Transformation between HL7 and Continuity of Care Record to facilitate web-based Personal Health Record systems

To establish interoperability between Health/Hospital Information System (HIS), there exist standards or protocols designed by capable organizations to help different HISs communicatebetter with each other. Reliable and accurate communication is nowadays a prerequisite to delivering fully integrated health care to patients. In practice, there are two main leading standards adopted by various HISs, Health Level 7 (HL7) and Continuity of Care Record (CCR). The HL7 v2.x set of healthcare messaging standards are the predominant ones used by healthcare institutions in much of the world. They have been designed for managing healthcare and so provide a complete set of information and messages necessary for the provision of healthcare. Also, the scope of HL7 has expanded to include standards for the interchange of clinical data in all settings, a reference information model, data types, decision support and clinical guidelines, clinical documents and clinical templates, clinical context objects, terminology, security, XML, and the electronic health record. More recently the Continuity of Care Record (CCR) standard was proposed as a digital form of referrals; it describes the condition of a person – a snapshot – at the time of the referral. It offers a light-weight, easy implemented approach, and its focus is on the exchange of health summaries. Personal Health Record (PHR) systems such as Google Health and Microsoft Health Vault use the CCR format for input (and output), which is correct, as such systems collect snapshots of health (rather than or in addition to healthcare) information. While both were initially made for different purposes, the need to collaborate with each other was soon deemed necessary, resulting in the release by HL7 of the Continuity of Care Document (CCD). This is a patient summary clinical document that is derived from the HL7 CDA (Clinical Document Architecture) Reference Information Model (RIM), but provides health summary information parallel to that of the CCR. This result is a standard that is much more complex than the CCR, so it still does not solve the integration issue between HISs which favour the HL7 (version 2.x or CCD) and those (especially PHRs)which prefer the CCR due to its simplicity. For healthcare institutions, which use HL7, to effectively communicate with PHR systems which use the CCR, there must be a translation between these two standard formats. We present such a translation; it is in the public domain, so is open for improvements from knowledgeable institutions and individuals.