Rendering Problem-Oriented CCD for chronic diseases.

Clinical Document Architecture (CDA) is an XML-based clinical document standard designed to ensure data exchange as well as semantic interoperability of healthcare information systems. Continuity care of documents (CCD), a template derived from CDA, is designed with the goal of displaying patient records more intuitively for clinicians, especially for when the patient has a long history of medical care.The rate of chronic patients in the general population has increased as longevity has increased substantially in the past few decades, and the trend towards longer and more complex medical records has made it time-consuming to read patient data even in the CCD document. The problem-oriented medical record (POMR) is an easily readable medical record style and it has been widely adopted in electronic health record (EHR) services in Europe. Unfortunately, POMR has not been integrated with the CCD-compatible representation so far. Hence this paper proposes Problem-Oriented CCD (PO-CCD) rendering based on CDA and POMR. To find out how a PO-CCD would be viewed by healthcare professionals and healthcare IT professionals, we drafted a few Problem-oriented CCD example documents and conducted a survey on their impression. Among our 41 respondents, 60% replied they would like to view patient charts in our Problem-Oriented CCD rendering side-by-side with the conventional CCD rather than the conventional CCD alone.