My employment health benefits include a discount if I provide "current biometric values" such as cholesterol and glucose in a health assessment questionnaire. My doctor just started giving access to lab results via a patient portal. The portal even supports download in CCD format:
As part of U.S. federal incentives for the adoption of electronic health records, known as Meaningful Use, the CCD and Continuity of Care Record (CCR) were both selected as acceptable extract formats for clinical care summaries in the program's first stage. To be certified for this federal program, an Electronic Health Record must be able to generate a CCD (or equivalent CCR) that has the sections of allergies, medications, problems, and laboratory results, in addition to patient header information. Several of these sections also have mandated vocabularies, such as LOINC for laboratory results, according to the federal program.
And what was the shortest path to get the data from my doctor's portal to my employer's health assessment?
Copy and paste, one field at a time.
The health assessment site doesn't support CCDs or anything like it. Maybe it's because they took one look at what's inside and ran away screaming. Who could blame them?
<component> <section> <templateId root="2.16.840.1.1138184.108.40.206.11" /> <templateId root="2.16.840.1.1138220.127.116.11.83.103" /> <templateId root="18.104.22.168.4.1.19322.214.171.124.1.3.6" /> <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problems" /> ... <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <templateId root="" /> <templateId root="2.16.840.1.1138126.96.36.199.83.7" /> <templateId root="188.8.131.52.4.1.193184.108.40.206.220.127.116.11" /> <templateId root="18.104.22.168.4.1.19322.214.171.124.126.96.36.199" /> <id root="XZomV5It-NdyF-BlXK-Fz1A-ZwTQpgeAUiE0" /> <code nullFlavor="NA" /> <statusCode code="active" /> <effectiveTime> <low nullFlavor="UNK" /> </effectiveTime> <entryRelationship inversionInd="false" typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN"> <templateId root="" /> <templateId root="188.8.131.52.4.1.193184.108.40.206.1.4.5" /> <id root="xNr52F8j-QD9W-19Fg-01c1-b96uLHssa0MF" /> <code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Problem" /> <text> <reference value="#prob3" /> </text> <statusCode code="completed" /> <effectiveTime> <low nullFlavor="UNK" /> </effectiveTime> <value nullFlavor="UNK" xsi:type="CD"> <translation code="V70.0" codeSystem="" codeSystemName="" displayName="Physical exam, routine" /> </value> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="" /> <code code="" codeSystem="" codeSystemName="LOINC" displayName="STATUS" /> <statusCode code="completed" /> <value code="" codeSystem="" codeSystemName="SNOMED CT" displayName="Active" xsi:type="CE" /> </observation> </entryRelationship> </observation> </entryRelationship> </act> </entry>
Whether motivated by good taste or fear of change, there is some respect for the humans first microformats principle; the bit I elided above is:
<title>Problems</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Problem Type</th> <th>Condition</th> <th>ICD-9 Code</th> <th>Effective Dates</th> <th>OnSet Dates</th> <th>Condition Status</th> </tr> </thead> <tbody> ... <tr> <td>Problem</td> <td>Physical exam, routine</td> <td>V70.0</td> <td>May 29, 2013</td> <td></td> <td>Active</td> </tr> ... </tbody> </table> </text>
That's pretty much what it looks like on the paper documents that the medical community has been using for decades:
|Problem Type||Condition||ICD-9 Code||Effective Dates||OnSet Dates||Condition Status|
|Problem||Physical exam, routine||V70.0||May 29, 2013||Active|
It's also useful data: you can paste it into a web form or a spreadsheet or database tool without losing the structure. After all, the
... goal is not adoption alone but 'meaningful use' of EHRs—that is, their use by providers to achieve significant improvements in care. — Blumenthal and Tavenner, New England Journal of Medicine, 2010
I can't help thinking that if interchange were based on simple, visible tables like that, my doctor's portal vendor woul notice that, for example, their CCD only contains lab panel names and not the actual labs with values:
|Test||Attribute||Value(Normal Range)||LOINC Code||Result||Date|
|CMP Comp. Metabolic Panel (14)**322000||()||May 30, 2013|
I've toyed with various tools for keeping a personal health record, and a spreadsheet works pretty well: one sheet (aka table) for problems, one for meds, one for labs, and so on.
To address the abiguity of short text column headings, we should, of course, ground the terms in the web using linked data techniques such as linked CSV and linked data tables. But even if the global identifiers got stripped, copying a table of lab values from my doctor's portal into a "paste your Cholesterol labs" box on the health assessment form should work just fine.