The Clinical Document Architecture and the Continuity of Care Record
A Critical Analysis
- Affiliations of the authors: Division of Newborn Intensive Care, Department of Pediatrics, Duke Health Technology Solutions (JMF), Department of Medicine (RCM), Division of Clinical Informatics (KK), Department of Community and Family Medicine and Department of Biomedical Engineering (KK, WEH), Duke University Medical Center, Durham, NC; Fuqua School of Business (WEH), Duke University, Durham, NC
- Correspondence and reprints: Jeffrey M. Ferranti, MD, Division of Newborn Intensive Care, Duke University Medical Center, Box 3179, Durham, NC 27710-0001; e-mail: <ferra007{at}mc.duke.edu>
- Received 12 September 2005
- Accepted 16 January 2006
Abstract
Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfortunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7 (HL7)'s Clinical Document Architecture (CDA) and The American Society for Testing and Materials (ASTM International) Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are those of the authors and do not represent the official viewpoints of either HL7 or of ASTM International.
Footnotes
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This article reflects the authors' opinions and is biased by two of the authors' close associations with HL7. However, the opinions expressed here are the opinions of the authors and do not reflect the opinions of the HL7 Board of Directors or of the HL7 organization.
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Although this paper critically analyzes the work of both ASTM and HL7 from the authors' perspective, the authors applaud the dedication and contributions of both organizations to the future of clinical care. They are particularly impressed by the organizations' recent harmonization efforts and look forward to the future promise of true semantic interoperability.
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Kensaku Kawamoto is a member of HL7. W. Ed Hammond, PhD, is a member of the HL7 Board of Directors, is Vice Chair of the HL7 Technical Steering Committee, and is also a member of ASTM International Committee E31.
