The CCR revolution

While most articles on health reform and health IT focus on computer standards the most vital element may be a piece of paper.

It’s called the Continuity of Care Record (CCR), sometimes the Continuity of Care Document (CCD). It has been in the works for over five years, and it’s something you will be handed after your future doctor visits. It’s a paper document generated by an XML schema.

While there’s a lot of technical argument going on about this (ASTM and HL7 are both hashing out standard details) the idea is that you will get a piece of paper, written in plain English, describing what happened at your doctor visit and what will happen next.

Medsphere Chief Medical Officer Edmund Billings is up-to-date on the technical arguments but says it’s the paper, in the hands of both the patient and the office, that’s the key.

“If they hand me the paper and post the data to a web site that would be killer, but it’s first getting it in hand that’s key. Right now you don’t have that. That’s what they’re pressing for. When you give the patient the information they own their care and it improves.”

Billings said Medsphere is currently creating a CCR that can be output as a version of an Adobe PDF file, a format that can be stored, printed or faxed, but also supports encryption so it won’t be stolen.

The interim meaningful use standards now going through public comment are based on the ASTM version of the CCR, but whose what goes in on the computer side is not nearly as important as what comes out, Billings said.

“In the criteria it says that for every encounter they want the patient to get a clinical summary—tests and allergies and etc.—and a summary of the visit that would have the plan going forward,” he explained. “How often are you handed that information when you leave a doctor? And they want access to clinically relevant patient education.”

As important as that follow-up may be for patient education, it’s just as important on the other side. “That means every smoker gets smoking cessation education. Every patient who has deep vein thrombosis will get drugs to avoid embolisms.”

The technical arguments now going on involve who gets credit, the role of handwritten data proving that the CCR was generated by a real doctor, and interoperability with PHR (Personal Health Record) systems like Google Health and Microsoft HealthVault.

But it’s most important to note that this is already happening. The process for demanding CCRs be given was begun in the stimulus last year, and the “meaningful use” regulations now going through final passage put the final details on the plan.

CCRs are not part of the health reform debate. They are health reform in action. When you leave the doctor in a few years, or your mother leaves one, there will be a piece of paper in the hand saying what needs to happen next, something on which patients and doctors can follow-up.

So any doctor or hospital looking at an Electronic Medical Record (EMR) system needs to know how that system will create CCRs, and how they will be followed-up through the hospital IT system. That’s where the health reform rubber will meet the road.