Understanding CCR

Update: Fixed typos, added links to related tools and articles, updated the example.

CCR or Continuity of Care Record is a standard meant to ease the exchange of clinical information with a relatively easy to read and practical data-format and schema. There is ton of great information about CCR on its resource site. CCR

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document format is supported by majority of personal Health clouds, both – Microsoft HealthVault & Google Health.

The CCR specification comprises an implementation guide, XML schema definition and a guidance spreadsheet for each data element that makes up the standard. These resources can be bought from ASTM.

The document format of CCR is very straight forward, consisting of a header,

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body and a footer with the following top-level elements:

Header Body Body Footer
  • CCR Document ID
  • Language
  • Version
  • Creation Date
  • Patient
  • From
  • To
  • Purpose
  • Payers
  • Advance Directives
  • Support
  • Functional Status
  • Problems
  • Family History
  • Social History
  • Alerts
  • Medications
  • Medical Equipment
  • Immunizations
  • Vital Signs
  • Results
  • Procedures
  • Encounters
  • Plan Of Care
  • HealthCareProviders
  • Actors
  • Signatures
  • References
  • Comments

    Google Health supports only a limited set of entities from the above, while HealthVault supports the entire standard and also allows transformation of some of these entities in to native HealthVault types. You can read more about working with CCR in HealthVault and various input mappings, output mappings, and CCR vocabularies.

    Here are some illustrative CCR figures from Dr. Waldren’s presentation (see end of article).

    image image

    Using the SNOMED-CT concepts one can write the Systolic Blood pressure reading in CCR as the following (UPDATE: Well-formatted the CCR to include source, object-id and actors, thanks to Matt Wagner):

    <?xml version="1.0" encoding="utf-8"?> <ContinuityOfCareRecord xmlns='urn:astm-org:CCR'> <CCRDocumentObjectID>Doc</CCRDocumentObjectID> <Language> <Text>English</Text> </Language> <Version>V1.0</Version> <DateTime> <ExactDateTime>2008</ExactDateTime> </DateTime> <Patient> <ActorID>Patient</ActorID> </Patient> <Body> <VitalSigns> <Result> <CCRDataObjectID>0001</CCRDataObjectID> <Description> <Text>Blood Pressure</Text> </Description> <Source> <Description> <Text>Unknown</Text> </Description> </Source> <Test> <CCRDataObjectID>0002</CCRDataObjectID> <Description> <Text>Systolic</Text> <Code> <Value>163030003</Value> <CodingSystem>SNOMEDCT</CodingSystem> </Code> </Description> <Source> <Description> <Text>Unknown</Text> </Description> </Source> <TestResult> <Value>120</Value> <Units> <Unit>mmHg</Unit> </Units> </TestResult> </Test> <Test> <CCRDataObjectID>0003</CCRDataObjectID> <Description> <Text>Diastolic</Text> <Code> <Value>163031004</Value> <CodingSystem>SNOMEDCT</CodingSystem> </Code> </Description> <Source> <Description> <Text>Unknown</Text> </Description> </Source> <TestResult> <Value>75</Value> <Units> <Unit>mmHg</Unit> </Units> </TestResult> </Test> </Result> </VitalSigns> </Body> <Actors> <Actor> <ActorObjectID>Patient</ActorObjectID> <Person> <Name> <CurrentName> <Given>John</Given> <Family>Doe</Family> </CurrentName> </Name> </Person> <Source> <Description> <Text>Unknown</Text> </Description> </Source> </Actor> </Actors> </ContinuityOfCareRecord> 

    Note CodingSystem element. It allows CCR to interpret various medical vocabularies.

    Relevant Tools:

    (Thanks to Kathleen Connor)

    • The CCR Validator, is an important resource to test/validate a CCR instance, is a now available  Not only does it validate the CCR against the XSD but also the constraints of the implementation guide.
    • An Open Source StyleSheet to view CCR files.
    • CCR to CCD & HL7 Mappers – tools which Map CCR to CCD and HL7 V2 & V3. You can access them directly here.
    • Application to embed CCR in PDF-HealthCare.

    Related Article(s):

    • To get familiar with CCR I would highly recommended this 13 minute video by Dr. Steve Waldren.
    • Adam Bosworth posted an interesting read on standards, his take (simple, human readable, focus on known structured data, etc.) favors CCR.

    In this series:

    1. Understanding Vocabularies. Wait! What did you say?
    2. Understanding Vocabularies #2 – HealthVault Recommendations
    3. Understanding SNOMED CT
    4. Understanding CCR
    Special thanks to Kathy Osborne for proof reading this post.

    2 thoughts on “Understanding CCR

    1. Thanks for the thorough introduction. What really attracted me to this page was that you were giving a practical XML sample, whereas much of the CCR documentation out there provides only higher level explanations at the “entity” level.

      With your permission, I have included this page in my collection of CCR and CCD XML samples on the web – http://tinyurl.com/yf6sv88


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