CCDA, CCD and CCR Compatibility

Comparison Grid

CCD/CCR Sections, and our current Webchart storage capabilities

InformationCCD/C32/IHE Segment(s)CCR Segment(s)Webchart Capabilities
Patient NamePrefix/Given(s) Family SuffixActor Info - Given, Middle, Family, Suffix, Title, NickName100%
AddressstreetAddressLine, city, state, postalCode, countryAddress - type, line1, line2, city, county, state, postalCode, country100%
Phone Numberstelecom use="HP","WP",etctelephone - value/type100%
Emailtelecom value='mailto:Email/URL100%
GendergenderCodeGender100%
Marital StatusmaritalStatusCodeStored in SocialHistory Section100%
RaceraceCodeStored in SocialHistory Section100% We are storing "R#" codes in the race field. We have functionality that returns the proper XXXX-X code from the rxdb_v1 race/ethnicity table based on that R code.
EthnicityethnicityCodeStored in SocialHistory Section100% We are storing "E#" codes as an observation. We have functionality that returns the proper XXXX-X code from the rxdb_v1 race/ethnicity table based on that E code.
Religious AffiliationreligiousAffiliationCode (HL7 Religious Affiliation vocabulary. Link)Stored in SocialHistory SectionNo standard way of collecting at the moment
Languages SpokenlanguageCommunicationNothing specifically defined -- Assumed to also be stored in SocialHistory SectionWe are storing as observations, using IANA language codes from http://www.iana.org/assignments/language-subtag-registry, and that gets put into the document
Next of Kin/Caregivers/Support Organizationspatient, guardianSupportWe can store "Guarantor" information this way. We don't collect (AFAIK) any other "Next of Kin" or other care giver/support organization information.
Healthcare ProvidersdocumentationOf, serviceEvent, performerHealthCareProvidersWe have physician information as User-patient relations
Pharmacies1.3.6.1.4.1.19376.1.5.3.1.2.3N/APharmacy user/patient relations.
Employer/School contacts1.3.6.1.4.1.19376.1.5.3.1.2.2 (O)Stored in SocialHistory SectionEmployer field info in patients, fairly static though. Do we store school information in those columns by convention for children?
Insurance Providers1.3.6.1.4.1.19376.1.5.3.1.1.5.3.7Payer100% Insurance tables
Allergy/Drug Sensitivity2.16.840.1.113883.3.88.11.32.6Alerts100% Allergy Tables
Conditions/Problems2.16.840.1.113883.3.88.11.32.7Problems100% Condition Tables
Medications2.16.840.1.113883.3.88.11.32.8Medications100% Medication/Prescription Tables
PregnancySection which is basically just marked with SNOMED code if a patient is currently pregnantN/A - Discussed as "coming soon" in 2006, but, has CCR progressed really since 2006? - Webchart puts pregnancies in CCR Conditions sectionActive Pregnancy Condition on Conditions
History of Pregnancies1.3.6.1.4.1.19376.1.5.3.1.1.5.3.4N/A - Discussed as "coming soon" in 2006, but, has CCR progressed really since 2006? - Webchart puts pregnancies in CCR Conditions sectionPregnancies in conditions table
Advance Directives2.16.840.1.113883.3.88.11.32.13AdvanceDirectives100% In CCD.. if you mark observations as an "Advanced Directive" template ID, they will flow into this section. AFAIK, in both cases, this is NOT designed to actually SHOW the/a document, or give you any real information about it's contents, it is simply there to indicate an Advance Directive of some type (living will, healthcare proxy, resuscitation status, etc) does exist for the patient. It is up to the physician to obtain the correct document. Re: from C32 specs: "This section contains data such as the existence of living wills, healthcare proxies, and CPR and resuscitation status. NOTE: The existence of an Advance Directive of a particular type (e.g., intubation) is a signal to the provider that such a directive exists. When determining how to care for a patient, the provider is advised to review the Advance Directive directly, rather than relying upon summary information contained within the Registration and Medication History". I think right now we actually do try to "show" some information via what we did with IHE, I think if that comes up again with IHE we should raise a red flag with them requiring that, and IMO, be only concerned with marking that documents exist in the patients chart.
