The Stage 2 Meaningful Use requirements regarding the Clinical Document Architecture (CDA) standard for Summary of Care Patient Records will turn out to be a big win for providers. The HL7 CDA format and standards should make it easier for physicians to store and “own” their patient records. In Stage 1 of Meaningful Use, CMS introduced the Continuity of Care Document (CCD) and Continuity of Care Record (CCR) personal health record (PHR) concepts. Now, instead of those standards, the patient health record will be recorded exclusively in an easier to implement CDA format. At the heart of the CDA solution is a library of reusable CDA templates that allow for easier machine-to-machine communication, facilitating the transfer and storing of more patient data.

Standardization of Vocabularies

As part of the introduction of the CDA standard to the Stage 2 Meaningful Use process, the Office of the National Coordinator (ONC) has, in their proposed rule, standardized the data vocabularies that must be transmitted within the CDA document. This is an improvement for providers and patients when compared to Stage 1, since, in the first stage of Meaningful Use, more than one vocabulary was allowed for certain important clinical data fields (example: medications, allergies, and problem lists). The diverse data vocabularies allowed in Stage 1 of Meaningful Use meant that different EHRs could “speak different languages”, even if they used the mandated CCD or CCR personal health record required in the first stage. When two EHRs speak different languages it makes it difficult for personal health record storage sites, like HealthVault®, to consolidate patient health records. More importantly for physicians, the variation in data vocabularies makes it difficult for a provider to migrate from one EHR to another.

Clinical Document Architecture (CDA) consolidated interoperability
Chart courtesy of the NeHC University presentation Utilizing the Standards and Interoperability Framework

Proposed common clinical vocabularies:

  • Smoking Status Types — SNOMED-CT® International Release January 2012
  • Medication List — RxNorm February 6, 2012 Release
  • Medication Allergies — RxNorm February 6, 2012 Release
  • Problem List — SNOMED-CT® International Release January 2012

It is important to note the ONC is proposing that problem lists be maintained within the CDA in the SNOMED-CT coding system. Providers will no longer be allowed to send ICD coded problem lists as part of a patient’s Summary of Care record. This means that physicians will need to learn how to code patient problems in the SNOMED-CT terminology. In a future blog post we will explain how MediTouch EHR® will assist physicians in learning and converting problem lists coded in ICD format to the SNOMED format.

We view the migration of the old patient health records standards to the Stage 2 (2014) Meaningful Use CDA standard as a win for providers. As a company that has virtually no start-up fees or long-term contracts with providers, a reader of our blog would find it counter-intuitive that we would support and promote this new standard. Without the typical 5 year contract and large investment in proprietary hardware that our competitors mandate, it seems that we would be most vulnerable to a new system that makes switching EHRs simpler. Instead, we believe that the new standard will offer more freedom for providers to move away from their older systems to ours, and that this new standard will be a windfall for our company. MediTouch® does not need to hold our users hostage with long-term contracts, or because there may be EHR system interoperability issues. We earn our users loyalty each month by providing stellar customer care and outstanding easy-to-use EHR software.