Questions and Answers

CCD, CDA, C-CDA… What’s the Deal?

The healthcare industry is infamous for its aggressive use of acronyms that often confuse people more than they help. Chief among these is the term CCD… and CDA, C-CDA. Though similar in both name and function, these terms don’t always mean the same thing.

Luckily, our resident HL7 Whisperer, Nick Hatt, is here to help you decipher what these terms mean, what they don’t, and how they relate to each other when it comes to sharing patient data with EHRs.

Is every CCD a CDA?

  • No, CCD stands for Continuity of Care Document, and it has origins as a paper document.

If I say “CCD” to someone at Redox, what will they think I mean?

  • We would think you are referring to a CDA document.

What’s a CDA?

  • A CDA is an electronic document written in the Clinical Document Architecture.

Is every C-CDA a CDA?

  • Yes. C-CDA is set of rules for CDAs to follow so that they are easy to exchange.

Is every CDA a C-CDA?

  • No. C-CDA is an implementation guide. It sets very specific rules about how to use CDA. C-CDA originated around 2010/Meaningful Use timeframe, and CDA is about 10 years older than that.

Is every C-CDA a CCD?

  • No. C-CDA spells out many different documents including CCD, but also Progress NoteDiagnostic Imaging Report, and Discharge Summary. Each of those has different rules for what it should include.

Are there CCDs that aren’t C-CDAs?

  • Yes. There have been many iterations of the CCD concept, most notably C32which was the de-facto standard before C-CDA was published.

What’s in CCD, why do they keep changing it?

  • Medications, Problems, Allergies, and Results are the required sections in C-CDA version 1.1, but there are many more optional pieces. They keep changing it to meet government regulations and to fix mistakes in the specification itself.

Wait, there are versions?

  • Yes, but most people only care about C-CDA v1.1 because the government mandated using that for the Meaningful Use program.

Does FHIR replace CDA?

  • Yes, hopefully.

Does FHIR replace CCD?

  • It can, but there need to be rules put in place, just like with C-CDA. Think C-FHIR. So far, no one has really taken that leap because FHIR is still unstable.

Can I delete a user in my organization?

Contact Redox if you need help deleting a user from your organization. To chat with us directly, you can click the button in the bottom right-hand corner of your screen!

Do I need a new source or destination record for each of my implementations?

Short answer – nope!

Long answer – still nope! You will have 4 records – 2 in Staging (1 Source record, 1 Destination record) and 2 in Production (1 Source record, 1 Destination record).

Each of these 4 records has its own respective ID. Every node on our network maintains this format. What this means is that when you send a message to an integration partner, that message should contain their Destination ID as well as your Source ID as a means of tracking where the data was generated and where it was sent to. Similarly, the messages you receive will contain your Destination ID and a Source ID indicating which of your connections that data came from.

Source and Destination IDs are auto-generated for each Source and Destination record. To find them, go to the Subscriptions page for your destination or source, there should be an ID link next to the name of your organization that you can click to display the ID.

If you need help creating a source record, check out our documentation.

Are There Limitations on API Calls or Callouts in 24hrs/a Week/a Month?

No!

We intentionally don’t place limits or structure pricing around a specific number of API calls because we want our pricing to be transparent and predictable for our partners. This way, they will know exactly how much integration costs, whether it is with Site #1 or Site #100.

Is a Data Model Bi-Directional?

Yes!

Subscription to any Redox data model allows you to Read and/or Write with your customer.

Is there any work being done to utilize FHIR resources or functionality?

Yes!

We’re part of Project Argonaut and are helping test FHIR as it matures. As it stands today, FHIR as a standard is still fairly immature and harbors a number issues that were present in previous HL7 initiatives. We’re helping mitigate these issues with Redox—foremost of which is variance between vendors and health systems.

With that, we’ll always support our own normalized data models to be EHR-agnostic, and as FHIR becomes more prevalent at health systems, we will support that as a communication channel as well.

Does Redox Support FHIR?

In short, yes!

We are plugged into Project Argonaut and pay very close attention to the development of FHIR standards.

We are fully prepared to support FHIR integration. We are finding that the implementation of FHIR (and the ability to support it) is still many months away for a variety of major EHR vendors, but nonetheless, Redox is ready to go.

The same way we support HL7v2 or custom web services today, we will support FHIR when it is in use.

Does Redox Work Outside of the United States?

Redox utilizes AWS hosting services that are distributed across the United States.

While there are no technical issues with supporting international integrations, laws around hosting can complicate things. Specifically, most European countries (Canada as well) require the service be hosted in that country.

Each country has its own way of handling security and privacy requirements (i.e. HIPAA in the US) that we’d need to meet, so beyond technical work, there’d be some legal and compliance requirements as well.

That being said, we are live in the Netherlands 🇳🇱  and are willing to engage in conversations to determine the viability of any project.

Do you integrate with “X”?

Our platform is vendor agnostic meaning we focus more on how the EHR system sends data and care less about which vendor it is. Generally speaking, we can support any format coming out of the EHR such as HL7, vendor APIs, web services, XCA, XML, FHIR, etc.

To-date, we have integrated with AdvancedMD, AllMeds, Allscripts, athenahealth, Cerner, drchrono, eClinicalWorks, Emdeon, Epic, Exscribe, Flatiron, GE Centricity, Greenway, IKnowMed, MAeHC, McKesson, Meditech, MediTouch/HealthFusion, MTBC, NextGen, Orchard LIS, Ortho Phoenix, QRS, SRS, and installing with more every day.

Don’t worry if you don’t see your EHR of interest above! As we encounter new EHR vendors we’re happy to jump on the phone with them and learn more about how they send data. It is worth noting that Stage 2 MU certified EMRs can send messages in a way we’re able to consume (which is the majority of the EMRs on the market today).

The goal is for you to code your integration once against our API and you let us worry about normalizing differences between health systems and EHR vendors, as well as the technical communication layer and implementation management.

Can I schedule a demo?

We have a pre-recorded demo that you can watch at your convenience using this link.

Alternatively, you can check out our Crowdcast for any up-coming intro webinars.