CCOW Information

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What is CCOW?

CCOW is a vendor independent standard developed by the HL7 organization to allow clinical applications to share information at the point of care.

Using a technique called "context management", CCOW allows information in separate healthcare applications to be unified so that each individual application is referring to the same patient, encounter or user. CCOW works for both client-server and web-based applications.

This means that when a clinician signs onto one application within a CCOW environment, and selects a patient, that same sign-on is simultaneously executed on all other applications within the same environment, and the same patient is selected in all the applications, saving clinician time and improving efficiency.

The advent of CCOW reflects a growing need in healthcare to offer clinicians secure, unified access to disparate clinical data at the point of care. Other technologies improving point of care access include wireless hardware, clinical web portals and "single sign-on" solutions.

The acronym CCOW stands for "Clinical Context Object Workgroup", a reference to the standards committee within the HL7 group that developed the standard.


What are the business benefits?

  • Greater flexibility of choice for health providers when purchasing healthcare applications because CCOW offers widespread interoperability between software from different vendors

  • Rapid, unified access for clinicians to patient data when they need it

  • CCOW's single sign-on management capabilities improve user efficiency (fewer time-consuming sign-ons to applications)

  • Context oriented workflow - clinical users can find and compare patient information they need quickly and easily, supporting better clinical decision-making

  • Leverages existing investment - By CCOW-enabling existing IT resources, health providers can realize the benefits of a single sign-on, patient centric information system without major re-investment in new technologies.



"We are seeing strong growth in the use of CCOW for interoperability, providing a wider choice of technology for health providers. At the HL7 booth at HIMSS 2003, held in San Diego in February, CCOW was used with two context managers and four client applications working independently with each of the context managers. We appreciate Orion Systems International's participation in this demonstration, which again showed the value of standards-based interoperability for healthcare."

Liora Alschuler, Consultant
Co-chair, HL7 Structured Documents Technical Committee
Co-editor, HL7 CDA and Project Manager for the HL7 HIMSS Demo


How does CCOW work?

The CCOW standard provides a mechanism for applications to share information so that they appear to behave as a single system. This shared information is known as the context.

An example of information stored in the context is the name and various identifying numbers of a patient. Applications on a CCOW-enabled desktop sharing a 'Patient' context will all display information about the same patient. Other standard contexts include 'User' and 'Encounter'.

CCOW specifies that a Context Manager component is responsible for maintaining the context. Applications are Context Participants that synchronize by querying the context manager to determine the current context and when they wish to update the context. CCOW also supports Mapping Agents, which map equivalent identifiers when the context is updated so that applications can interoperate without sharing the same identification information for patients or users.

CCOW provides two options for communication between components - a Web (HTTP) mapping, and an ActiveX mapping. This allows interoperation to occur even between applications employing different technologies.

CCOW specifies security protocols that must be obeyed when the context includes 'secure subjects' such as user information. This prevents malicious users gaining access to applications or parts of applications by faking context information.


Where do I find the CCOW standard specification?

Full technical specifications for the latest version of CCOW are available online from the HL7 Bookstore at (HL7 Members receive a discount off the regular purchase price.)


How can I impliment a CCOW-enabled IT infrastructure?

Context Manager

The central component in a CCOW-enabled architecture is the context manager. There are several commercially available products implementing the CCOW standard for a context manager, including Sentillion® Vergence® and Carefx™ Fusion. An alternative is Orion Health's HIE or EHR solutions, utilizing a web-based portal, enabling total point-of-care integration.

Before buying a context manager, make sure you see the vendor's "Declaration of Conformance". In particular, a context manager should employ both the Web mapping and the ActiveX mapping, in order to give you more flexibility in selecting applications.

Existing Applications

Many different applications, including radiology, lab, portal software and billing applications are now CCOW compliant. If critical applications in your IT infrastructure do not support CCOW, there are four possible approaches:

  • Ask application vendors if they can provide CCOW-compliance. Many vendors are building CCOW support into new versions of their applications.
  • Undertake a development project to build CCOW support into the applications. Ask your context manager vendor how they can help you with this part of the project.
  • Web applications can be integrated using web portal technology. A CCOW-compliant web portal solution will then allow these web applications to participate in a context without the individual applications being explicitly aware of the CCOW standard.
  • Replace them with applications that provide support for CCOW (see below).
New Applications

If CCOW interoperability is a major part of your IT infrastructure then CCOW-compliance is an important feature to look for in new applications.

Before purchasing an application, make sure you see the vendor's "Declaration of Conformance". Not all CCOW-compliant applications are capable of sharing the same information. There are separate checkboxes on the declaration for each of the patient, encounter, observation and user links and you should consider carefully whether the application supports the links that you wish to implement.

Mapping Agents

Often applications linked with CCOW don't actually use the same information despite sharing the same context (for example, two applications may use different Medical Record Numbers to identify patients). In order to ensure that these links work, it may be necessary to develop mapping agents to map between the different identifiers. Again, the best way to approach this part of the project is to ask your context manager vendor how they can help you out.


Free CCOW demonstration

Orion Health offer free product demonstrations on their website including their HIE and EHR solutions.



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