Information Technology Reference
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codeSystem=”2.16.840.1.113883.6.1”
tells the computer that the coding system used is LOINC, one of the systems we
mentioned under Data Standards.
Sample of XML from a CCD 12 :
<templateId root=”2.16.840.1.113883.10.20.1.16”/>
<!- Vital signs section template ->
<code code=”8716-3” codeSystem=”2.16.840.1.113883.6.1”/>
<title>Vital Signs</title>
<thead><tr>
<th align=”right”>Date / Time: </th>
<th>Nov 14, 1999</th>
<th>April 7, 2000</th>
</tr></thead>
<tbody><tr>
<th align=”left”>Blood Pressure</th>
<td>132/86 mmHg</td>
<td>145/88 mmHg</td>
</tr></tbody>
Technically inclined readers will notice that this illustration, taken from a web
page, has some HTML tags mixed in with the XML. They are for formatting of the web
page for human viewing and are not needed for machine interpretation of the XML.
The third:
code code=”8716-3”
is the LOINC code for vital signs. You have had your vital signs taken if you have
ever had a medical office visit. Vital signs normally include height, weight, tem-
perature and blood pressure. I only show blood pressure and I removed some of the
HTML tags to save space. I also reformatted the sample to prevent lines from wrap-
ping over to make it easier to read. To test your understanding of this sample and to
verify that XML is reasonably human readable, you should easily be able to figure
out that this patient has two blood pressure readings and that the second of these was
higher than the first. See if you can verify that by studying the Sample of XML
from a CCD (above) .
This brief introduction to XML and the CCD should give you a sense of what is
possible. Since a computer can read the clinical information and use the coding
system information to “understand” what it means then a CCD sent from one pro-
vider's office to another could, in theory, be broken up into the individual data items
by the receiving provider's certified EHR and put into the patient's record, as we
described earlier.
12 We've not previously discussed a predecessor of the CCD, the CCR, because the CCD has been
accepted as the US standard format for an electronic patient summary. At present an EHR can be
certified if it can generate either the CCD or CCR format but the trend is in the direction of the
CCD. The differences are quite technical [ 26 ] but, most importantly, the CCD was developed
within the CDA architecture.
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