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The certification regulations associated with Meaningful Use Stage 1 (§ 170.205) called for using the HITSP C32 as the specification for the Continuity of Care Document (CCD). For those who wan’t an intensive discussion on the technological applicability of the CCDA a highly recommend the classes offered by HL7 and a series of posts by Keith Boone in his Motorcycle Guy blogs.
The Consolidated CDA is one of the finest examples I have seen of of organizing a slew of separate specifications into a coherent and consistent set of specifications.
Previously documents based on the HL7 Clinical Document Architecture were individual specifications developed by different consensus groups. As illustrated in Figure 1 the CCDA represents revised specifications of 9 major types of documents based on a consistent framework of document sections and representation of different types of structured clinical data. The templates in the box are just what you would expect templates to be, a skeleton for positioning a group of data items inside an XML document. Figure 2 is a screen shot of a partial page of the specification that describes the required and optional sections of the CCD.
However many of these document types describe a variety of different notes based on the specific procedure being described.
Each document template is specified in a manner responsive to its individual use cases so they will need different data in the header, different sections and specific entry-level templates.
The CCDA enables consistency without arbitrarily requiring it. This is a critical advantage for developers. Another major benefit is that it brings the business names for sections and data elements much closer to the surface.
Wes Rishel is a vice president and distinguished analyst in Gartner's healthcare provider research practice.
One of the bugs in maintaining a schedule with deadlines set by law is that there is always a trade-off between using the standard that has been most wrung out or the newer standard that reflects lessons learned in the wringing out. A few OIDs were harmed in the process, and there are some minor variations here are there (there’s a nice change section in the spec) but the work is mostly a clean up incorporating lessons learned implementing Cxx, not a brand new specifications. Most of the templates, as Arien observes have already gone through a great deal of testing in their original state. There were two demonstrations at HIMSS (I wouldn’t call them pilots) that did involve quite a bit of testing, one involving SEMHIE and another with three other vendors. Comments or opinions expressed on this blog are those of the individual contributors only, and do not necessarily represent the views of Gartner, Inc. To the doctor, illness is a disease process that can be measured and understood through laboratory tests and clinical observations. The doctor’s focus is more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. Many doctors do not see the role of physician as listener, but instead view their function more as a human car mechanic: Find it and fix it. Changes in our culture and in the practice of medicine have also added tension to the doctor-patient relationship. In some ways we have become more doctor dependent, because we see doctors sooner than people did 50 years ago, yet we are less dependent on the doctor for information and decision making. Doctors underestimate the amount of information patients want and overestimate how much they actually give.
Patients who use the doctor as a scapegoat for their anger at the illness are less likely to get good care. In a video-taped study of 171 office visits, doctors who encouraged patients to talk about psychosocial issues such as family and job had more satisfied patients and the visits were only an average of two minutes longer.
The Democratic presidential nominee came off a successful convention week in Philadelphia and landed right back in hot water with another fabrication. The Republican nominee followed up by smearing a war hero’s family, revealing his ignorance about Russia’s incursions into Ukraine, denying a relationship with Russian President Vladimir Putin that he had previously claimed, and failing to quell suspicions that his team changed the GOP platform to protect Putin’s interests.
Hillary Clinton may be rising in the polls as a result, which is good news for people like me across the political spectrum who find Trump to be vacuous, soulless, and temperamentally unfit for the presidency. Scientists finally worked out what killed a group of the creatures stranded for millennia on an island no bigger than Disney World. Meanwhile, 10,000 kilometers away, the last, lonely woolly mammoth of Alaska’s Saint Paul Island is dying of thirst. The Republican nominee falsely claimed that Hillary Clinton was rigging the debates and that the NFL had complained to him in a letter—perhaps preparing excuses to avoid debating. Several times during the Republican National Convention, I found myself in the midst of conversations—with journalists, delegates, and others—about whether or not Donald Trump would bother to participate in the presidential debates this fall. Forecasting Trump’s decisions is impossible, but if the Republican nominee decides he wants to skip at least one debate, he started laying the groundwork this weekend.


As usual, Hillary & the Dems are trying to rig the debates so 2 are up against major NFL games. In 2006, Donald Trump made plans to purchase the Menie Estate, near Aberdeen, Scotland, aiming to convert the dunes and grassland into a luxury golf resort. But few expected that his initial comments would be an attack on Khizr Khan’s wife, who stood beside her husband for emotional support but did not herself deliver a speech. The newly published script of Jack Thorne’s play is a compelling read but an uncomfortable fit within J.K. Speaking in Columbus, Ohio, on Monday, the Republican argued for ceding Crimea to Russia to avoid “World War III” and preemptively questioned the legitimacy of the November election.
Speaking on Monday in Columbus, Ohio, Donald Trump delivered a new series of head-spinning remarks. Four couples in Oregon are trying to ease the burdens and costs of modern parenthood by sharing a home, a truck, and nightly dinners. COLTON, Oregon—On 20 acres of land outside Portland, eight adults are rethinking what many Americans would consider a normal family structure. The four couples—two with young children, two with teenagers—share the property, a rambling plot of land with meadows, forests, a brook and an assortment of old rusted-out cars and trailers leftover from the previous property owner.
Perhaps the hardest thing to do in contemporary American politics is to imagine how the world looks from the other side.
The vast majority of Americans support vaccines, but some presidential candidates are playing coy on the issue.
