Software vendors who agree to share this set of computable health data about a person gain value in the same way that any network effective product or service gains value, e.g. telephone and faxes.Users of these products then leverage that value to become better at communicating and sharing, which over time may lead to better clinical decisions, fewer and less costly medical errors, and greater efficiency as hands-off between providers involves less rework and duplication of effort. The differences between the CCR standard and the CCD are quite easy to articulate and explain. The CCR standard is the simpler of the two, came first, and is in widening use. It consists of a header, a footer, and a body of health data organized into as many as 17 sections, e.g. problems and conditions, medications list, allergies list, family history, procedures, encounters, and so on. It uses a bit of XML technology, called a schema, to direct how the data are to be tagged using XML, and to enforce certain conventions such as time and date and the identification of coding systems used. The CCR’s sections are optional, that is, a CCR xml file can be valid even if it includes just a header, a footer, and one section, say the medications list or lab results of a patient.
Of course, the CCR standard can also allow for other sections to be added on as needed. Google’s CCR profile, for example, includes 8 sections, which reflects an industry trend to be economical with the CCR xml file’s contents and keep things as simple as possible while momentum builds and experience of exchange is gained. It is very important to understand that the CCR standard is intended to structure the data as much as possible. Short textual elements are allowed, but the purpose of structuring the data using XML tags and coding systems is to maximize the possibility that the CCR’s data elements can be both machine readable as well as human expressible. If there is a bias within the CCR standard community, it is for what Adam Bosworth calls “”computability,”” that is to say that the CCR standard is a way of structuring data, and not a way of moving documents that were previously paper. The CCR standard is not a discharge summary or an encounter/visit note. It is intended to be a “”snap shot”” of a person’s summary health information. The CCD, or Continuity of Care Document, is more complex, is based upon the CCR standard schema in part, and has not yet been tested in the market.
It is derived from and must be integrated with other HL7 standards; it is in fact a particular instance of a class of HL7 standards known as the Common Document Architecture or CDA. The formal designation for the CCD is the CDA CCD, and is described by HL7 officials as having several “”levels”” which refer to the extent to which the information in the CCD xml file is merely textual, as in most health care documents, or structured, as in the CCR standard.reduslim fa male A CDA CCD level two is a text document with no structured XML, and therefore no computability. A good example of this type of CDA CCD document can be seen at John Halamka’s web site entry of March 6, 2008, examination of the source code for which shows no structure more complex than an HTML table. A “”level three”” CDA CCD file will have structured XML included in it, in which case it could be used to exchange computable data machine-to-machine. The CDA CCD’s structured data component is supposed to be harmonized with the CCR’s xml, (see HITSP slide), but it’s not clear that full harmonization will ever materialize. At the time of this writing, the level three CDA CCD is not used by a single institution on a production basis according to a HIMSS Analytics Report called “”EMR Adoption Model.”” One of the nice things about the CDA CCD is that it can accommodate large blocks of text from provider institutions that want an XML package for portability of documents, but don’t have the capability of structuring data from their EMRs to create a CCR. Many large health care provider institutions are “”document rich,”” but “”data poor,”” and may want to approach computability in stages using the CDA CCD. Anyone who managed to read my descriptions of the two standards above will likely come away thinking that they are really very different tools, and address the needs of quite different constituencies.
And that would be correct. Both the CCR standard and the CDA CCD deserve to be tested in the market place of ideas and products, and both have their uses, advantages, and disadvantages. The CCR standard is proving very useful and agile for health data exchange where small amounts of data can be computed upon using web services, which Google Health beta is showing to be possible. The CDA CCD is proving useful as a means to gain portability of formerly paper documents and creates a glide path for increasing level of computability as the data become increasingly structured. Which brings me to the finale of this post, namely, to state in plain language that interoperability can only be approached in incremental stages when so much health data and information exists in non-structured formats. The principle to uphold is the encouragement of any and all efforts to innovate in the direction of computability and interoperability, even if some of these appear less than perfect or even piece-meal. One size will not fit all uses or use-cases, and what is good for consumers’ PHRs may not be the same thing that works in a very large medical enterprises. Control over standards by large enterprises and/or their vendors is spurious, anti-competitive, and probably won’t be effective.
