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EMR >> EMR Research
Clinical Context Object Working Group (CCOW)
Electronic Medical Records
- CCOW
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Aimed at facilitating the integration of applications at
the point of use, CCOW is an
end-user-focused standard that complements HL7’s traditional
emphasis on data interchange and enterprise workflow. Using
a technique known as context management, the clinical user’s
experience is one of interacting with a single system, when
in fact he or she may be using multiple, independent
applications from many different systems, each via its
native user interface.
By synchronizing and coordinating applications so that they
automatically follow the user’s context, the CCOW Standard
serves as the basis for ensuring secure and consistent
access to patient information from heterogeneous sources.
The benefits include applications that are easier to use,
increased utilization of electronically available
information, and an increase in patient safety. Further,
CCOW support for secure context management provides a
healthcare standards basis for addressing HIPAA
requirements. For example, CCOW enables the deployment of
highly secure single sign-on solutions.
Impact
CCOW’s impact on the healthcare industry is apparent. Leslie
Kelly Hall, CIO of St. Alphonsus Regional Medical Center
described what CCOW has meant for her organization. “It's
difficult to overstate the significance of this breakthrough
because it means physicians finally have intuitive access to
the entire breadth and depth of clinical information.”
All of the major HIS vendors are now shipping or planning on
shipping both Windows- and Web-based CCOW-compliant
applications, while vendors in virtually every segment of
the clinical healthcare market have adopted the standard as
well. VHA Inc.—a nationwide network of 1,900 leading
community-owned healthcare organizations and their
affiliated institutions—now requires all of its new business
partners to be CCOW-compliant. A growing number of
healthcare organizations are also implementing context
management solutions to link together diverse multi-vendor,
multi-technology IT systems on an enterprise-wide basis.
How It Works
The CCOW Technical Committee became a part of HL7 two years
ago after starting out as an independent healthcare industry
consortium. In that short time, the committee has developed
and ratified four versions of the CCOW Standard. This
unprecedented pace has been, in part, due to the modular
component-based nature of the architecture upon which the
standard is based, enabling new specifications to be
developed in a complementary and add-on manner.
CCOW’s Context Management Architecture (CMA)
was founded on the principle that common context can be
estab¬lished across applications by identifying things—such
as a patient—or concepts—such as a clinical encounter—in a
manner that different applications can never¬theless
recognize.
The core architecture is comprised of three main types of
components: applications; a context manager that coordinates
and synchronizes applications; and mapping agents that can
represent the various synonymous real-world identifiers used
to identify clinical patients, users, etc. The architecture
defines the roles and responsibilities for each of these
components and precisely prescribes the interfaces that
enable them to communicate. The architecture does not define
or dictate the implementation of any of the components.
The user sets the context using any CCOW-compliant
application, for example, to select a patient of interest.
The application then tells the context manager that it wants
to set the patient context and provides the context manager
with an identifier that indicates the context subject,
which, in this case, might be the medical record number for
the patient of interest.
The context manager then tells the other applications that
the context has been changed, and each application obtains
the patient’s identifier from the context manager. Each
application then adjusts its internal state and data display
accordingly. This all happens in real-time.
Detailed How It Works
The user sets the context using any CCOW-compliant
application—for example, he or she selects a patient of
interest. The application then tells the CCOW-compliant
context manager that it wants to set the patient context,
and provides this context manager with an identifier that
indicates the context subject, which in this case might be
the medical record number for the patient of interest. The
context manager then notifies the other applications that
the context has been changed, and each application obtains
the patient’s identifier from the context manager. Each
application then adjusts its internal state and data display
accordingly.
Context links may be common or secure. Any application may
set or get the context data for a common link. In contrast,
only site-designated applications may set and/or get the
context data for a secure link. Applications, the context
manager and mapping agents use digital signatures to
authenticate the messages they send and receive and to
ensure the integrity of the data within these messages.
The basic idea is to provide a means for the various CCOW
components to trust each other, for example, to enable
applications to know that they are communicating with the
real context manager (as opposed to a rogue application that
is pretending to be a context manager).
One of the more elegant capabilities provided by the
architecture is that the use of different context subject
identifiers is hidden from applications. An application only
needs to know its own identifiers. A mapping agent works in
conjunction with the context manager to map the identifiers
used by the application that sets the context to identifiers
that may be understood by other context-sharing
applica¬tions. For example, one application may use a
hospital-assigned medical record number to identify
patients, while another application in the same institution
uses clinic-assigned medical record numbers to identify the
same patients.
The CCOW architecture was designed to be
easily implemented within all types of health care
applications and using a variety of technologies. Particular
emphasis was given to ensuring that CCOW compliance could be
easily retrofitted into existing applications. It is not
necessary for an application developer to implement a
context manager or mapping agents, as these components are
external to the application can be obtained from other
sources.
Source: http://www.hl7.org/library/committees/sigvi/ccow_overview_2001.doc
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