CCD vs. CCR and Part of MU

I’ve been a fan of the concept of CCR since it first started many years ago. However, I’ll be honest that I haven’t followed the progression of CCR much since then.

I know that Google Health was using a modified version of CCR. I also know a number of EMR vendors that have integrated CCR with their EMR. So, I’m looking to my readers to give me an update on what’s been happening with CCR.

Also, I’ve been hearing some people refer to it as CCD instead of CCR. I think that CCD stands for continuity of care document. I assume it’s basically the document that CCR uses to share healthcare information?

At one of the conferences I attended, they suggested that CCR was the standard that was going to be used to show “meaningful use.” I haven’t ever seen the standard formalized. Did I miss this somewhere?

Ok, here’s looking to you. Leave some comments on what you know about CCR.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • John,

    One way to think about it: CDA is data that goes in at the point of care, and CCR is data that comes out and goes to the patient or other providers like a report — hopefully in a “meaningful” way. One goal is for the patient to be “transferable” in and around the system.

    CCD bridges CDA and CCR. Overly-simplistic, but one view.

    — Jack

  • Colleagues: The CCR standard is alive and well, being used all over the world for computable summary health data and its messaging. It is used both internally in large organizations, as a means of data transport and exchange, and externally, as for moving data from a hospital to patients’ PHRs. See for a press announcement of Thailand’s Bumrungrad Hospital and Microsoft HealthVault, that mentions their use of the ASTM CCR standard.
    See the Medpedia entry under CCR standard for more information.
    With kind regards, DCK

  • David,
    That’s kind of the point of this post. Not to suggest that CCR isn’t alive. In fact, it’s because I think that it’s alive and well that I want to learn more about where it’s being used and how the standard is evolving. Who’s the driving force behind it? What are the goals of CCR? Who is adopting the standard?

  • CCR moves SUMMARY health data.
    CCD moved DOCUMENTS.
    They are both important!
    When I see a patient in the ER, I want to know their medications and their past medical history but I also want to read their last discharge summary and their last cardilogy consultation and their catheterization report.

    CCR and CCD are both important.
    We need to see data AND documents.

  • Glad to see David Kibble here. He is an EMR Rock Star! He could be the Bill Gates of EMRs (without the billions of dollars) 🙂

  • CCR )continuing care record) is an ANSI standard. CDA (clinical document architecture) is an HL7 standard. HL7 and ANSI have approved the CCD as a joint standard. CCHIT talks only about CCD for certification. A quick search on the ONC website also show multiple references to CCD as recommended for meaningful use.

  • CCR is championed by David Kibbe who has been very critical of CCHIT and CCHIT’s leader (I forget his name). I think CCHIT does not mention CCR because of this conflict between these two very influencial men and their organizations.

    CCR is here to stay and so is CCD. I am not sure about CCHIT although the people who run CCHIT make lots of money each year from doing certifications and collecting money from our government. They are very motivated to survive and will do almost anything to keep their paychecks rolling in.

  • The AAFP defines “continuity of care” as the process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care.

  • Thanks for the analysis and information. I’ll have to contact David Kibbe directly. Maybe he’ll consider doing a guest post on this blog about the standards or at least about CCR.

  • I am really glad to see such a useful infromation about CCD and CCR. This really helped me alot understanding the basic concepts behind the idea.

  • CCR ASTM standard for Clinical Summary using XML one way

    CDA HL7 standard for Clinical Documents (Generic) using XML in a
    fashion that seems to be incompatible with CCR

    CCD Supposedly the long sought “Harmonization” of CCR & CDA
    as a CCR expressed in XML in a fashion that did not violate
    either approach to using XML. This should have become the
    standard, but for reasons that Kibbe, Waldren and Waegeman
    could explain is still not the agreed standard.

  • Ha!… as if sorting out these artifically-created standards would help a single patient! Adopt a single, central computer system, as any sane country would have, and the time we waste on this nonsense would be painfully transparent.

  • Russell,
    Great idea on the single system for the country. Kind of like the one they tried in Great Britain that was a colossal failure and lost them something like $12 billion. Yep, that’s a country the size of something like Maine. I’m sure the US would do much better with a MUCH more complex healthcare system to boot.

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