Remarks from David Kibbe, MD, about CCR | Functional Status, and Google Health

I’ve decided to give the continuation of this discussion (started here) it’s own post, to freshen it up a bit.

ePatientDave asked:

Long story short – the CCR schema is not freely available ($100) so pts can’t discuss whether Goog should have implemented other Types for Functional Status. They only did Pregnant and Breastfeeding. Some of us wanna know what they other available values are.

David Kibbe wrote us both in e-mail:

Dear Dave and Ted: It’s great to have these questions asked, and important to respond. The Functional Status data object (section) of the CCR standard may include any condition that the user/implementer thinks is related to functional status. Google Health has given as examples pregnancy and breast feeding, with SNOMED codes, but one might also enter “BKA right leg,” or “severe respiratory impairment due to COPD,” with codes for those.

The reason for this: There is no formal vocabulary within the industry or profession for Functional Status, and so the standard doesn’t refer to one. Perhaps there should be, and I think that as people start to use the CCR standard for health data exchanges, it may be one of the things that the industry needs and then creates. The same can be said for the CCR standard’s data object (section) on Advance Directives. While there are some industry conventions for descriptors here, as “do not rescucitate,” and codes may be found for these, there is no universally agreed up set of codes that could be plugged in here that everyone would accept.

Lots and lots of work to do! We’ve laid the path, but we certainly haven’t put in all the sign posts, paved the road with asphalt, or installed traffic signals!

One other comment: The CCR standard is not a formal data model. It could very well become the basis of one. But people think, sometimes, that this is all perfectly arranged and designed, to the point of being a data model. And that would be correct.

Hope this is helpful.

I think that the Participatory Medicine folks should help the CCR standard community to build a CCR Wiki that would move this all along a bit faster. What do you think?

Kind regards, DCK

And a follow-up from David:

Steven and I have also done a number of CCR Training Workshops for programmers and developers, the so-called “deep dive” into the CCR standard. And I’ve started an entry in Medpedia on the CCR standard.

As well as one from Steven Waldren, MD:

There is a fair amount of material on about the CCR. I also did a video tutorial that goes over the schema at a high level. It can be found here:

Thanks to all for their support of this conversation being transparent.

As an aside in my own work with a colleague, we’ve discovered “At this time, Google Health does not support diet and exercise information, nor images such as x-rays.” (From their Third-Party Services Overview).

Clearly we have some more work to do for these standards and the services to use them to capture information that’s as health related as medications or lab tests (see my series of posts on Safeway’s Food PHR, FoodFlex)


Thanks for the link, Dave – I see that there is a discussion of adding exercise data to Google health, and a workaround is suggested here.

The way things were written it seemed like this would violate third party use, but from the discussion it looks like Google is working on this and using the API this way shouldn't disqualify its use,


Ted Eytan, MD