2014 will see wide-scale production and exchange of Consolidated CDA documents among healthcare providers. Indeed, live production of C-CDAs is already underway for anyone using a Meaningful Use 2014 certified EHR. C-CDA documents fuel several aspects of meaningful use, including transitions of care and patient-facing download and transmission.
This impending deluge of documents represents a huge potential for interoperability, but it also presents substantial technical challenges. We forecast these challenges with unusual confidence because of what we learned during the SMART C-CDA Collaborative, an eight-month project conducted with 22 EHR and HIT vendors.
As a follow-on to the last post about Direct messaging, I want to distinguish the Mass Medical Society’s vision of a “whitelist” from another concept that confusingly shares the “whitelist” moniker. Below, I’ll introduce two distinct terms and try to clarify the distinction:
“OR-gate whitelists” expand the communication pool
Mass Medical Society envisions a kind of per-physician “whitelist” that I’ll call an OR-gate whitelist. The basic premise of an OR-gate whitelist is that a physician can add any Direct address to her OR-gate whitelist via a UI in her EHR or HISP. By doing so, she’d be able to send secure e-mail to that address — regardless of CAs, trust bundles, or pre-existing local policy. An OR-gate whitelist acts like a logical “OR gate,” meaning that a message will be sent if institutional policy allows it, or if a physician’s personal OR-gate whitelist allows it. With OR-gate whitelists, physicians can send to any Direct endpoint in the world, full stop.
“AND-gate whitelists” restrict the communication pool
The current Massachusetts HIWay has a deployed a different kind of “whitelist” functionality that I’ll call an AND-gate whitelist. Mass HIWay maintains a state-wide AND-gate whitelist of acceptable Direct addresses to which HIWay users are allowed to send Direct messages. An AND-gate whitelist acts like a logical “AND gate,” meaning that a message will be sent only if institutional trust bundles allow it (i.e. the recipient’s cert is signed by a CA that the organization trusts) and the institution’s AND-gate whitelist allows it. So Mass HIWay’s state-wide AND-gate whitelist is a way to avoid allowing, say, “all eClinicalWorks users across the whole country” into the pool at once. Instead, access can be restricted to the intersection of two sets: “All eClinicalWorks users across the whole country” and “Users on the Mass HIWay AND-gate whitelist.”
As Meaningful Use 2014 EHRs come online this winter, clinicians across the country gain access the host of new features included in the MU 2014 Certification Requirements. In this post, we’ll dig into one of these features: EHR-based secure e-mail capabilities that operate using the “Direct Project” specification. (If you’re new to this world: when you hear “Direct Project,” you should think “secure e-mail for healthcare.”)
With support from ONC, the SMART Platforms team is working with Lantana Consulting Group to simplify and improve data exchange based on the HL7 Consolidated Clinical Document Architecture (C-CDA) standard for health summary data. We are working to ensure that real-world Health IT software can consistently produce and consume C-CDA documents, which will be a Meaningful Use Stage 2 (MU2) requirement for transitions of care between providers and for patients’ access to their own data. To this end, we’re formulating clear, “fill-in-the-gaps” implementation guidance for MU2 certification and beyond.
We’ve assembled a team of Health IT organizations for lightweight participation in a pioneering interoperability collaboration. We will identify and address “grey areas” in at least seven key domains of the C-CDA specification: demographics, medications, problems, allergies, vital signs, lab results, smoking status. Continue reading “Introducing the SMART C-CDA Collaborative”
The SMART team is proud to introduce the C-CDA Scorecard, a web-based tool to help vendors, providers and other health data holders produce high-quality clinical summaries for Meaningful Use Stage 2.
Get ready for Meaningful Use Stage 2
Consolidated Clinical Document Architecture (C-CDA) is the specification cited by Meaningful Use Stage 2 for creating structured clinical summary documents. C-CDA documents are required by MU2 to support transitions of care, to enable patient-driven “view/download/transmit” objectives, and to promote medical record data portability.