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Product CCD

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Product Brief - CCD - Continuity of Care Document

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Product Name

CCD - Continuity of Care Document


Standard Category

Health Information Exchange Standards

Integration Paradigm



Informative, HL7 Implementation Guide


  • CCD Release 1


HL7 and ASTM International created the Continuity of Care Document (CCD) to integrate two complementary healthcare data specifications ASTM’s Continuity of Care Record (CCR) and HL7’s Clinical Document Architecture (CDA).

The CCD was selected by the Healthcare Information Technology Standards Panel (HITSP) as the harmonized format for the exchange of clinical information, including patient demographics, problems, medications and allergies, and was recognized in 2008 in the US by the Secretary of Health and Human Services for this use. (See C 32 standard). It has been named in US Regulations for exchange of clinical information in the Meaningful Use IFR.


The HL7/ASTM Continuity of Care Document (CCD) is an implementation guide for sharing Continuity of Care Record (CCR) patient summary data using the HL7 Clinical Document Architecture (CDA). CCD establishes a rich set of templates representing the typical sections of a summary record and expresses these templates as constraints on CDA. These same templates—for vital signs, family history, plan of care, and so on—can then be reused in other CDA document types, establishing interoperability across a wide range of clinical use cases. The CCD is the basis for interoperability in the US Health Information Technology Standards Panel (HITSP) and Integrating the Healthcare Enterprise (IHE) use cases.

What is the Continuity of Care Document?

The CCD is a joint effort of HL7 and ASTM to foster interoperability of clinical data to allow physicians to send electronic medical information to other providers without loss of meaning, which will ultimately improve patient care. It passed balloting in February 2007 and is endorsed by the Healthcare Information Technology Standards Panel (HITSP) as the harmonized format for the exchange of clinical information including patient demographics, medications and allergies. The CCD is a CDA implementation of ASTM's Continuity of Care Record (CCR). It is intended as an alternate implementation to the one specified in ASTM ADJE2369 for those institutions or organizations committed to implementation of the HL7 Clinical Document Architecture. The CCD represents a complete implementation of CCR, combining the best of HL7 technologies with the richness of CCR’s clinical data representation, and does not disrupt the existing data flows in payer, provider, or pharmacy organizations. The CCD is an XML-based standard that specifies the structure and encoding of a patient summary clinincal document. It provides a "snapshot in time," constraining a summary of the pertinent clinical, demographic, and administrative data for a specific patient. From its inception, CDA has supported the ability to represent professional society recommendations, national clinical practice guidelines, standardized data sets, etc.

Business Case (Intended Use, Customers)


Implementations/ Case Studies (Actual Users)


The CCD is endorsed by the Healthcare Information Technology Standards Panel (HITSP) as the harmonized format for the exchange of clinical information, including patient demographics, medications and allergies. It was recognized by the U.S. Department of Health and Human Services as part of HITSP's first set of interoperability standards in January 20008. The HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component (CS32) describes the document content summarizing a consumer’s medical status for the purpose of information exchange. The content may include administrative (e.g., registration, demographics, insurance, etc.) and clinical (problem list, medication list, allergies, test results, etc.) information. This Component defines content in order to promote interoperability between participating systems such as Personal Health Record Systems (PHRs), Electronic Health Record Systems (EHRs), Practice Management Applications and others.


In 2008, Integrating the Healthcare Enterprise included the CCD for Patient Care Coordination in seven of its profiles. IHE’s XDS Medical Summary for referral and discharge is also being built upon HL7’s CCD.

Implementation Guides Using CCD

There are several CDA, Release 2 implementation guides completed or in draft that make use of CCD templates. These include:

  • CDA for Consult Notes, Release 1 (see link to CDA Implementation Guide), and
  • CDA for Operative Notes (see link to CDA Implementation Guide)
  • CDA for History and Physical
  • Quality Reporting Document Architecture
  • CDA for Procedure Notes (Draft)


Work Groups


Certification Available
  • see also CDA Certification


From HIMSS 2009

Relationship to/ Dependencies on, other standards

  • CDA R2

Links to current projects in development