Jack H. Evans
Director of Solutions Architecture
Indiana Health Information Exchange
It’s not a CCDA. Really… it’s not.
The dictionary says an acronym is a word formed from the initial letters of other words. Sometimes, acronyms feel like a recipe for a headache. There’s nothing quite like initials to make communications hard. Technology is full of them, though, and so is medicine. We’re at the intersection of both industries, on a street corner I call “Acronym Central.” It feels like drowning in alphabet soup, sometimes.
It gets really tricky when two acronyms are really close to each other. Is it LDL or HDL that’s the “bad” cholesterol?
INPC members get approved access to data from other members for patient care. Our CareWeb user interface is a great way to view that data. Recently, we’ve also gotten requests from members to send the data electronically into their computer systems. This lets them view the data locally, right in their EHR. Often, they want to receive the data packaged in a Continuity of Care Document, or CCD. Some members want to send their data to us in that format, too.
The CCD was created by Health Level Seven (they go by their own acronym, HL7), which is part of their overall Clinical Document Architecture (CDA). CCD is designed to be flexible, and clinical data can be placed in the document in different ways. Other organizations came up with recommendations for how to arrange the content in a CCD. For a while, the style of CCD that was the most popular was called C32; not very descriptive. There were several other kinds of documents as well, which led to confusion. To help manage this, HL7 came up with a variation of their design to bring all of these documents together in one place. They called it Consolidated Clinical Document Architecture (C-CDA). The C-CDA specifies 13 kinds of documents, one of which is the CCD. When Meaningful Use came along, the US government required a C-CDA compliant CCD for transitioning patients. So… when there’s an ADT, ONC wants a C-CDA CCD to go via TCP/IP to a HISP for MU2 TOC. Oh, my spinning head.
It’s natural to want to simplify how we talk about our work. Clinical data is complicated enough as it is, no one wants to make matters worse. Over time, it’s becoming common to say “send me a CCDA,” meaning a CCD (document) that’s C-CDA (architecture) compliant. Even though it’s not really a CCDA, it is nice to have a couple fewer letters flying through the air.