The standards are supposed to make our lives simpler, not more complicated. Spread the love Categories: Uncategorized Tagged as: EHR, Health 2.0, Startups “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/tag/fed/”,”200″,”OK”,” By DAVID ERICKSON, Federal Reserve Bank of San Francisco and JAMES S. MARKS, Robert Wood Johnson Foundation We all have a vision of the “Main Street” we would like to live near – tree-lined, friendly and safe. But our “Main Streets” are in disrepair. Across the country, they lack sidewalks, parks, well-stocked grocery stores with fresh food, healthy homes and apartments, and convenient public transportation. And it turns out, these things add up to a lot more than just an unpleasant place to live – they can have a major impact on our health. There has been much in the news about the costs of medical care and our current and future economic competitiveness because of those costs. But little has been done as a nation to see if we can reduce the amount of disease we have to treat. On Main Street in America, a woman with diabetes – perhaps one who is newly insured under health reform – will see her doctor, who after telling her what medications and tests she needs, will tell her to improve her diet and be more physically active. But what if she returns home, to a neighborhood that makes following the doctor’s advice nearly impossible because there is no supermarket with fresh food like in Detroit, where there are only 5 grocery stores for a city of 139 sq. miles? Continue reading… “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2007/07/26/blogs-healthnewsreview-org-a-daily-checkup-on-u-s-health-news-coverage-by-gary-schwitzer/”,”200″,”OK”,” Gary Schwitzer is Publisher of HealthNewsReview.org.
He’s a journalism professor at the University of Minnesota, a member of the Association of Health Care Journalists and, formerly, a 15-year television medical news reporter. There’s probably never been as much high-quality health care journalism in the U.S. as there is today, but, at the same time, there’s probably never been as much schlock. We invite THCB readers to visit our site – HealthNewsReview.org – a groundbreaking effort to provide daily checkups of U.S health news coverage. A team of more than two dozen reviewers from across the U.S. – organized and funded by the Foundation for Informed Medical Decision Making – regularly reviews health care news stories reported by about 60 major news organizations. The reviewers have different backgrounds – journalism, public health, medicine, health services research – but they apply the same 10 standardized criteria in their reviews of stories. (See “How We Rate Stories”) After a little more than a year of operation, and after reviewing 400 stories, our database allows us to hold up a pretty clear mirror to news decision-makers about their performance. One clear area of failure: discussion of health care costs. At a time when health care spending represents 16% of the GDP, the costs of ideas being discussed in news stories are ignored in the vast majority of stories.
Close behind is the failure to quantify the size of the benefits and harms of treatments, tests, products and procedures. Such news coverage creates almost a “kid-in-the-candy-store” portrayal of health care – all new ideas are amazing, harmless, and cost isn’t an issue. When you think about how many Americans may get most of their health care information from major news organizations, this is a troubling picture that feeds the “worried well,” the “pill for every ill” portion of the population, and the cyberchondriacs with unrealistic expectations of their health care system. Is it any wonder why we have a difficult time engaging citizens in a meaningful discussion of health care reform? Journalists have been overwhelmingly receptive to our reviews. It is clear that many of them aren’t getting this kind of guidance from editors in their newsrooms and they welcome our independent, balanced reviews. Health care journalism has taken a beating in the current economy of many news organizations, where staff cutbacks sometimes result in the expectation that fewer do more with less. Of all beats, of all topics, health care may be the one that can least afford such cutbacks. We welcome your readers’ visits to our site and their feedback. If we can help improve health journalism and the flow of information to consumers, maybe we can help improve the national discussion about health care.
