Use the Carecoordination module

Purpose

This document shows how to use the CCDA module as found in OpenEMR 4.2.x and higher: creating a CCDA file for an existing patient; creating a new patient by importing a CCDA file and importing CCDA data for an existing patient.

Introduction/ Caveats

This document shows the workflows used in a testing environment so may not exactly duplicate all aspects of clinical use. But they should be close.

This summary shows how to perform three activities:

• Create a CCDA from an existing patient record
• Create new patient from CCDA file
• import existing patient data from CCDA

Refer to the wiki page Carecoordination Module Configuration to get the module ready to use. An OpenEMR Administrator's user account is required for these activities.

Note that the module was significantly updated in OpenEMR 7.0 and 7.0 Patch 1.

Procedures

Create a CCDA from an existing patient record

• For testing, we created a 4 yr old patient to be sure some Clinical Reminders would be activated.
• Ensure that an encounter exists for any patient whose record is being exported to CCDA
  

1. On left Nav Menu:

'Modules→CareCoordination' (left oval)

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2. Click 'Export' tab (top arrow)

3. Select the type of CCDA to produce (top rectangle)

Transition of Care is default Patients who have exportable encounters are automatically listed

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Alternatively you may click the 'Search' button and search by:

• encounter date range
• pt name/ id
• encounter number

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Export Immunization CCDAs

Syndromic Surveillance CCDA

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Note: Immunization and Syndromic Surveillance CCDAs were not tested

4. Generate the patient listing with the 'Search' button

5. Select the checkbox at right end of the patient listing (circle)

For larger image click pic, then 'Full resolution'

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6. Click "Send To" button (arrow)

7. Download panel opens; select 'Download' (oval)

8. Click 'SEND' button (rectangle)

It was occasionally necessary to click the 'Transition of Care' sub-tab to display the 'Send To' button

After OpenEMR processes it you will be able to download the CCDA.zip file according to your OS/ browser method (not pictured).

Import external CCDA file

When you receive a CCDA file you may create a new patient with it or merge the information in it with an existing patient's record.

1. When you receive an external CCDA file place it in a known location e.g., Downloads or some purpose- made directory/ folder (MS Windows 7 system pictured)

2. Find and unzip the incoming CCDA.zip file.

For larger image click pic, then 'Full resolution'

3. Navigate to its extraction location

For larger image click pic, then 'Full resolution'

Buried two directories (folders) deep in the extracted content is a file "CCDA_[number].xml" with a "xml" extension (NOT the xsl one).

It may be convenient to move this xml file to a more accessible location e.g., your desktop or Downloads.

Back to OpenEMR to create a patient from the CCDA xml data.

In real life you wouldn't have the patient in your system yet. If you made the CCDA file from an existing patient, you'll need to delete the patient you used to create the CCDA file. Also- CCR and CCD files were not available to test but those tabs have the same icons as Transition of Care so presumably their function is similar?

4. In left nav menu: 'Modules → Carecoordination' (left oval below)

5. Click 'Import' tab (arrow)

6. On Import tab select new 'CCDA' subtab (rectangle)

7. Click the upload file icon (right circle)

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8. Use your browser dialog to locate and select that xml file from step 3 above (not pictured)

A row appears with some patient identifiers from the CCDA file.

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• Icons at right of line allow various treatments of the incoming file.

• Click the very left triangle (below) of the patient line for read- only display of all the health information in the CCDA

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Add as new Patient

Precisely that.

9. Click the head icon (oval at right)

10. Agree to "Add as new patient" (dialog not pictured)

It is done.

Alternatively, the other icons allow you to review or edit the CCDA information before adding the new patient.

View Details

Produces a two part printable html display of the CCDA data.

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The top is CCDA document identifiers/ metadata

The bottom is the CCDA data.

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Merge to any patient

This icon appears when the incoming patient does NOT already exist in the system. CCDA data may be merged into the record of any other existing patient.

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1. Click icon and the Merge panel appears

2. Enter the existing patient's PID in merge panel

3. Select from list of possible matches

Review and Approve

This icon appears when the patient already exists in the system.

It allows you to review, edit then accept incoming data.

• Edit an entry and select 'Update' in the dropdown (oval lower right below)
• 'Import All' button stops edits at their current state preventing further changes (arrow top right)
• 'Accept' or 'Discard' buttons (rectangle top center) takes the changes into the patient record or rejects the CCDA import.
• Back arrow (circle top left) lets you navigate back to the main import screen.
  

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