Electronic medical records have begun to flow more freely between previously isolated health care entities. Where EMRs once were frozen in independent and often proprietary data silos within hospitals and private physician practices, health data exchange is now possible using the continuity of care document, an international standard for electronically sharing patient information.

CCDs enable providers to easily access health information from previous encounters and to update that information when the patient is transferred or referred to the next provider. That means no more guessing about allergies or medications.

The Healthcare Information and Management Systems Society believes that real interoperability—not simply exchanging documents, but exchanging data that can be used for analysis—only can be achieved with the CCD standard.

Quality of Care is the Beneficiary

"I'm not aware of any hospital organization or vendor that either hasn't already implemented CCD or has it on their strategic roadmap for implementation sometime in 2011," says Robert Dolin, M.D., board chair of HL7. HL7 developed the CCD with ASTM, another international organization with a focus on health information technology.

Dolin believes the biggest CCD obstacle for hospitals will be getting some independent clinicians up to speed. "The challenge hospitals face is going to be the small practices that don't yet have an EMR," he says.

Once independent clinicians adopt a certified EMR, the CCD issue becomes moot. "Capabilities to generate and communicate the CCD are inherent in any meaningful use-certified solution," Dolin says.

One way to meet the challenge of incorporating CCDs from independent physicians is to connect practices directly to the hospital EMR.

The ThedaCare community health system in Wisconsin shares its EMR with about 90 percent of the independent physicians with whom it partners, solving most CCD data flow issues. None of the remaining 10 percent of clinicians have their own EMR implemented at this time. "Our strategy has been to include as many independent physicians as we can in our EMR, so we have a fully integrated community EMR," says Keith Livingston, senior vice president and CIO.

CCDs usually are easier to implement if you own all the hospitals in a network, but independent hospitals in the Spokane, Wash., area found a way to achieve this in spite of their autonomy. "We've been able to connect independent, rural and remote hospitals and practices to one network," says Marc Johnston, director of regional accounts at St. Luke's Rehabilitation Institute in Spokane. St. Luke's is a division of the nonprofit Inland Northwest Health Services, formed in the 1990s by two competing hospital systems as a way to deliver health care more efficiently. The merger put the region on the cutting edge of innovation.

INHS' technology division supports dozens of hospitals and hundreds of physician practices by providing EMR solutions, hosting, consulting and technology management services. Fourteen INHS-supported hospitals are on H&HN's 2010 Most Wired list and three to four times as many clinicians in the Spokane region have adopted EMR solutions than in other parts of the country. "Most communities are running between 15 and 20 percent physician EMR adoption," Johnston says. "In Spokane, 65 percent of the area's 750 physicians have adopted EMRs, and most of them are highly integrated into the hospital network."

The effect of the Spokane network is that health information contained in the CCD now follows patients from the first encounter to discharge, from initial independent clinic visit to emergency department to hospital admission to post-acute rehab. "Any care provider throughout the entire patient experience now has access to the most current information," Johnston says.

Data flows out of the hospital as well. "We also feed hospital data to any physician EMR that can take our format, which is standard HL7," Johnston says.

INHS soon will be positioned to share health data with entities outside the Spokane area. "The CCD will let us communicate patient health information to areas outside the INHS region, like Seattle and Tri-Cities, where we don't share data today," Johnston says.

Douglas Page is a freelance writer in Pine Mountain, Calif.