Immunizations2.16.840.1.113883.3.88.11.32.14Immunizations100% Injection table... although, all injections are not technically "immunizations" correct (and not all immunizations are neccesarily injected(?))... seems like this might also be a place, other than observations, where we need to make some clarifications on types of data being stored.
Vital Signs2.16.840.1.113883.3.88.11.32.15VitalSigns100% Stored in Observations, but, no good grouping of these. Per C32: "The differentiation between Vital Signs and Results varies by clinical context. Common examples of vital signs include temperature, height, weight, blood pressure, etc. However, some clinical contexts may alter these common vitals, for example in neonatology "height" may be replaced by "crown-to-rump" measurement."
Results2.16.840.1.113883.3.88.11.32.16Results (Contains the patient's pertinent Results - lab, imaging, interventional)100% Per C32: "This module contains current and relevant historical result observations for the patient. The scope of "observations" is broad with the exception of "vital signs" which are contained in the Vital Signs sections". In CCD.. if you mark observations as "Lab Results" template ID, they will flow into this section.
Encounters2.16.840.1.113883.3.88.11.32.17EncountersWe do not currently put either CCD or CCR encounters section information into our files.
Procedures2.16.840.1.113883.10.20.1.12Procedures100% Procedure tables
Family History2.16.840.1.113883.10.20.1.22FamilyHistory100% Family History Tables
Social History2.16.840.1.113883.10.20.1.15SocialHistory - Defined in CCR to hold these coded description types: (Marital Status, Race, Ethnicity, Religious Preference, Living Situation, Employment, Tobacco Use, Alcohol Use, Recreational Drug Use, Toxic Exposure, Treatment Restrictions.)100% In CCD.. if you mark observations as "Social History" template ID, they will flow into this section. For CCR, we dump everything in "Social History" for the most part.Social History Storage and Formatting
Medical Equipment2.16.840.1.113883.10.20.1.7MedicalEquipmentNo proper place within webchart that these get stored currently. Might get represented as a condition (ie, "Pacemaker"), but, this is probably not the most proper place, and it would not then get listed in Medical Equipment sections of CCD & CCR, would get shoved into conditions instead.
Plan of Care2.16.840.1.113883.10.20.1.10PlanOfCarePer CCD 2007: "The plan of care section contains data defining pending orders, interventions, encounters, services, and procedures for the patient. It is limited to prospective, unfulfilled, or incomplete orders and requests only.".Right now, this is somewhat undefined right now, I think we had things specifically put in to "pass" IHE, but, I don't know that that is standardized within Webchart.
Hazardous Working Conditions1.3.6.1.4.1.19376.1.5.3.1.1.5.3.1 - IHE - Hazardous working conditions contains a narrative description of the patient's hazardous risks.Stored in SocialHistory SectionI know we collect a lot of this information for DOW, Lilly, etc. This info would basically be jammed into 'results' right now, instead of a section such as this.
Functional Status1.3.6.1.4.1.19376.1.5.3.1.3.17 - IHE - The functional status section shall contain a narrative description of capability of the patient to perform acts of daily living.FunctionalStatusWe don't specifically collect right now.
Foreign Travel1.3.6.1.4.1.19376.1.5.3.1.1.5.3.6 - IHE - The foreign travel section contains only narrative text describing the patient's travel history.N/AWe don't specifcially collect right now.