Spread the love Categories: Uncategorized Tagged as: Uncategorized “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2010/05/03/health-2-0-webinar-with-onc/”,”200″,”OK”,” Health 2.0 Presents: A Conversation with the Office of the National Coordinator for Health IT A Webinar featuring Joshua Seidman, Acting Director, Meaningful Use, Office of Provider Adoption Support, ONC Health 2.0 and the Health 2.0 Accelerator have teamed up to bring you a conversation with members of the Office of the National Coordinator for Health IT. On Wednesday, May 5, 2010 at 1pm ET / 10am PT Dr. Seidman will discuss meaningful use and its implications for health IT at a physician and hospital level. In particular, his talk will cover the central tenets of meaningful use and how it aligns with an overall vision of health IT as a catalyst for improved clinical outcomes and efficiency. Other issues such as external innovation from an infrastructure based on MU architecture will be covered, as well as implications for consumers/patients. For more background, check out the Federal Advisor Committee Blog.
Register today at http://www.health2con.com/webinars/. And don’t miss out on the next Health 2.0 event, Health 2.0 Goes to Washington! More details at http://www.health2con.com/dc-2010/. Spread the love Categories: Health 2.0 “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2010/06/19/alere-interviewed-at-ahip/”,”200″,”OK”,” By Matthew Holt At the AHIP conference in Vegas earlier this month I sat down with the CEO of Alere, Tom Underwood, and long-time friend of The Health Care Blog, Gordon Norman (Alere’s SVP of Innovation). I asked Tom about the services they provide within personal health support and their recent acquisition of RMD Networks. Gordon got the big question: does disease management program really work? Tom got the easy questions about the future of the business. Spread the love Categories: Matthew Holt “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/2005/08/18/pharmapolicy-part-d-sponsors-brace-for-intense-competition-for-seniors/”,”200″,”OK”,” And you thought that Medicare Part D was a big giveaway to the drug companies and PBMs…. Well this article in AISHealth.com’s Managed Care Week suggests that Part D sponsors are gearing up for intense price competition to recruit seniors and that the PDPs (participating drug plans) who will do best are those health plans that understand how to take risk. That’s a little odd as my understanding of the PDPs’ role in part D for the first couple of years was that if they lost money the government would make up the shortfall. Of course if that’s not the case and they do lose money we could see a repeat of the stampede out of Managed Medicare of the late 1990s –not something the Administration would like to see given how confusing the Part D benefit is in the first place. To be fair I can’t find any references to who’s really at risk, and whether losses by plans will be covered if participants drug costs exceed their premium income.
If anyone does understand this, please add your wisdom into the comments! Here’s the official CMS site. Spread the love Categories: Uncategorized Tagged as: Pharma, Policy, Uncategorized “,””,””,””,””,””,””,””,””,”” “https://thehealthcareblog.com/blog/tag/solo-practice/”,”200″,”OK”,” By MARGALIT GUR-ARIE Last week I went to see a doctor about an EHR. Dr. Greene (not his real name) is a typical solo primary care physician in a typical small town in the typical middle of nowhere. Four hours from the closest airport and miles and miles of winding roads, cow pastures and corn fields away from medical centers of excellence.
Dr. Greene is in his late fifties and has been practicing medicine for over thirty years in the same location. He works six days per week and missed “two and a half” days of work since he hung his shingle up and never missed a Rotary Club luncheon. Dr. Greene is planning on practicing for ten more years and now, he wants to go electronic. Dr. Greene’s practice is located in a small and spotless one-story building with large windows and an open floor plan. We sat down at a white laminate round table in the kitchen during his lunch break. His wife of many years is his office manager and the only other employee is a nurse who doubles as front office receptionist. His shortest appointment is for 30 minutes and new patients, who are scheduled for 1 hour, come at the end of the day just in case it takes longer than planned. His notes, written on special gold colored paper in nicely rounded cursive font, are concise and neatly organized by visit date.
Like most doctors who use paper charts, he doesn’t code his visits. He checks diagnoses and procedures on a sparse super-bill devoid of any numbers. His wife and office manager takes it from there and all his claims go out electronically every day.
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