CCD Implementation Documentation

Owned by Deepa Ganu
Last updated: Oct 31, 2022 by Sibendire Joshua
4 min read

Background:
The Continuity of Care Document (CCD) is an electronic document exchange standard for sharing patient summary information. Summaries include the most commonly needed pertinent information about current and past health status in a form that can be shared by all computer applications, including web browsers, electronic medical record (EMR) and electronic health record (EHR) software systems. The CCD specification is a constraint on the HL7 Clinical Document Architecture (CDA) standard. The CDA specifies that the content of the document consists of a mandatory textual part (which ensures human interpretation of the document contents) and optional structured parts (for software processing). The structured part is based on the HL7 Reference Information Model (RIM) and provides a framework for referring to concepts from coding systems such as from SNOMED and LOINC.The patient summary contains a core data set of the most relevant administrative, demographic, and clinical information facts about a patient's healthcare, covering one or more healthcare encounters. It provides a means for one healthcare practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another practitioner, system, or setting to support the continuity of care. Its primary use case is to provide a snapshot in time containing the pertinent clinical, demographic, and administrative data for a specific patient.
This project is to support OpenMRS’ ability to generate and exchange patient clinical summaries using the Clinical Document Architecture (CDA) model, an xml-based HL7 version 3 standard for clinical documents.In this project , we have used the predefined Runtime API provided by MDHT tools. 

Every OpenMRS implementation has a concept dictionary that defines the medical concepts (questions and answers) used as the building blocks for forms, orders, clinical summaries, reports and almost every aspect of the data. Each concept can be mapped to a universal code system like SNOMED , LOINC , ICD , etc. This concept dictionary comes with a bundled concept dictionary where most of the concepts are mapped. The concepts can also be grouped together to form a concept set. For eg : I group individual concept like height , weight , BMI , pulse , etc and create a concept set like Vital Signs. While exporting the patient summary in the CCD format , the data should be tagged with the universal code system.

 The patient data(demographics , vital signs , social history , diagnosis , etc)  is captured  either by using observations or creating the html forms. The OpenMRS data model is not restricted to categories like vital signs , social history , family history, etc , all this data is captured in terms of concept.

While exporting the clinical summary of a patient in the CCD format , one should export all this data into different sections like allergy , encounter , vital signs , social history , etc . Since OpenMRS does not provide a standard way to group these concepts together (different implementations have different concept dictionary) as a part of this project , we give an admin page which lets the user decide which concept belongs to which section of the CCD format. 

Below are the steps which explain how to use this module.
Note : We assume that the data for the patient is already existing in the system 
Step 1: Install the module , upload the .omod file using Admin--->"Manage Module"


Step 2 : Click on "Configure CCD Sections" to configure which concept do you want under a certain category .In this module you can add an individual concept or a pre defined concept set. 

In the similar manner you can configure all the other sections .

While adding the concept , the application checks if the concept is mapped to a one of the universal code system in the list given below

 C4 (aka CPT-4):2.16.840.1.113883.6.12
C5 (aka CPT-5):2.16.840.1.113883.6.82
CD2 (aka CDT-2):2.16.840.1.113883.6.13
FDDX:2.16.840.1.113883.6.63
I9 (aka ICD-9 or ICD9):2.16.840.1.113883.6.42
I9C (aka ICD-9-CM):2.16.840.1.113883.6.2
I10 (aka ICD-10 or ICD 10 or ICD10):2.16.840.1.113883.6.3
I10P (aka ICD-10-PCS):2.16.840.1.113883.6.4
LN (aka LOINC):2.16.840.1.113883.6.1
MEDCIN:2.16.840.1.113883.6.26
RxNorm:2.16.840.1.113883.6.88
SNOMED-CT (aka SNOMEDCT or SNOMED CT):2.16.840.1.113883.6.96
In case the concept is not mapped to one of the code systems mentioned above , the module does not let you add the concept to the section.

Also it does not let you add a same concept two times in the same section .

Also the implementer's are free to add any concept to any section , but you need to do that carefully because the xml would get generated based on how you have configured these sections. One can add "alcohol per day" concept to the vital sign section too, the observation for this concept would be then exported in the vital sign section.So the admin needs to configure these sections very carefully.

Step 3: To export the data in the CCD format , go to Admin ---> Export Patient Summary 


Step 4 : Select the patient and click on the "Export Patient Summary", the clinical patient summary in the CCD format gets downloaded on your computer.

The video is uploaded on you tube http://youtu.be/G3_kQbM48qk