Continuity of Care Record

Physician's Money Digest, April 2007, Volume 14, Issue 4

About 5 years ago, representatives from the Massachusetts Medical Society, American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics, and several other organizations joined in an effort to create a data set that could satisfy all medical needs to inform a physician about a patient's history and health status. Under the coordinating effort of one of the largest standards development organizations, American Society for Testing and Material's (ASTM) International, a national standard was achieved for the continuity of care record (CCR). The CCR is technology-neutral, meaning that one can prepare and send the data set electronically as a Word document, print it, and hand it to a patient, fax it to another provider, e-mail it, or send it as an HL7, the leading messaging standards developer in health care.

The CCR through interoperability communicates the following sections:

  • Payers. Complete fiduciary information of the patient. This includes authorization data related to patient and/or provider.
  • Advance directives. If the patient has them, such as "do not resuscitate" and durable power of attorney for health care.
  • Support. The patient's personal support system, such as family.
  • Functional status. The patient's competency, ambulatory status, ability to care for self, activities of daily living, etc.
  • Problems. A complete picture of the patient's health history.
  • Family history.
  • Social history. A patient's occupational, personal, social, and environmental data, in addition to administrative data such as marital status, race, ethnicity, and religious affiliation.
  • Alerts. All alerts, allergies, and adverse reactions are listed.
  • Medications. A patient's medications and pertinent medication history—harmonized with National Council for Prescription Drug Programs medication data.
  • Medical equipment. Implanted and external medical devices and equipment relevant to current health status.
  • Immunizations.
  • Vital signs. Current and historically relevant vital signs.
  • Results. Laboratory, diagnostic, and therapeutic results.
  • Procedures. Interventional, surgical, diagnostic, and therapeutic procedures.
  • Encounters. Hospitalizations, office visits, home health visits, long-term care stays, and other pertinent encounters.
  • Plan of care. All active, incomplete, or pending orders; appointments; referrals; procedures; services; clinical reminders prompting disease prevention; disease management; patient safety; and health care quality improvements, including widely accepted performance measures.
  • Health care providers. These data are represented in XML language for machine processing, but are also humanly legible. In addition, HL7 has developed a version that better fits into its framework for clinical document architecture (CDA). "The CCD [continuity of care document] includes the best of HL7 technologies, the rich experience of the ASTM’s CCR with clinical data representation, and does not disrupt the existing data flows in payer, provider, or pharmacy organizations," states the national Health Information Technology Standards Panel (HITSP). The CCD will enable legacy and other systems using HL7 technologies to take advantage of the CCR data set.