A + B = CCD C32?

Implementing CDA Part I

I’m told that RelayHealth began thinking about structured health summaries in 2007…but the first recorded thought about coding to CDA (Clinical Document Architecture) standards was documented in 2010. This was the time of CCD C32.

I went straight to the source to learn about the Great Implementation of 2010, interviewing our now Data Platform Director of Product Management, Charles Curran, who was a one-year-seasoned Product Manager when he was tasked with building processing support for CCD C32.

(Paraphrased for length, but not for content or color)

RelayHealth first began its relationship with health summaries in 2007, building prototypes for the military’s health system. “We helped them build their CCD from scratch.” Charles notes that RelayHealth was “at the forefront of technology” in many ways, from parsing CDA documents as discrete data elements to inventing the ability to generate an aggregated CCD from the parsed data.

“We implemented Version 2.3 first…the document was actually called C32. [Version] 2.5 referenced C83 and C85 which is another example of why this sh*t is so confusing because we’re implementing C32 which is referencing C83, which is referencing C85, which sucked,” says Charles.

Charles’s biggest complaint with the standard was the lack of documentation to help implementers. At the time of building the C32 processor, Charles thought the CCD C32 standard was “really confusing…there were no good sample sections being like ‘here’s what it looks like’; It was all inference based on confusing language…Non-declarative statements, right, where ‘you could do this’ or ‘you could do that’. It was all very frustrating.”

“We think it means ‘this’, but how do we validate that in the real world? We needed to actually get out there and implement our interpretation with lots of groups.”

Testing with other vendors proved difficult. Charles believes that other major vendors were looking at CCD around 2010 to prepare for Meaningful Use 1; however it wasn’t for two more years that Meaningful Use 2 spurred most vendors to leverage the CDA technology in a Production environment.

“MU2 was when we started seeing large scale adoption in Production, where vendors could support it and customers had a need for it…Really it has been the past year, year-and-a-half that we’ve gotten CDAs from all different vendors”.

How did these new players affect the evolution of CDA? What additional obstacles did the RelayHealth team face?

To be continued…

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