CCDA Testing Protocols

DS4P Document Policies

  • Webchart will include content when a CCDA document has a “restricted” level of data in the view of the CCDA document, as well as display the re-disclosure text provided in the CCDA document.
  • Webchart does not take any other steps in the handling of the DS4P marked documents, the operators of the system with the document can choose how they want to handle the document.

Template ID Sections in Observation Codes

This is a list of Template ID sections available to put on observation codes in webchart, and where, if anywhere, they would appear in the CDA/CCDA:
Template ID Sections in Observation Codes

WC Code DefineLabelCDA Section AppearingCDA Document Types Appearing
CDA_TEMPLATE_ID_IHE_CODED_RESULTS_SECTION"LAB RESULTS"ResultsAll
CDA_TEMPLATE_ID_IHE_REVIEW_OF_SYSTEMS_SECTION"REVIEW OF SYSTEMS"Review of SystemsAll
CDA_TEMPLATE_ID_IHE_SOCIAL_HISTORY_SECTION"SOCIAL HISTORY"Social HistoryAll
CDA_TEMPLATE_ID_IHE_VITAL_SIGNS_SECTION_CODED"VITAL SIGNS"Vital SignsAll
CDA_TEMPLATE_ID_IHE_ADVANCE_DIRECTIVE_SECTION_CODED"ADVANCED DIRECTIVES"ADVANCED DIRECTIVESAll
CDA_TEMPLATE_ID_IHE_HISTORY_OF_INFECTION_SECTION"HISTORY OF INFECTION"HISTORY OF INFECTIONANTEPARTUM HISTORY AND PHYSICIAL
CDA_TEMPLATE_ID_IHE_HX_OF_PRESENT_ILLNESS_SECTION"HISTORY OF PRESENT ILLNESS"HISTORY OF PRESENT ILLNESS
CDA_TEMPLATE_ID_IHE_MATERNAL_DISCHARGE_BABY_STATUS"NEWBORN STATUS AT MATERNAL DISCHARGE"NEWBORN STATUS AT MATERNAL DISCHARGE
CDA_TEMPLATE_ID_IHE_NEWBORN_DELIVERY_SECTION"NEWBORN DELIVERY INFORMATION"
CDA_TEMPLATE_ID_IHE_CARE_PLAN_SECTION"CARE PLAN"
CDA_TEMPLATE_ID_IHE_ANTEPARTUM_EDUCATION_SECTION"ANTEPARTUM EDUCATION"
CDA_TEMPLATE_ID_IHE_REASON_FOR_REFERRAL_SECTION"REASON FOR REFERRAL"
CDA_TEMPLATE_ID_IHE_MODE_OF_TRANSPORT_SECTION"MODE OF TRANSPORT"
CDA_TEMPLATE_ID_IHE_HOSP_DISCHARGE_MEDS_SECTION"DISCHARGE MEDS SECTION"
CDA_TEMPLATE_ID_IHE_HOSPITAL_ADMISSION_DIAG_SECTION"HOSPITAL ADMISSION DX"
CDA_TEMPLATE_ID_IHE_ASSESSMENTS_SECTION"ASSESSMENTS SECTION"
CDA_TEMPLATE_ID_IHE_PROCEDURES_INTERVENTIONS_SECTION"PROCEDURES AND INTERVENTIONS"
CDA_TEMPLATE_ID_IHE_MEDICATIONS_ADMINISTERED"MEDICATIONS ADMINISTERED"
CDA_TEMPLATE_ID_IHE_INTRAVENOUS_FLUID_ADMIN"INTRAVENOUS FLUIDS ADMINISTERED"
CDA_TEMPLATE_ID_IHE_PREGNANCY_HISTORIES_SECTION"PREGNANCY HISTORIES"
CDA_TEMPLATE_ID_IHE_HISTORY_OF_INFECTION_SECTION_CODED"CODED HISTORY OF INFECTION"
CDA_TEMPLATE_ID_IHE_HX_OF_PAST_ILLNESS_SECTION"HISTORY OF PAST ILLNESS"
CDA_TEMPLATE_ID_IHE_ED_DISPOSITION_SECTION"ED DISPOSITION"
CDA_TEMPLATE_ID_IHE_ALLERGIES_SECTION"ALERTS"
OBS_TEMPLATE_ID_PATIENT_DEMOGRAPHICS"PATIENT DEMOGRAPHICS"
OBS_TEMPLATE_ID_PATIENT_EXTENDED"PATIENT EXTENDED DATA"
OBS_TEMPLATE_ID_PATIENT_ADMIN"PATIENT ADMIN DATA"
CDA_TEMPLATE_ID_CCDA_INSTRUCTION_ENTRY"PATIENT INSTRUCTIONS"
CDA_TEMPLATE_ID_CCDA_FUNCTIONAL_STATUS"FUNCTIONAL STATUS"
CDA_TEMPLATE_ID_CCDA_CONSOLIDATION_ASSESSMENT"CONSOLIDATION/RISK CATEGORY ASSESSMENT"

WebChart Documentation

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