The Continuity of Care Document Exchange

For Stage 1 Meaningful Use, Eligible Providers, Eligible Hospitals and Critical Access Hospitals must demonstrate the ability to exchange key clinical information with other providers.

The requirement for Stage 1 MU is simply that providers must perform at least one successful test of their certified electronic health record system to send key clinical information electronically. Key clinical information could be a patient’s problem list, medication list, medication allergies, patient care summary, or diagnostic test results.

Patient care summaries may be generated from an EHR based on the HL7 Clinical Document Architecture (CDA) standard. This standard specifies how key components of information are relayed, using standard codes such as LOINC and SNOMED that most electronic systems should recognize.

The Continuity of Care Document (CCD) specification further organizes the information in the CDA specific to a core set of data elements required for effective patient care summaries. These elements include administrative information, such as who the referring physician is and from which facility the patient is being transferred, to the patient’s basic demographic information (name, date of birth, gender, etc.). The CCD also contains information on the most recent healthcare encounter for that patient; it provides a snapshot in time with pertinent clinical, demographic and administrative information.  For more information, see IMPACT Project: UTF/CCD.

All certified EMRs should generate a CCD. However, the quality and amount of information contained in the CCD can vary greatly between the various software products. The Office of the National Coordinator for Health IT (ONC) is working with the Standards and Interoperability Framework group to improve the information being transferred within CCDs from certified EHR products.