Information Technology Reference
In-Depth Information
Fig. 3.1
A Simplified Representation of the Exchange of an XML Formatted Continuity of Care
(CCD) Document using DIRECT
In its original conceptualization DIRECT was seen as a digital replacement for
the fax machine physicians commonly use to share charts. Indeed, the DIRECT
attachment can be just that - a PDF or TIFF image useful for very little other than
viewing or printing at the receiving end. As we'll see in the later chapters, DIRECT
can be, and is starting to be, used for far more interesting things such as the example
of sharing clinical data we just gave or even sharing data from an EHR with the
patient. It is important to understanding where things are going to recall that Stage
2 of Meaningful Use requires that patients actually access their data and exchange
messages with their provider using “secure messaging” - DIRECT.
Rather than an image of a paper document, the attachment could be an Xtensible
Markup Language (XML) formatted Continuity of Care Document (CCD), a
machine readable patient summary record now accepted by the federal government
as the key informational component of care coordination via health information
exchange. The ability to create the CCD is part of certification, so any certified EHR
can produce it. The specifics of what it contains from EHR to EHR are not as con-
sistent as would be ideal, however, so there are a number of associated issues and
concerns in merging clinical data obtained using DIRECT from disparate EHRs as
we've just hypothesized. [
6
] We'll further explain XML and take a closer look at the
CCD in the section on Data and Interoperability Standards.
CONNECT:
ONC has also supported the development of CONNECT, an open
source technology for the more robust kind of health information exchange that
does, at least for now, require a centralized approach. [
7
] As we have seen, DIRECT
is a simple, inexpensive way for providers to share information and, as we'll discuss
