1. What is a CCR?
Continuity of Care Record, or "CCR", was developed and enhanced in response to the need to organize and make transportable a set of basic patient information consisting of the most relevant and timely facts about a patient’s condition. Briefly, these include patient and provider information, insurance information, patient’s health status (e.g., allergies, medications, vital signs, diagnoses, recent procedures), recent care provided, as well as recommendations for future care (care plan) and the reason for referral or transfer. This minimum data set will enhance the continuity of care by providing a method for communicating the most relevant information about a patient and providing both context and support for the electronic health record (EHR) through extensions.
2. Who is supporting the CCR?
Here is a brief list of current support members:
3. What are the benefits of the CCR?
The CCR should have a great impact on the quality of care, on the reduction of medical errors, and on the containment of costs. The potential benefits are obvious:
- The next healthcare provider will not have to guess about a patient’s allergies, medications, or current and recent past diagnoses and other pertinent information.
- The next healthcare provider will be informed about the patient’s most recent healthcare assessment and services.
- The next healthcare provider will be informed about recommendations of the caregiver who last treated the patient.
- As patient demographics will be provided, time and effort will be saved by not having to repeatedly ask a patient for demographic information in detail. Rather, it can be verified, which takes less time.
- A patient’s insurance status will more easily be established. Over time, this can be expanded within the system.
- Costs associated with the patient’s care will be reduced, for example through avoiding repetitive tests and basic information gathering.
- The effort required to update the patient’s most essential and relevant information, will be minimized.
4. What information is contained in the CCR?
At present, the CCR consists of six sections of mandated core elements. Each of these sections has the possibility of five extensions, where appropriate. The sections are:
- Header, or Document Identifying Information, contains required information about the referring or "from" clinician, as well as information about the referral or "to" provider, and document date. It also addresses the purpose for creating the document and reason for referral.
- Patient Identifying Information: This section includes the required information to identify and distinguish the patient throughout the referral process, transitioning to and from hospital, clinic, physician office, or home environments (any care setting). The CCR can be used in both a centralized system and/or federated or distributed identification system that links various providers and contains the minimal set of identifying information that could be used by any record system [paper or electronic] to assign the individual their own identifier.)
- Patient’s Insurance and Financial Information. The individual’s Medicare or commercial insurance information. Data elements include Insurance Company Name, Subscriber’s Name, Subscriber’s Date of Birth, Subscriber’s Member ID, and Other Insurance Information. These are the minimal data elements from which eligibility for insurance coverage may be determined.
- Health Status of the Patient: This section includes the following information:
- Diagnoses, Problems, and Conditions are preferably ranked by order of importance or in reverse chronological order. They are described in plain English and by code, according to the selected coding system. Also included are date of onset, date of most recent resolution, status, patient awareness of condition, family history, social history, and a source field.
- Adverse Reactions/Alerts lists allergies by agent and symptom with optional fields for source and date of last reaction, as well as other pertinent alerts about the patient.
- Current Medications are listed by brand name, generic name (optional), code system, code, start date, dose, schedule, refills, prescriber, status, and a comments field.
- Immunizations documentation includes information about each disease against which immunization was given, the date the immunization was received, and (optional) dose strength, unit and route of administration as well as manufacturer and lot#.
- Vital Signs documentation includes height, weight, blood pressure, temperature, respiratory rate, date vital signs were recorded, pulse oximetry, and optional peak expiratory flow rate (PEFR), as well as head circumference (for Pediatrics).
- Laboratory Results documentation includes blood sugar, urine protein, creatinine, sodium, potassium, hemoglobin, hematocrit, WBC, and the date the sample was taken.
- Procedures/Assessments documentation includes descriptions of procedures, code system, procedure code, procedure date and time, location, result and performed by whom. Also included here are assessments, such as mental health assessment, functional assessment.
- The Health Status section may be amplified in the optional “extension” for medical specialty-specific information. For instance, pediatric providers may want to include a growth chart in the CCR.
- Care Documentation: This section includes some detail on the patient-clinician encounter history, such as the dates and times of recent and pertinent visits and the purposes of the visits and names of clinicians or providers. This documentation section may be significantly expanded in the optional “extensions”.
- Care Plan Recommendation: The Care Plan is a free text entry section that includes planned or scheduled tests, procedures, or regimens of care.
5. Do I need an electronic medical records (EMR/EHR) system to generate a patient's CCR?
No! There is a growing number of vendors that offer free (or inexpensive) CCR editing tools that enable users the ability to easily create, view and/or edit CCR documents. The CCR can then be easily exchanged with other care providers, whether or not an EMR/EHR system exists...continuing the continuity of care process.
6. Can I use a CCR for a Personal Health Record (PHR)?
Absolutely!. The CCR is built upon W3C XML (Extensible Markup Language), a global computer language used primary to facilitate the sharing of data across different information systems. Many vendors are offering portable PHR products based upon the CCR Interoperability Standard (or subset).
7. How can I learn more?
We will continue to add information. Please feel free to post a comment or request, we will reply ASAP.
Email me your request
