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The Use of the CCD as a Possible Way to Provide Data for the Patient

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CCD stands for Continuity of Care Document and is based on the HL7 CDA architecture, said Brull. CDA, or Clinical Document Architecture, is a "document standard," governed by the HL7 organization. "HL7 is the leader in healthcare IT standards, with its v2 and v3 standards," Brull said. "The HL7 v3 standards include messaging and document standards

The document standards for HL7 v3 is CDA, and one of the documents within the CDA architecture is CCD."

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With the rise of electronic health record usage, the need for a standardized way to exchange comprehensive clinical documents between providers -- beyond individual results and reports -- became clear

Continuity of Care Documents (CCDs) were developed to meet this need and their usage is being bolstered by Promoting Interoperability Program (formally meaningful use). As the technology evolves and health systems become more interoperable, document exchange will be seen more and more. Here are some frequently asked questions on CCDs, and the C-CDA framework those documents are a part of, to help you understand them better. CCD is a generic term for an electronically generated, patient-specific clinical summary document. As a result, CCDs are sometimes called a few different names – Continuity of Care Document, Summary of Care Document, Summarization of Episode Note – just to name a few. For this explanation, we will use Continuity of Care Document or CCD. The purpose of a CCD is to improve communication between health care providers during a transition of care – when a patient is being referred to another provider or coming back to their normal provider after a hospital stay, for example. CCDs are generated out of a provider’s electronic health record (EHR) system and include care summary information. CCDs can also include advance directives, family history, social history and insurance information. For Promoting Interoperability Program (formally Meaningful use), there are more required data elements, including smoking status, vital signs, care plans and more. When done optimally, CCD exchange can reduce staff time spent gathering patient clinical information during transitions of care. And CCDs generally expand the clinical information available to community providers and give them more details on the care patients received at outside facilities. Combined with existing medication, imaging and lab data being shared from hospitals and labs, CCDs may give providers the additional clinical data needed at the point of care.

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Recent federal health information technology incentives adopt an extensible standard, called the Continuity of Care Document (CCD), as a new basis for digital interoperability. Although this instrument was designed for individual provider communications, the CCD can be effectively reused for population-based research and public health. Population analysis empowers public health agencies, disease registries, medical researchers, and practicing clinicians to monitor care quality and improve disease management beyond face-to-face patient encounters (Steinbrook R., 2006). Potential applications of EHR technology to population analysis are straightforward. Health surveillance should rely on automated detection rather than manual inspection. Quality measures should be calculated and streamed directly to agencies for quality improvement. Comparative effectiveness should leverage the emerging wealth of digital data to inform decisions on care appropriateness and provide feedback to clinicians. What limits these applications is the divergence of how EHRs capture and record medical data without a standard method to exchange information between these systems

This observation led the President’s Council of Advisors on Science and Technology and the Institute of Medicine2 to recently identify interoperability as the major deficit of current health information technology. From their perspectives, fluid and secure data exchange has the most immediate potential to improve care quality and efficiency nationwide. Achieving robust interoperability requires common language and structures to medical data so communication is seamless to care providers. This contrasts with current practice. Today, implementations of medical data exchange force both senders and recipients of medical data to plan in advance the content and format of exchange (Graham DJ, Campen D, 2005).

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Altogether, while full semantic interoperability remains distant, a great deal of useful work has been and is being done. For example, the adoption of open standards such as HITSP TP50, C76 and IHE RFD, CRD, and DSC greatly enhance the ability of EHRs and registries to function together and reduce duplication of effort

Functional interoperability is a goal that can be achieved in the near term with significant gains in improving workflow and reducing duplication of effort for providers and patients participating in registries. The successive development, testing, and adoption of open-standard building blocks, which improve functional interoperability and move us incrementally toward a fully interoperable solution, is a bridging strategy that provides benefits to providers, patients, EHR vendors, and registry developers today.

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Harris CD, Pan L, Mukhtar Q. Changes in receiving preventive care services among US adults with diabetes, 1997–2007. Prev Chronic Dis. 2010;7(3):A56.

Steinbrook R. Facing the diabetes epidemic—mandatory reporting of glycosylated hemoglobin values in New York City. N Engl J Med. 2006

Cebul RD, Love TE, Jain AK, Hebert CJ. Electronic health records and quality of diabetes care. N Engl J Med. 2011;365(9):825–833

Graham DJ, Campen D, Hui Ret al.Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. Lancet. 2005

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