1. HIT Standards Committee Clinical Operations Work Group 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 MedicationsAllergies Social History Demographics Payer.. Vital Signs Problems A CCD based document CCD: A collection of templates representing core content for healthcare summary documents with template content from CCR Family History 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 MedicationsAllergies Social History Demographics Payer.. Vital Signs Chief ComplaintDischargeDiagnosis Problems A CCD based document A CDA based document compatible with CCD Mode ofTransportNew Section… Template content from CCR Family History Surgical Finding Discharge Diet CDA CCD 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 Next Steps –Seek HIT Standards Committee input –Continue Workgroup discussions to create future recommendations to the full Committee