1. Status of the CCR: Continuity of Care Record Claudia Tessier, CAE, RHIA Co-Chair, ASTM E31 Workgroup on CCR Executive Director, MoHCA Health Tech Net February 20, 2004

2. What Is the CCR? Core data set of the most relevant and timely facts about a patient’s 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

5. 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.

6. How Does the CCR Help Practitioners? With the CCR the next healthcare practitioner can Be informed about a patient’s 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 patient’s most essential and relevant information in an EHR. Reduce costs associated with the patient’s care.

7. What’s in the CCR? CCR identifying information Patient identifying information Patient insurance/financial information Advance directives Patient’s health status Care documentation Care plan recommendation Practitioners

8. 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

9. Conceptual Model

10. 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/Problems and Care Recommendations.

11. 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:

12. 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 patient’s treatment.

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

20. Thank you! For more information on the CCR Claudia Tessier, RHIA 202-659-2699 ctessi@attglobal.net