“It could be that the CCR is the only business model that works for a RHIO,” suggested St. Charles, Ill., family physician Stasia Kahn at the 23rd annual Towards the Electronic Patient Record (TEPR) meeting here this week.

Kahn talked about how she and other physicians in the Chicago area are building the foundation for a regional health information organization with the help of the CCR — an XML data set of essential information for when patients move between care settings — and encouraged other practitioners to adopt the standard. “There’s a lot of providers still waiting, and my message to you is there’s no reason to wait any longer,” said Kahn, who called the CCR the only real way to send secure, electronic clinical data from provider to provider right now.

But that may soon change, as a health-specific version of the Portable Document Format, known as PDF-H, is on its way, thanks to a collaboration between PDF inventor Adobe Systems and computer chip-maker Intel, with support from several medical specialty societies.

“Raise your hand if you can open a PDF document on your computer,” instructed Steven Waldren, director of the Center for Health Information Technology of the American Academy of Family Physicians. After pretty much everyone in the room complied, Waldren said, “That’s the use case.”

Two standards-development organizations, namely AIIM – the Enterprise Content Management Association and ASTM International, are working on best practices and an implementation guide for PDF-H that should be ready within the next month or two. Befitting something that will handle patient-specific clinical information, the PDF-H will be more secure than the standard PDF.

Melonie Warfel, director of worldwide standards and life sciences Adobe, said that digital signatures will provide the necessary audit trail of PDF-H access. Though Adobe has not released the signatures module for PDF-H just yet, built-in password protection accomplishes the same goal. Also, Warfel noted that some 1,800 other companies offer PDF-related applications, so the extra security of digital signatures is bound to proliferate once AIIM and ASTM complete the standards process.

One attendee suggested that the PDF-H could be a short-term solution to the problem of interoperable healthcare data exchange, but Rick Peters Jr., chairman of ASTM Committee E31 on Healthcare Informatics, responded by saying it could be more than a stopgap. “It’s a pretty slick container…when we cannot assure ourselves who’s at the other end,” said Peters.

A live demonstration Monday of the rather slick importation of CCR data into a PDF form, the adding of attachments to a PDF, and the subsequent updating of the CCR with attachments was tediously slow, but presenters said that electronic health records can be programmed to import information and attach documents automatically, greatly streamlining the patient referral process.

Depending on the vendor, an EHR may not be capable of importing CCR data. Current ambulatory EHR certification standards do not require such a function, and likely won’t until at least 2009, but some believe the market is heading that way, requirement or not.

It may not matter if one format wins out over the other — or, for that matter, if a Health Level Seven offering called the Continuity of Care Document gains prominence—because PDF-H is meant to complement rather than supplant other interoperability standards, according to Waldren. “It’s another option to move this data around,” he said.

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