Continuity of Care Documents (CCDs) – What Are They and How Are They Useful?

Date: November 12th, 2014Category: CORHIO e-NewsletterTopics: Care Coordination, Transitions of Care, Care Summaries

CCDs are a type of electronic document that summarize patient information and help providers communicate clinical information during transitions of care.

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 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.

What is a CCD?

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 article, 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.

What does C-CDA mean?

C-CDA is short for Consolidated Clinical Document Architecture and is a specific type of CCD. C-CDA has been adopted as the industry standard for creating patient care summary documents. What makes C-CDA significant and an improvement on previous standards is that the data exchanged is machine-readable, so it can be picked up by HIE systems and parsed out into patient records. The C-CDA format is specified as a requirement for EHR vendors pursuing ONC certification for their products. The C-CDA format is also specified as a requirement for Stage 2 of Meaningful Use.

What information is in a CCD?

Data typically shared in a CCD includes:

  • Patient demographics
  • Patient history
  • Medications
  • Allergies
  • Procedures
  • Encounters
  • Problem lists
  • Diagnosis
  • Lab results
  • Immunizations
  • Health risk factors

CCDs can also include advance directives, family history, social history and insurance information. To meet the objective for Stage 1 Meaningful Use that requires sending CCDs outbound from an electronic system, CCDs must include problems, allergies, medications and lab results. For Meaningful Use stage 2, there are more required data elements, including smoking status, vital signs, care plans and more.

What are the potential benefits of CCD exchange?

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.  

What are the current limitations of CCDs?

If you are the “receiver” of another provider’s CCD, you are reliant on what the “sender” thinks you need to know about the patient and their recent encounter(s). Some senders might just send all of the patient’s clinical information in their system, resulting in an unwieldy amount of information. CORHIO staff have seen CCDs in excess of 200 pages. Hospitals more commonly send the longest CCDs. Conversely, the sender might include too little information in the CCD, which could cause gaps in care or require a provider to make additional phone calls to track down the missing information.

In addition, the functionality and usefulness of CCD exchange between EHRs is really at the beginning stages. Some EHRs are only capable of sending and ingesting CCD information on a limited basis, if at all. For CCD exchange to be truly valuable, the information contained within the documents needs to be parsed out and able to populate fields within the patient record. When this technology is commonplace, CCD exchange will have much more clinical value to providers.

Is CORHIO currently helping providers exchange CCDs?

Yes, we have started to receive CCDs into the CORHIO network from certain select providers and we are analyzing how best to deploy CCD exchange more broadly across the CORHIO network.