How Can a Standard CCD Help Communicate Information to Patients?
CCR is also an XML-based standard used for clinical data exchange, but was developed by ASTM International. CCR provides a “snapshot” of treatment and basic patient information – it is not comprehensive like an EHR. Its primary function is to ease the transition of a patient from one provider to the next. The information included in the record focuses on the diagnosis and reason for referral rather than symptoms and treatment chronology. It may include information from only a single provider visit or may be more extensive to include data from multiple visits. The amount of information included varies by provider and patient.
Few in healthcare argue that exchanging patient health records electronically is a bad idea. HIEs around the country are already touting the benefits of their services, namely a reduction in unnecessary patient trauma and unnecessary costs. In 2011, there were 255 HIE organizations in the U.S., yet only 24 reported that they were financially sustainable. In other words, there are 231 HIEs that are currently not making enough revenue to cover operating expenses. Many of these HIEs are able to continue operation due to HHS grants and because member healthcare organizations are willing to risk a short-term financial loss because they believe the HIE will gain widespread provider acceptance, which will eventually help them recoup early losses through several cost savings measures and future government reimbursement incentives (e.g., bundled payments, quality of care benchmarks). Local physician practices are slow to adopt EMR systems due to significant costs that can outpace Meaningful Use reimbursements and, some would argue, because they have no financial incentive to enthusiastically adopt a new healthcare system that moves away from the fee-for-service model they have successfully used for generations. From strictly a business sense, it’s logical for them to ask “What’s in it for me?” before investing hundreds of thousands of dollars on an EMR system just so they can connect with the local HIE. HIE directors must prove to the referring physician community that patients overwhelmingly want a system that securely exchanges their medical data, and that belonging to such a system will provide the physicians a return on their investment of an EMR system with external connectivity, HIE fees, and all the additional technology and staff required to make it functional. Through Meaningful Use and HHS, the government is also playing a major role in pushing all providers toward a modern, electronic medical system. However, time is of the essence for HIE sustainability and there are no government mandates that require participation in an HIE, regardless of the obvious benefits it has for patient care. Meaningful Use Stage 2 objectives may push eligible professionals to utilize an HIE, but those rules are not effective until 2014.
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. 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 (Grannis SJ, Biondich PG, 2005). This observation led the President’s Council of Advisors on Science and Technology1 and the Institute of Medicine 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. This is akin to installing a unique web browser for each Web site on the Internet; the complexity and burden of such networking effectively isolates medical data at the point of care. Health information exchanges confront this same obstacle, where even successful networks note the challenge of normalizing heterogeneous EHR data (Blumenthal D, 2010). Information exchange is consequently the exception rather than the norm. Recent federal initiatives, however, are beginning to dismantle these barriers.
Overall, 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.
Grossman C, Powers B, McGinnis JM, Institute of Medicine Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care. Washington, DC: National Academies Press; 2011
Grannis SJ, Biondich PG, Mamlin BWet al.How disease surveillance systems can serve as practical building blocks for a health information infrastructure: the Indiana experience. AMIA Annu Symp Proc. 2005:286–290
American Recovery and Reinvestment Act of 2009. Washington, DC: 111th Congress of the United States of America; 2009
Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010