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First published February 24, 2006 as JAMIA PrePrint; doi:10.1197/jamia.M1963
Journal of the American Medical Informatics Association 2006;13(3):245-252
© 2006 American Medical Informatics Association


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Submitted on September 12, 2005
Accepted on January 16, 2006

The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis

Jeffrey M. Ferranti MD1*, R. Clayton Musser MD, MS2, Kensaku Kawamoto3, and W. Ed Hammond PhD4

Affiliation of the authors: 1 Division of Newborn Intensive Care, Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Health Technology Solutions, Duke University Medical Center, Durham, NC; 2 Department of Medicine, Duke University Medical Center, Durham, NC; 3 Division of Clinical Informatics, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC; Department of Biomedical Engineering, Duke University Medical Center, Durham, NC; 4 Department of Community and Family Medicine, Duke University Medical Center, Durham, NC; Department of Biomedical Engineering, Duke University Medical Center, Durham, NC; Adjunct Professor, Fuqua School of Business, Duke University, Durham, NC

* To whom correspondence should be addressed.

Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfortunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7's Clinical Document Architecture (CDA) and ASTM International's Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are their own and do not represent the official viewpoints of either HL7 or of ASTM International.




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