continuity of care record claudia tessier, cae, rhia co-chair, astm e31 workgroup on ccr executive...
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Continuity of Care Record
Claudia Tessier, CAE, RHIACo-Chair, ASTM E31 Workgroup on CCR
Executive Director, MoHCA
What Is the CCR? A snapshot in time: A core data set of the
most relevant 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.
The CCR…
Provides information that is• Appropriate, succinct, organized, and up-to-date
• Interoperable through use of specified XML code
• A necessary bridge to a different environment, often with new practitioners who know little about the patient.
Will address specific domains through extensions: long-term care, acute care, disease management, personal health record, etc.
Development of the CCR Unique standards development effort Consortium of sponsoring organizations
• ASTM International • Massachusetts Medical Society• HIMSS• American Academy of Family Physicians• American Academy of Pediatrics• American Medical Association• Patient Safety Institute• American Health Care Association• National Association for the Support of LTC• Additional sponsoring organizations pending
Sponsors represent:
ANSI-recognized standards development organization
Over 400,000 practitioners Over 13,000 IT professionals Over 12,000 institutions in the long-term care
community that provide care to over 1.5 million elderly and disabled
Patients, patient advocates, data sources, corporations, provider institutions….
This Unique Initiative Is…
Patient-focused
• Not about what the system says to do but about what patient information is most relevant
Provider-focused
• Practitioners determine what information is most relevant
Content-focused
• Emphasis is on what providers need to know to deliver good patient care
This Unique Initiative Is Also… Stimulating cooperation among
• Organizations, such as ASTM and HL7
• Professional specialty organizations and their practitioners
• Provider institutions
• Vendors These diverse groups are working together
• To develop and implement the CCR
• To assure its interoperability
• To develop demonstration projects Generating interest among
• Patients and patient advocates
• Federal agencies, payers, others
The CCR Is Not… An EHR
• It is not a complete electronic health record of a patient’s lifelong health status and healthcare
• It is not universally accessible• It does not have a universal patient identifier
A progress note, discharge summary, or consultation• It is not limited to information from a single encounter• It is not free-text based
A loose dataset of health information• It is a defined set of core data in specified XML code
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.
What’s in the CCR or Core Data Set?
CONCEPTUAL MODEL OF THE CCR
CCR Identifying Info.Info re “from/to” Providers/CliniciansDocument DatePurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health Status
Family HistoryAdverse Reactions/Allergies/Etc.Social History & Health Risk FactorsMedicationsImmunizationsVital Signs/Physiological MeasurementsLaboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Eligibility, co-payment, etc. .
-
specific Info
-Info
Enterprise-, Institution-specific info.
-
specific information
Clinical Specialty-specific information
specific Info
Disease Management-specific informationspecific Info
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
01/10/04
8
Conditions/Diagnoses/Problems
7
V12: 01/11/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives Optional Extensions
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
CCR Identifying Information
Section 1 Referring (“from”) practitioner Referral (“to”) practitioner Date Purpose/reason for CCR
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
Patient Identifying Information
Section 2 Required information to
uniquely identify the subject patient
Not a centralized system or a national patient identifier, but a federated or distributed identification system that • Links various practitioners
• Contains the core data set of identifying information that could be used by any record system to assign the individual their own identifier.
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
Patient Insurance/Financial Information
Section 3 Basic information from
which eligibility for insurance benefits may be determined for the patient.
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
Advance Directives
Section 4 Indicators that resuscitation
efforts are to be either unrestricted or to be limited in some way.
Includes what is commonly known as the DNR (Do Not Resuscitate) status of the patient as addressed in such documents as living wills, healthcare proxies, and powers of attorney.
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
Patient Health StatusSection 5
Conditions/Diagnoses/Problems Family History Adverse Reactions/ Allergies/Clinical
Warnings and Alerts Social History and Health Risk
Factors Medications Immunizations Vital Signs and Physiologic
Measurements Laboratory Results and Observations Procedures/Imaging This section may be amplified in
extensions for clinical specialty-specific information regarding patient.
