Part of the Nightingale Notes EHR software is CCD software which helps convert electronic CCD is a Continuity (Care Document) patient data into an easy to read PDF.

A CCD is a Continuity of Care Document.

So what does that mean for non-techies?

Here’s what you need to know.


Anytime we want to communicate with another person, the first step is to find a language we both understand, and if weShutterstock2_edited-resized-600 don’t speak the same language, we need a translator or a common language.

What is HL7?

In the world of health data exchange, HL7 is a method of translating, or helping people speak the same common language.

HL7 is an agreed upon standard way to communicate between entities that provide healthcare and who don’t necessarily use the same healthcare nomenclature.

The Mirth appliance (appliance really means a server with special software installed on it) is the way we can deliver messages in HL7 to other places.

  • If a public health agency collects data about you and a hospital collects data about you, they both collect some common information
  • They each also collect information that is unique to the services and care they provide you
  • Even when the services and care are similar, they may each talk about them using different languages/terminologies

However, the common shared language is HL7.

What does HL7 do?

Shutterstock19_edited-resized-600Health Level 7 (HL7) started in 1987. It is a non-profit organization that was accredited by the American National Standards Institute (ANSI).

HL7 specifies how information is exchanged, and the file formats for healthcare information.

For example, there are HL7 specs for:

  • Admission Records
  • Discharge Summary
  • Continuity of Care Document (CCD)

We all know the Omaha System right? The Omaha System is utilized by our clients to document the care they provide to patients.

Hospitals that see those same patients may not use the Omaha System to describe the care they give.

The hospitals need to know and understand what care the Public Health Department provided and vice versa.

How does HL7 help clients, hospitals and public health agencies?

HL7 gives instructions on how to share information about a client’s health, and the care provided, between the hospital and the public health agency.

HL7 says “put all a client’s medications here on a CCD.” It also says put problem information (Omaha System problems or other nomenclature) “here” on a CCD.

This allows public health clinicians and hospital clinicians to look at a CCD and find the information they want in a place they expect it.

What is the CCD for?

A CCD is often electronic, meaning it’s a file of non-human readable information that is not very pretty.

Instead of simply being database records, this information can be put into an easy to read format like a PDF.

See the example below of a person from Minnesota who takes several medications and has been seen for several problems.

This is what the Nightingale Notes EHR software does.

A CCD can be generated for a client in a PDF.

Then, in Minnesota, where the data exchange project is nearing its end, those agencies in the grant will be able to have information about a client sent to the HIE in MN at the end of December, in the less pretty format which is better for computers to read.

The second part of this feature will only be available to grant partners in Minnesota.

How else does Nightingale Notes EHR fit in?

We have to work with each state’s HIE to establish communications and iron out a lot of technical details in the CCD software to make this happen.

We are working with North Dakota to do the same by March of next year. Of course, this is a simplistic overview.


What else does the Mirth appliance do?

Now, just a bit more about the Mirth appliance.

It does more than just deliver messages for us, it also helps our data get through to other places that have unique “doorways.”

Some places we want to send data might only accept it through a TCP/IP protocol, or a Web Service.


  • Takes our data and get through those doorways.
  • Manages the messages going back and forth via Nightingale Notes

Imagine 835 messages, Immunization records, CCDs, all being sent to us at the same time from lots of other places.

Mirth is like the night security guard, only it’s on duty all the time.


  • Watches the messages
  • Ensures they are formatted right
  • Checks for security credentials to see if they should get through our door
  • Keeps them all in line


If you’d like to know how Nightingale Notes and CCD software can help you, and your health programs, why not contact us today at (507) 388-4141?