Pediatric Informatics: Computer Applications in Child Health (Health ...

262 G.R. Kim and C.U. Lehmann
There is also a need for standard structures in which to package information for
clinical use. These standards specify the order and attributes of data as they are to
be specified when sending messages that represent specific entities. Perhaps the
most visible effort at common standards by physician organizations in this regard
has been in the creation of a standard for the ASTM’s Continuity of Care Record
(CCR). See Case Study.
18.4 Conclusion
At present, only about 20% of pediatricians use an EHR. 16 Technical barriers
to pediatric adoption of EHRs have included the lack of definition of pediatric
functionalities required of EHR systems as well as a lack of standards for EHR
interoperability. 26 However, work in these areas is progressing with increasing
participation of child health professionals in organized and academic medicine to
define these standards (in cooperation with standards development organizations)
and their place in certifying products that meet the needs of the pediatric workplace.
A major challenge to academic pediatrics is to prove that data standards can
lead to improved health outcomes for children.
18.5 Case Study: The Evolution of an EHR
Standard – CCR/CDA to CCD
The Continuity of Care Record (CCR, “Specification for Continuity of Care
Record, E2369-05” 17 ) is an American National Standards Institute (ANSI 18 )accredited
health information technology standard developed and maintained by
volunteers from both health care and technology professions, under the auspices
of the American Society for Testing and Materials (ASTM International, the
world’s largest standards development organization (SDO) ). Development began
in August, 2003, and the standard was published in January, 2006. 19
The purpose of the CCR standard was/is to make it possible for a digital summary
of relevant administrative and clinical health information about an individual
to be created, stored, and passed from one computer system in a standardized electronic
format. The problem that the CCR standard was developed to address is the
pervasive lack of interoperability standards among health care computer software
(including electronic health record systems). The CCR gained the sponsorship and
endorsements of a number of professional organizations, including the American
Academy of Pediatrics. 20
However, the development of a Clinical Document Architecture (CDA) by
Health Level Seven (also an ANSI-certified standard first released in 2000 21 and
updated in 2005 22 ) posed a problem of two standards for the same purpose that were
not interoperable. Although there were distinctions (The CCR was not a complete