Increasingly, healthcare organizations are being required to share data both to improve processes at the point-of-care and to improve administrative processes that enable better quality to be achieved at more efficient costs. Essentially, healthcare organizations are being tasked with expanding data sharing to better promote the Triple AIM.
Previously, organizations involved in data sharing may have provided highly specified integrations such as sending billing data (typically CPT codes along with associated diagnose codes), or they provided custom data extractions from an EMR database for a registry vendor (e.g., Philip’s Wellcentive or a bespoke data warehouse). Integrations to provide data at the point-of-care were often also customized and relied upon a third-party longitudinal or community HIE (health information exchange) product.
Over the last few years, however, there has been a push to use more standardized data sources to both lower the cost of such implementations and to decrease the time and complexity involved in implementing such interfaces. Now, more-often-than-not, an analytics vendor will first look at CCDs (continuity of care documents) and then only move to other projects if there are gross deficiencies; moreover, due to the growth of projects such as Commonwell/Carequality along with DirectTrust, CCDs are becoming the standard document used to exchange clinical information at the point-of-care. CCDs often contain information about diagnoses, procedures, procedure history, recent labs, ongoing care plans, and medications.
In analytics, it is not uncommon for projects to involve creating a bulk CCD backload archive of current patients and then to have an ongoing feed for new patients or for existing patients that have had appointments. Where possible, it is usually preferable in these instances to send longitudinal CCDs as the goal is not to create an easy to read or digest document for a recipient but, rather, to create a comprehensive document that can be parsed and then imported into an analytics system to determine a patient’s compliance with clinical quality measures such as those used for HEDIS or by Medicare (such as the GPRO measure set). This data can be sent through a variety of means, but it is not uncommon to see data sent in batches via sFTP because the calculation and presentation of the data often does not occur in real-time due to performance issues. Some systems, for example, only update data on a weekly basis. That said, some products also receive data through web services as the entire process can be deemed more secure and there are sometimes management or scaling issues with large numbers of sFTP accounts.
For data used at the point-of-care, the CCD documents used are often less than longitudinal, and it is more often to see documents that are more attuned to the specific visit that generated the document. While this results in a less comprehensive document, it, however, also results in a document that can be more easily read and processed by the recipient be it a nurse, medical assistant, care manager, or clinician. When using a technology such as a Carequality/Commonwell, the CCD is pulled from the originating source when requested by the recipient’s EMR. Another common way to receive such documents is via DirectTrust. When using DirectTrust, a CCD and other accompanying documents are sent manually by the sending EMR after a visit. Accompanying documents could be appropriate scanned documents and a PDF/image copy of recent visits. This is usually done when either a referral is generated, or when the loop is closed on an existing referral. CCDs are also used with HIEs that have products that can be used at the point-of-care (longitudinal records). When these integrations occur, CCDs are often generated after a visit is concluded and sent via a web service to the HIE.
CCDs are far from perfect as they often lack data that clinicians seek out and are sometimes difficult to work with; moreover, it has been evident that EMR vendors have not implemented them consistently. That said, they do provide a degree of standardization, and they have – to an extent – eased many of the headaches involved in providing meaningful and actionable healthcare data to end users whether it be on the administrative end or for care providers.