From the perspective of presidential politics, the question of vaccine safety seems like the pseudoscientific issue that might never die.Though a connection between vaccines and autism has been debunked at the highest levels for at least six years, the issue keeps creeping into public debate. Last week, Green Party nominee Jill Stein made headlines for equivocating on the safety of vaccines.
A short documentary profiles the difficult lives of senior citizens who have lived in the city for decades.
It represents a prodigious amount of work in the HL7 Structured Documents Work Group, many others  in HL7, the S&I framework, IHE  and the Health Story Project. Although the CDA did impose some consistency on all such documents the individual groups often approached the representation of clinical data differently, in terms of the sections of a document and in terms of how individual data items such as vital signs or lab orders were represented. As these document types were incorporated in the CCDA HL7 uncovered and dealt with potential inconsistencies in their definition, and real-world experience using older definitions.
When a consensus group is compiling the templates that compose a document their job is easier if they re-use existing templates rather than creating new ones.
When they develop code to relate the contents of specific templates to their database they can reuse the entry-level templates in multiple sections and multiple documents.
The fist is that it includes all the specifications necessary to describe a document type in a single specification.
This is not to say that there may not be reasons to be critical of specific issues, or that we don’t find important issues as this draft goes into trial use. He covers electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards. To the best of my knowledge there has been no production testing of the CCDA so far; it was only released as a draft standard for trial use in February. Yet patients who use alternative medicine, for example, may not tell their doctors for fear of ridicule or being labeled as Silly or uneducated.
A new study published this year in Journal of the American Medical Association (JAMA) found that 72% of the doctors interrupted the patient’s opening statement after an average of 23 seconds. Yes, doctors and patients will always be on opposite ends of the healthcare system, but that doesn’t mean they can’t pull in the same direction. Incidentally, doctors also benefit from the patient-centered approach, researchers note, because they feel more job satisfaction and are less likely to burn out. Research confirms that the health of the doctor-patient relationship is the best predictor of whether the patient will follow the doctor’s instructions and advice. Patient-centered relationship that accepts the patient’s unique knowledge as just as important to outcome as the doctor’s scientific knowledge. Your candidate staged a winning convention in Philadelphia: big stars, tight messaging, and a compelling case against her rival, Donald Trump. He and the estate’s owner, Tom Griffin, sat down to discuss the transaction at the Cock & Bull restaurant.


Rowling wrote a short post (since deleted) on Pottermore, the official Harry Potter website, detailing her thoughts about using time travel as a device in literature.
They’re trying to address many of the burdens that come with modern life, including the hours taken up by full-time jobs and the challenges of raising children in a nuclear family. There’s a main house and two small cabins out back; One of the only rules for the community is that everybody will share the main house’s two bathrooms, one shower and the kitchen. I suspect that ONC was actively working in the background to push the various organizations to solve intellectual propert and cultural issues that made prior collaboration more difficult. The section templates help the programmer establish the context of a simple data item in order to know how to represent the data in the developer’s database. Previously working with the C32 required simultaneously using material from several different documents. I think that the NPRM comments of these developers will be critical to ONC’s decision.
Readers may copy and redistribute blog postings on other blogs, or otherwise for private, non-commercial or journalistic purposes, with attribution to Gartner. Patients who were allowed to state their concerns without interruption used only an average of 6 more seconds. Disagreements involve everything from expecting an instant cure to demanding prescriptions. While one doctor’s difficult patient may be another doctor’s favorite, researchers have identified common characteristics of patients that everyone agrees are hard to manage. We’re a few centuries out from inventing writing and entering the Bronze Age, but we are already smelting copper and lead, fashioning silk, and making wheels. But rising sea levels cut it off from both continents and turned it into one of the world’s most remote islands. Griffin recalls that Trump was a hard-nosed negotiator, reluctant to give in on even the tiniest details. In the third book in the Harry Potter series, The Prisoner of Azkaban, Harry’s friend Hermione Granger uses a device called a Time-Turner to attend multiple classes in a single school hour, and the Time-Turner later factors into the plot when Harry and his friends use it to battle Dementors and help Sirius Black escape execution. But I’ve also been talking to his supporters and advisors, trying to understand how they see and hear the same things that I do, and draw such very different conclusions.
You think Donald Trump is screwing up because he keeps saying things that you find offensive or off-the-wall. Perhaps the patient wasn’t asked, perhaps they said no allergies, perhaps they declined to answer. A document conformant to the CCDA CCD template will have some differences when compared to one conformant to the HITSP C32 specification. The incremental work to program a second document type should be much less than the first. I will come back to this advantage of re-use in the blog that discusses the NPRM. The good news is that many of the same developers have been participating in the CCDA development and are in a good position to judge how radical the changes are versus the benefits. To answer these questions, more and more researchers are putting the doctor-patient relationship under the microscope.
In the Middle East, the great civilizations of Egypt and Mesopotamia are poised to take off. But, as Michael D’Antonio writes in his recent biography of Trump, Never Enough, Griffin’s most vivid recollection of the evening pertains to the theatrics. This all but guaranteed that Trump, who has spent his whole life working to garner more media attention than others, would respond. What follows isn’t a transcription—it’s a synthesis of the conversations I’ve had, and the insights I’ve gleaned, presented in the voice of an imagined Trump supporter. However, the fine print in the regulation belies a very different approach to certification and interoperability in Stage 2. While their kin went extinct on the mainland sometime between 14,000 and 13,200 years ago, the Saint Paul mammoths persisted for millennia more.
It was as if the golden-haired guest sitting across the table were an actor playing a part on the London stage.
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