample (test) CCR XML file. If you’re medically inclined, you’ll see that it’s an XML representation of a prednisone taper. I didn’t put this XML file together, but I consider this a sort of “hello, world” – to show that a clinical summary can be represented with a human and machine-readable file.
CCR is figuring into many well publicized Health 2.0 applications and I am of course a fan of anything that has its genesis in engaging patients in their care.
AMA on NPR; Patients judge quality by presence of an EHR; CCHIT Expansion Plans for 2009
April 5th, 2008 | Popularity: 82% 0 comments | Leave a reply- Topics – e-Visits @ TransforMED – Transforming Medical Practices – Article on whether the tipping point has been reached for e-visits
- WordPress Plugin: SIMILE Timeline at freshlabs journal – Nice visualization tool
- Doctor-Patient ‘Web Visits’ Spur Privacy Concerns : NPR – Should the American Medical Association always present the contrarian view around patient access? I don’t agree with the implication that cell phone / telephone is “most secure.” Anyone who has been in an airport recently would probably agree.
- WSJ.com/Harris Interactive Study Asks: Are There Fair and Reliable Ways to Assess Healthcare Quality? – Patients are saying that having an EHR is a “fair” assessment of quality
- Expansion of CCHIT Certification for 2009 (PDF Presentation) – Overview of CCHIT’s work to date and future strategy. Disclaimer: I am on the Foundations Workgroup
- Meet the Press — Robert Scoble — The Blogosphere | Fast Company – How Tim Ferriss used the blogosphere to his advantage
- News – Diversity gap found among state’s doctors – sacbee.com – “Not just a civil rights issue, a public health issue”
- YouTube – Microsoft Surface Parody – Why not use the device the size of a small car? The peril and promise of on demand video in shaping your message.
Promising Reimbursement Methodology; More on Music and Real Estate Industries; Another Blog Post Goodbye to an Employer
January 15th, 2008 | Popularity: 45% 1 commentJanuary 12th through January 13th:
- Prometheus Payment, Inc. – A new payment model that supports outcomes, evidence-based care, and transparency
- The music industry | From major to minor | Economist.com – “Then they had the money and could have built the competence by buying concert agencies and merchandise companies,”…Now it may be too late.
- Coverity Incorporated Scan – Company working with the US Govt to harden open source code for use by agencies including Homeland Security. They are finding bugs and the bugs are being fixed.
- Online Real Estate Sites Work To Get A Listing Standard – Another industry that is seeing the benefits of standards, and the challenges of disruption
- Gone Indie ? Thought Palace – Interesting insight on the work environment at Apple. LEAN production? You decide. I will say, though, that even though Apple is not embracing Web 2.0 like other companies are, I have solved many problems using their hosted discussions. These actually work well on Apple’s site I think because they do a great job of leveraging their loyal customer base. Yet another blog “goodbye” to an employer.
- Lean Manufacturing Blog: 1 Hour Kaizen – Excellent template and approach to small improvements. Just takes an hour. Can we have physicians shadowing nurses and vice versa?
A CIO posts his medical record in 2 formats; Employer Best Practices for PHRs
December 24th, 2007 | Popularity: 20% 0 comments | Leave a replyPCHIT links for December 24th:
- Life as a Healthcare CIO: Standards for Personal Health Records – To prove a point about portability, John Halamka, MD, posts his medical record on his blog, in unstructured and structured formats.
- Health Privacy – Health Privacy 101 – HPP Releases Best Practices for Employers Offering PHRs. A good primer on PHR practices for employers.
