Satva presses for interoperability: conference tackles technology issues, business case for Continuity of Care Document.
Article Type: Conference notes
Subject: Computer software industry (Conferences, meetings and seminars)
Interoperability (Conferences, meetings and seminars)
Software (Conferences, meetings and seminars)
Behavioral health care (Conferences, meetings and seminars)
Patients (Care and treatment)
Patients (Conferences, meetings and seminars)
Author: Grantham, Dennis
Pub Date: 02/01/2010
Publication: Name: Behavioral Healthcare Publisher: Vendome Group LLC Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Health care industry; Psychology and mental health Copyright: COPYRIGHT 2010 Vendome Group LLC ISSN: 1931-7093
Issue: Date: Feb, 2010 Source Volume: 30 Source Issue: 2
Topic: Canadian Subject Form: Behavioural medicine Computer Subject: Software quality
Product: Product Code: 7372000 Computer Software NAICS Code: 51121 Software Publishers SIC Code: 7372 Prepackaged software
Accession Number: 221186285
Full Text: The Software and Technology Vendors' Association (SATVA) envisions a Continuity of Care Document (CCD) to meet the needs of behavioral healthcare providers. To achieve this goal, the New York City-based organization brought together leaders from behavioral health, addiction treatment, medicine, and information technology in a late January interoperability conference held in Phoenix.

According to Bill Connors, CEO of Sequest Technologies of Lisle, Ill., and SATVA vice chairman, the conference agenda included demonstration of an interoperable Continuity of Care Document (CCD) prototype between two different EHR platforms; an exploration of the adequacy of existing CCD designs and templates for use by behavioral healthcare; and an evaluation of business and medical case scenarios under which different elements of CCD information might eventually be exchanged with primary care, emergency, surgical, or other medical providers.

To date, the enthusiasm of some behavioral health providers for interoperable health information has been chilled by the patient-consent requirements needed for release of certain types of data (e.g., addiction and addiction-treatment information) by HIPAA's section 42 CFR (Code of Federal Regulations), Part 2 privacy laws.

"We know that 42 CFR is the elephant in the room and [the conference recognized] that it's way beyond the scope of our work. We're not trying to determine what data goes where, because we know there are a lot of people looking at that issue," says Connors. "At the same time, the government seems to be headed toward interoperability. We want to show that, when the business/legal/privacy issues get ironed out, the technology will not be an issue. The goal is to demonstrate that interoperability is possible and that technology will not be an obstacle to achieving it."

The fact that the conference attracted a wide range of behavioral health players is "historic," says John Raden, Chairman of SATVA and CEO of The Echo Group, Conway, NH. The conference, he says, "was the first time all of the stakeholders in the behavioral sciences were working together to come up with interoperability standards that incorporate relevant behavioral health information." Raden asserts that the conference "was an important step in assuring that our customers have an opportunity to take advantage of HITECH funding."


Such HITECH funding, though not available today, may indeed be possible, but Connors says that the proposed standard is just the first step of a longer process--a process aimed at securing that funding and acceptance of the CCD standard throughout the behavioral health industry. "I wish it [obtaining HITECH funds] were as easy as showing proof of concept, showing that we can do [interoperability]," Connors says. One thing the effort does show, he asserts, is "the willingness of SATVA member companies to meet the needs of the market and make an impact on how behavioral health does business."

Why develop a standard now?

The impetus for SATVA's CCD standard effort stems from several factors: the direction of the market, looming behavioral health standards from CCHIT, and the apparent acceptance of CCD as a primary means of interoperability. "It's all woven together in many ways with the meaningful use definitions, many of which require interoperability of data," Connors explains, adding that a behavioral health CCD standard would bring together "efforts going on across the country" that point to "the need for behavioral health to exchange data with ambulatory care, acute care, and other behavioral health providers.

"The level of collaboration around the issue of interoperability is really mind-boggling. SATVA members know that we can't afford to have 'siloed' approaches. Our viability in the marketplace depends on our ability to work together to exchange data."

The CCD standard, the foundation on which SATVA plans to build its draft interoperability document, was adopted in 2007. It brings together two previously accepted, but incompatible electronic data exchange formats: the West Conshohocken, Penn.-based ASTM International's Continuity of Care Record (CCR, ASTM 2369) and the Health Level Seven (HL7) Clinical Document Architecture (CDA). A Corepoint Health white-paper states that CCD "harmonizes the two separate standards by using CCR within the broader context of CDA," adding that the CCR is intended to "increase the quality and efficacy of patient transfer between points of care" and will be "instrumental in driving the adoption of electronic health records (EHRs)" and "more modern methods for patient data exchange." (1)

While sharing and demonstrating methods and mechanics for data interchange within the CCD format occupied one day of the conference, the conference had another, perhaps more important agenda, says Connors. The second and third days of the conference "explored whether the CCD, as currently written, is comprehensive enough to do the job for behavioral health. We wanted representatives of the business side, medical side, and legal side to talk about what the issues are, what the concerns are, what data might be needed when a behavioral health or addiction patient needs other types of care, such as primary, emergency, or surgical care."

The CCD format offers the basis for many data elements through plug-in templates (CCR users would recognize them as "elements") that hold data about an individual's problems, procedures, family history, social history, medication, immunization, vital signs, test results, payers, advance directives, and more. "The questions are, 'What is needed?' and 'Do existing templates provide it in a way that is comprehensive enough for behavioral health?'" says Connors. "If so, great," he adds, "but if not, we have to look at what additional issues or information might be needed or shared in particular situations."

Among the scenarios warranting further exploration are whether Axis 5 diagnosis information (not currently part of the CCD) is needed, whether current CCD templates can accommodate results from behavioral or substance-abuse screening tests, and whether current CCD information is sufficient to assist a medical provider in differential diagnosis of psychiatric symptoms (e.g., psychotic episode or drug abuse).

The conference made these assessments with the help of senior personnel from the National Council and MHCA, CEOs and CIOs from SATVA customers who operate behavioral health and addiction treatment centers, legal experts, and physicians with expertise in privacy law and standards development. These included Larry Gentilello, MD, a professor of surgery at the University of Texas Southwestern medical school in Dallas and director of the American Board of Addiction Medicine; and Robert McClure, MD, VP and CMO of Ridgefield, Conn.-based Apelon, a consulting firm that specializes in data standards and interoperability.

"There are three legs to this stool," says Connors: the technology, the business case, and matters of law and confidentiality. "We're looking at the first two and putting together a draft standard for a behavioral health CCR that puts the required data and a mechanism of exchange--a means of restricting or allowing passage of particular data--in place. If and when we get an understanding of that third leg--which data must be exchanged and when--we'll be ready to go."


(1.) Corepoint Health. The Continuity of Care Document: Changing the Landscape of Healthcare Information Exchange. Copyright 2009. Retrieved from

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