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
Care Documentation
Section 6 Some detail on the
patient-practitioner encounter history, such as dates and purposes of recent pertinent visits and names of practitioners seen.
May be significantly expanded in future extensions.
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
Care Plan Recommendation
Section 7 Includes planned or
scheduled tests, procedures, or regimens of care for the patient.
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
Practitioners
Section 8 Information about those
healthcare practitioners who are participants in the patient’s care
Links as appropriate to Conditions/Diagnoses/ Problems and Care Documentation encounters
CCR Identifying InformationInfo re “from/to” PractictionersDatesPurpose
Patient Identifying Information
Patient Insurance/Financial Info
Patient’s Health StatusCondition, Diagnosis, or ProblemFamily HistorySocial History & Health Risk FactorsAdverse Reactions/Allergies/etc.MedicationsImmunizationsVital Signs/Physiological Measuremts.Laboratory Results/ObservationsProcedures/Imaging
Care Documentation
Optional Extension
Enterprise-, Institution-specific info.
Clinical Specialty-specific information
Disease Management-specific information
Personal Health Record information Documented by the Patient
Care Documentation for Payers (Attachments)
Practitioners
1
2
3
4
5
6
Mandated Core Elements of the CCR
Version 10
8
7
V13: 02/08/04
Care Plan Recommendation
Optional Extension
Optional Extension
Advance Directives
Optional Extensions
A Sample Data Group
Medications• Definition: Generic name of current and
relevant past prescribed substances, including OTC, herbal, and homeopathic substances. Brand name is inadequate.
• Comments/Examples: Medication: Trimethoprim/Sulphamethozaxole
• Required or Optional: Required
• XML: <MEDICATION>
Extensions for Additional Content Enterprise and institution-specific, e.g.,
acute care, LTC Clinical specialty-specific, e.g, pediatrics,
nursing Disease management
• Disease-specific information, performance measures, guidelines, etc.
Payers: financial information/attachments Patient-entered Personal Health Record
The CCR Can Stimulate EHR Adoption Because…
Through specified XML code it is interoperable, so it will enable EHR systems to• Import and export all CCR data
• Interchange the CCR between otherwise incompatible systems
• Minimize workflow disruption for practitioners
More about XML and the CCR Through XML, CCR can be prepared,
transmitted, and viewed • In a browser• In an HL7 CDA-compliant document• In secure email• In any XML-enabled word processing document• In multiple formats
It can also be• Printed as a paper document• Stored on a portable storage device for use as a
personal health record
Why So Much Interest in the CCR? Multiple uses
• Referral, transfer, discharge, or other instance when patient is seen by another provider
• Other uses include personal health record, research, and public health initiatives
Introduction to electronic documentation and ultimately to EHR• Can stimulate use of computers in healthcare
Flexibility• Whatever patient information is relevant can be
accommodated
Why So Much Interest in the CCR? It is not a top-down approach
• End-users, i.e., practitioners have participated in its design
• The originator determines the relevant content It has support and leadership from organizations
representing end-users, who are• Involving, advising, and assisting their constituents in its
adoption It allows options for implementation
• Paper or electronic It has potential to reduce inefficiencies and costs
• Practitioners won’t have to search for relevant information
• Fewer repeat lab tests and other evaluations
Why So Much Interest in the CCR? It offers support for patient safety and reduced
medical errors• Through easy access to critical data such as medications
and allergies It encourages patient involvement and improved
provider/patient relations• It is patient focused
• It offers patients easy access to their health information
• Patients don’t have to repeat same information over and over
• It can help populate a personal health record
• It can stimulate the patient to become more involved in and informed about their healthcare
• It can involve patient in transfer of information (USB)
In Summary:
Practitioners, provider institutions, patients, vendors, and other stakeholders perceive the CCR as• Relevant
• Doable
• Transportable and interoperable
• Valuable
