1. HIT Standards Committee
Clinical Operations Workgroup
Workgroup Update
Jamie Ferguson
Kaiser Permanente
John Halamka
Harvard University
30 June, 2010

2. Problem Statement
• Implementers of CCR and CCD for transfers of care
also need other standard document types, e.g.,:
– Inpatient Discharge Summary
– ED Discharge Summary
• These documents may contain specialized content not
found in CCR or CCD, e.g.,:
– Discharge Diet
– Surgery Description
– Surgical Operation Note Findings
– Estimated Blood Loss
– Chief Complaint

3. Review: CCR and CCD
A CCD based document
CCD: A collection of templates representing core content for
healthcare summary documents with template content from CCR
Family History
Medications
Problems
Allergies
Social History
Vital Signs
Payer
Demographics
....
CDA: A foundation standard enabling the definition of templates
for a broad range of healthcare documents

4. Extending And Reusing Existing Templates In
Other Documents
A CDA based document
compatible with CCD
A CCD based document
CCD Template content from CCR
Chief Complaint
Diagnosis
Discharge
Transport
Mode of
Surgical Finding
New Section…
Discharge Diet
Family History
Medications
Problems
Allergies
Payer
Social History
Vital Signs
Demographics
....
CDA
Identified by the CCD document ID number
Identified by another identifier, e.g., an
ED Discharge document ID number

5. Discussion points
• We plan to make recommendations to the Standards
Harmonization entity as outlined in the Concept of
Operations plan
• General direction of WG: Recommend that the process
should standardize templated CDA sections to build
upon and extend what was done in CCR and CCD
• WG direction is consistent with NIST direction for testing

6. Discussion points, continued
• Must enable more documents and reuse existing work
• May also recommend this direction for attachments
• Identification of complete documents assembled from
templates:
– A few complete documents might have complete document IDs,
e.g., discharge summaries, ambulance services, etc.
– Otherwise, a general method for identification should be devised
• Embedded or concatenated identifiers would avoid enumerating a
combinatorial explosion of complete documents assembled from
templates
• Coordination of templates with value set standards
– E.g.,: value sets for hospital readmission measures could be
coordinated with discharge summary template standards

7. Next Steps
• Seek HIT Standards Committee input
• Continue Workgroup discussions to create future
recommendations to the full Committee