Status of the CCR: Continuity of Care Record

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Status of the CCR Continuity of Care Record

• Claudia Tessier, CAE, RHIA
• Co-Chair, ASTM E31 Workgroup on CCR
• Executive Director, MoHCA
• Health Tech NetFebruary 20, 2004

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What Is the CCR?

• Core data set of the most relevant and timely
  facts about a patients healthcare.
• Organized and transportable.
• Prepared by a practitioner at the conclusion of a
  healthcare encounter.
• To enable the next practitioner to readily access
  such information.
• May be prepared, displayed, and transmitted on
  paper or electronically.

3
Development of the CCR

• Unique standards development effort
• Consortium of sponsoring organizations
• ASTM International
• Massachusetts Medical Society
• HIMSS
• AAFP
• AAP
• Additional sponsoring organizations pending

4
CCR Will Benefit Healthcare Process

• Foster and improve continuity of care
• Enhance patient safety
• Reduce medical errors
• Reduce costs
• Enhance efficiency of health information exchange
• Assure at least a minimum standard of health
  information transportability when patient is
  referred to, transferred to, or otherwise seen by
  another provider

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Why Is the CCR Needed?

• CCR addresses the lack of appropriate, succinct,
  and up-to-date patient health information for
  practitioners at a new point of care.
• CCR data is essential to good patient care and
  serves as a necessary bridge to a different
  environment, often with new practitioners who
  know little about the patient.

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How Does the CCR Help Practitioners?

• With the CCR the next healthcare practitioner can
• Be informed about a patients allergies,
  medications, current and recent past diagnoses,
  most recent healthcare assessments and services,
  advance directives, and the recommendations of
  practitioners who last treated the patient.
• More quickly and easily verify patient
  demographics and insurance status.
• Minimize the effort to update patients most
  essential and relevant information in an EHR.
• Reduce costs associated with the patients care.

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Whats in the CCR?

• CCR identifying information
• Patient identifying information
• Patient insurance/financial information
• Advance directives
• Patients health status
• Care documentation
• Care plan recommendation
• Practitioners

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CCR Standard Specification

• CCR scope
• Referenced documents
• Terminology (definitions)
• Significance and Use
• Specifications
• Conceptual Model
• Sections of CCR
• Annex A Spreadsheet of core elements
• Annex B XML schema
• Annex C Example report

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Conceptual Model
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Annex A of Standard Specification

• Detailed list of the CCR data groups.
• Fields
• Associated definitions, comments, examples
• Specification of whether field is required or
  optional
• Required XML when preparing CCR in a structured
  electronic format
• Notes
• Date groups can be repeated as necessary
• Wherever a code is used (e.g., Diagnosis 461.9),
  the type and version of the system (e.g.,
  ICD-9-CM) used to assign the code must be
  included.
• Links where appropriate to Conditions/Diagnoses/Pr
  oblems and Care Recommendations.

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A Sample Data Element

• Social History and Health Risk Factors
• Definition This Data Group provides information
  on social and personal factors that may impact
  the patient's health.
• Comments/Examples Smoking/Tobacco Use, Diet,
  Exercise, ETOH Use, Living Situation, Travel
  History, and Environmental or Occupational
  Exposures.
• Required or Optional Optional
• XML ltRISK.FACTORgtltATTRIBUTEgt

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When Is the CCR Used?

• Referral or transfer Referring practitioner
  transmits the CCR to receiving practitioner and
  new care setting where patient is being sent so
  that it arrives before or with patient.
• Discharge without a referral or transfer CCR is
  provided to patient for future use, including
  visits to urgent care or emergency department,
  and to whomever patient designates as primary
  care practitioner responsible for followup care,
  if needed.
• Personal health record Patient keeps copies of
  his/her CCRs and supplements them, e.g., with
  alternative medicine information and other PHI.
• Other Also useful to researchers and others not
  directly involved in patients treatment.

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For Maximum Utility XML

• XML structured electronic format makes CCR
• Interchangeable
• Allows flexibility to prepare, transmit, and view
  CCR in multiple ways
• In a browser
• HL7 CDA-compliant document
• Secure email
• Within any XML-enabled word processing document
• Allows display of fields in multiple formats
• Allows interchange of CCR between otherwise
  incompatible EHR systems

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The EHR and the CCR

• Using the XML specified in this standard, EHR
  systems will be able
• to import and export all CCR data
• to enable automated healthcare information
  transmission with minimal workflow disruption for
  practitioners.
• The CCR will provide additional content and
  support for the EHR through extensions.

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Extensions for Additional Content

• Enterprise and institution-specific
• Acute care, long-term care, home care, etc.
• Clinical specialty-specific
• Pediatrics, Nursing, etc.
• Disease management
• Disease-specific information, performance
  measures, guidelines, etc.
• May be used by health plans, pharmas, patient
  advocacy groups, others promoting best practices
• Payers
• Additional financial information and care
  documentation
• Patient-entered Personal Health Record
• Complimentary and alternative medicine
• Private or sensitive health information
• Expanded family history

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Other CCR-related Activities

• HIMSS/HL7 demonstration at HIMSS
• Connectathon
• CCR representatives assisting HL7 with
  preparation
• TEPR CCR demonstration
• USB drive with CCR loaded on it
• Will require secure access
• Vendors will demonstrate ability to upload, read,
  and transmit CCR

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Other CCR-related Activities

• Potential for demonstration and implementation
  projects
• Possible funding through private and public
  organizations, e.g., AHRQ grants
• Demonstration of utilization of CCR in movement
  of patients between practitioners and
  care-settings
• Long-term care to/from acute care settings
• Primary care to/from specialist
• Acute care to/from home care
• Several similar efforts internationally, e.g.,
  Finland, Denmark, England, The Netherlands,
  Germany, Spain

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Development of CCR and Extensions

• Meetings of stakeholders
• Circulation and website postings of evolving
  standard
• Balloting
• Requires ASTM membership
• Nonmember database also developed for updates,
  meeting notices, opportunities for input

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CCR Timeline for 2004-2005

• CCR balloting in February, results in March
• April meeting agenda
• Resolve negatives, if any
• Expand awareness of CCR
• Develop implementation guide
• Develop extensions
• Do demonstration projects
• Ballot standards addressing extensions and
  implementation guide
• Maintain/update standards

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Thank you!

• For more information on the CCR
• Claudia Tessier, RHIA
• 202-659-2699
• ctessi_at_attglobal.net