CCOW Considerations
By Clyde Smith
If you have much exposure to clinical applications, you have probably read about or discussed the need for
synchronizing the patient context between applications to increase the efficiency of the clinician. CCOW, or
Clinical Context Object Workgroup, is an HL/7 standard that is designed to facilitate communications between the
applications so that when the context is changed in one application on a workstation, the other applications on
that workstation are notified of the change and seamlessly change their context to match the application that was
originally changed. Despite the fact that CCOW is a standard, there are many challenges to face when attempting to
design and implement a CCOW solution for an organization. Some things to keep in mind when undertaking a CCOW
project include:
- It is important to make an inventory of the applications that will utilize CCOW in your designed
solution. Choosing the best CCOW solution can only be done with the full knowledge of each clinical
application vendor’s capabilities and compatibilities in mind evaluated against the CCOW context manager
vendor’s capabilities.
- It is also important to consider all of the architectures of the applications you will be
“bonding”. Applications that run under differing architectures (i.e., Citrix, terminal servers, web
servers, terminal emulation, etc.) may require differing capabilities from the CCOW context manager
vendor.
- There are various levels of context that can be managed (patient level vs. visit/encounter
level, etc.). It is important to understand the functionality of each application to determine if it
will functionally support your vision of the final solution.
- Great care should be taken to ensure how each system stores and expects to receive the primary context
field. In many organizations, it is not unusual to see various representations of what we would consider to
be the same value (i.e., Medical Record number in system 1 is 4567890 but appears as 00004567890 in
system 2).
- A network assessment may need to be done to insure that any additional traffic generated by context
changes will not cause the network performance to suffer after implementation. This can occur in cases
where a designed Context Change requires a security clearance on one or many of the systems that are
linked; the SSO context manager will have to be contacted for each and will need to return a message
especially where an application’s security is set high, or if the application takes an early exit due to
HIPAA required timeout settings.
- A “Proof of Concept” model should be strongly considered due to the many complexities involved in
testing and implementing a CCOW solution.
- A comprehensive testing plan must be written and executed in order to insure the proper
functionality of the CCOW solution. Here are one or two examples of items that might be missed from a
typical testing plan:
- What happens to unsaved data on a background screen when a notification to change the
context is received?
- What happens when an application has timed out and is restarted?
- cWhich view does that application go to when the context is changed? Is it the desired
screen?
- What happens when a context change to a patient/visit is requested and the patient/visit
is not currently in another open CCOW enabled application (due to interface errors or down
time)?
- Ensure that it is clearly understood by everyone with a stake in the systems that each time any of
the CCOW enabled applications are changed, upgraded, or enhanced, time will need to be taken to perform a
full regression test will be required to maintain peak performance and accuracy. This may cause apparent
small projects to take much longer than originally anticipated thereby slowing the pace of the clinical
systems team.
- Context changes in non-CCOW compliant applications are possible, but will require some customized
analysis, planning, development, testing, and maintenance. While this functionality is possible, you
will certainly need to carefully consider the amount of “care and feeding” that these custom solutions
may require in order to continue to be of value to the clinicians that use them.
- Context management products provide highly flexible and powerful logging and reporting
capabilities. This can be of significant value both clinically and from a compliance perspective
HIPAA, Data Security, etc.). It is important to allot time during the project to analyze what
information and/or reports will be available and to develop a plan for who will receive and act on the
information contained therein
This list of considerations is by no means a comprehensive or complete list, but is intended to ensure
that the reader understands and plans for the proper level of complexity in the design, development,
testing, and implementation of a CCOW solution. If you would like more information, please feel free to
contact Clyde Smith at csmith@getvitalized.com or Jack Wagner
at jwagner@getvitalized.com for assistance
with your project.