Exchanging Medical Data Between Providers Leaves Room For Improvement

John D’Amore, President & CTO Diameter Health 1005 Boylston St #304 Newton MA 02461MedicalResearch.com Interview with
John D’Amore, President & CTO
Diameter Health
1005 Boylston St #304
Newton MA 02461


MedicalResearch: What are the main findings of the study?

Answer: We examined C-CDA (Consolidated Clinical Document Architecture) documents from electronic health records and other health information technology vendors. C-CDA documents are an XML format for transmitting patient data (e.g. problems, allergies, medications, results, vital signs, smoking status). Usage of C-CDA documents is required for Stage 2 of Meaningful Use in the United States. Overall, we were readily able to extract data elements from these documents, but we found many places where clinical content could be improved. This leads to policy recommendations on improving C-CDA production and consumption. Since thousands of hospitals and many more physicians will be required to exchange these documents in the coming year, we believe our findings to be important and timely for those seeking to improve care continuity and information exchange.

MedicalResearch: Were any of the findings unexpected?

Answer: Since this is a newly adopted standard, we actively looked for places where information might be incorrect or difficult to interpret in C-CDA documents. These issues were identified in many different domains of C-CDA documents. We were surprised at the complexity of some issues, especially terminology. Improved terminology testing and resources for vendor implementation, as suggested by the research, could be simple ways to improve C-CDA interoperability.

Many health IT vendors were willing to participate, work on document quality and publicize their samples. This was very encouraging in an industry often cited for not supporting interoperability.  The public samples are available in a GitHub repository https://github.com/chb/sample_ccdas.

MedicalResearch: What should clinicians and patients take away from your report?

Answer: Clinicians and patients who use C-CDA documents to exchange information should be aware that they may omit relevant clinical data and require manual reconciliation. For example, a patient’s medication list may have all the correct drugs but may not include information on their respective doses, frequencies or routes of administration. Regulations and market adoption in the coming years will determine if C-CDA documents can effectively exchange information between healthcare providers.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Answer: C-CDA is an important standard for exchanging medical data, but there are still many areas for improvement. Future research should focus on determining the best way to normalize information from C-CDA documents and how C-CDA documents can be best utilized to improve care.


Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative
John D D’Amore, Joshua C Mandel, David A Kreda, Ashley Swain, George A Koromia, Sumesh Sundareswaran, Liora Alschuler, Robert H Dolin, Kenneth D Mandl, Isaac S Kohane, Rachel B Ramoni

J Am Med Inform Assoc amiajnl-2014-002883Published Online First: 26 June 2014 doi:10.1136/amiajnl-2014-002883


Last Updated on December 21, 2014 by Marie Benz MD FAAD