Clinical Exchange Document (CED)™ is a term we use at Allscripts to cover the multitude of standards-based, XML-format documents that are interoperable in healthcare exchanges. To improve their “meaningful usefulness,” the HL7 Structured Document Workgroup launched a short survey, which will gather feedback from providers about what data is most relevant and pertinent to them.

Widespread use and variation of CED

With Meaningful Use, providers have used CED (in the form of C-CDA) more frequently to exchange content between healthcare sites and providers. The Certification Rules have called out different HL7 Implementation Guides for use, such as Transitions of Care, Data Portability and View Download and Transmit. With each iteration of these Implementation Guides, the industry moves closer to constructing content that is semantically interoperable.

However, we continue to hear that these documents, in spite of improved guides and constraints, are not meaningfully useful. There continues to be wide divergence of documents across the vendor and provider communities. Additionally, there has been much testimony to various professional societies and technical groups, and even the U.S. Congress, about issues with CED content.  For example, we have heard:

  1. Documents are ginormous (a very technical term).
  2. We cannot find what we need.
  3. It’s just a CCD – where’s the narrative?
  4. Where is the operative note?

And the list goes on from there.

Be heard: What content do you consider relevant and pertinent?

The HL7 Structured Document Workgroup recently launched a short survey to collect, analyze and report on what data providers find to be relevant and pertinent. The survey takes into account that there are varying degrees of relevance based upon practices, patient acuity, workflow and a number of other factors.

The survey also is trying to help us in the engineering and information-technology domain understand how systems might algorithmically select this content when a system generates CED – to date, an elusive goal.

The survey is meant for providers – not technical or information-technology people – because we’d like to hear from all who practice the delivery of health care. If you want to read more about the project please visit the HL7 Structured Document Relevant and Pertinent project page.

The survey is open through the end of November. We expect to be able to share data analysis and publish results in May of 2016.

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About the author

George Cole is Principal Scientist, Community Solutions at Allscripts. He has been with Allscripts for more than 30 years and leads internal efforts on standards and interoperability. Outside of Allscripts, he is currently the lead of the Content Standards Workgroup for The CommonWell Health Alliance. He is an active member of HL7’s Structured Document and also Health Standards Integration workgroups. George had the honor and privilege to serve as a member of the HIT Standards Committee’s Architecture, Services and APIs Workgroup. Last year he was an invited panelist at the IOM Digital Learning Collaborative Roundtable on Value and Science-Driven Health Care. He was an active participant with the Beacon-EHR Affinity workgroup, and a member of the CCHIT Interoperability Experts Panel. He represented the EHR Association as a member of the CDC IISB Transport Experts Panel. George was a Faculty Board member of The CDA Academy. George is am a member of the IHE Patient Care Coordination Technical Committee, and the ITI Technical Committee. He has been co-editor of the following IHE profiles: Retrieve Form for Data Capture (RFD); Referral / Order Linking (ROL); Multiple Content Views (MCV); Reconciliation of Clinical Content and Care Providers (RECON). He was also profile mentor for the Structured Data Capture (SDC) profile in the QRPH domain


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