Mark Anderson talks about the Continuity of Care Document (CCD) standard

Mark Anderson of the AC Group, Inc. and Robert Gleeman talk about the CCD standard. Click the Play button to watch this interview.

This is a transcript of the above interview.

Robert Gleeman:  This is Robert Gleeman with EMR Update. I'm talking on Casual Friday with Mark Anderson from the AC Group. Mark, thanks for being with me again, today.

Mark Anderson:  Well, thanks for giving me a call, here. It's been awhile since we've talked, and there's a lot of things going on since that news conference.

Robert:  There are many things going on in response to the stimulus bill, and you have some specifics that a person should be mindful of when buying an EMR. You mentioned to me in an email that one of the main points that you've been talking about is the requirement to be connected to a community HIE. What is a community HIE, Mark?

Mark:  Well, basically, there are three provisions underneath the stimulus act, the high‑tech act. Obviously, one is certification; one's reporting data. The second one, really, was being able to be connected to a connected to a community health information exchange.

The goal of the high‑tech act is to get rid of silos of information and getting all of the doctors connected together. So, an HIE really allows doctors on separate EMR applications to share clinical information about the patients. The data is collected once, but all of the doctors in the community who are treating the patient have access to that information.

Robert:  So, it seems to all be about connectivity. You mentioned also in your email that the connectivity goal is PHR, public health record. We've been hearing about the Google public health record. Is that the same thing? Or is that a personal health record?

Mark:  Well again, what the government is talking about is getting all of the information from all of the different providers that are treating a certain patient. So, the patient has access to that information. Most people are calling that a personal health record, one place the patient can go to learn everything about themselves. Then they can take that information to another provider in a different city or different state, or at least allow the doctor access to that information.

Now, there's Google Health, and you also have Microsoft Health involved. These are kind of like those products. They allow the patient to enter information. But what we really have to have is the provider information updating into a location, along with the patient able to put their health‑related information in. We need data from all sources, so there is truly one personal health record for that patient, no matter which provider they go to.

Robert:  Are you finding that the patient wants to be involved in this record‑keeping process? Are they cooperative?

Mark:  Well, I think it's just beginning today. Kind of look at it as when a patient shows up in a doctor's office, the doctor asks the patient to fill out a number of forms dealing with their social history, the medical history, the family history, what medications you've been on and what other doctors have you seen. So they're already asking the patient to fill out information, but it's done paper.

This way, the patient goes online, fills out the information one time. And no matter which provider they go to, that doctor has that information. So yeah, the patients are getting involved. The surveys have shown that about 68 percent of all patients that have been surveyed would prefer to fill information out before they showed up in a doctor's office.

Robert:  So you're saying, as a prerequisite to get these high‑tech funds from this stimulus bill, you really need to look at connectivity. How are you supposed to know about how connective this EMR product is? Should you go by CCHIT?

Mark:  Well, that's a good helping point. CCHIT, based on the 2008 standard, requires vendors to be interoperable. What they're saying is that you have to be able to send a document, like a fax. In the 2009 standard, we believe that they are also going to build in data exchange, discrete data exchange following the continuity of care document infrastructure, CCD. This is the combination of the CCR standard plus the HLSMA [sp] standard. So, basically CCR plus CCDA is the patient care document standard.

We believe that to get the stimulus package you're going to have to exchange data with all providers in the area. Right now, the CCD standard seems to be where everybody is moving towards. You have to be CCD compliant before the doctor will be able to get access to the stimulus money.

Robert:  Now, you said that you're talking about this a lot. Is that what you're doing right now? You're in Atlanta, Georgia, as I understand it.

Mark:  Yeah, we're finding that there are probably about 100 of these projects that have been going on across the country. We used to know them as RIOS. We kind of joke around that RIOS didn't work because there were four initials. You really need three initials for everything in healthcare. But there are a lot of projects going on that are called HIE informations. What a lot of them are doing today is exchanging information between the hospital and the doctor, or between the LabCorp/Quest and the doctor.

In the future, we're going to be exchanging data between the primary care doctor, sending information to the cardiologist, who may send them onto the GI doctor. All that information may get summarized to go to the emergency room doctors, so they can get access to information about the patient.

The nice thing about this is you don't have to be using an EMR to get access to summary information. If you're a physician that's on paper ‑ there are paper‑based charts today ‑ when a patient checks in, basically a clerical person, or the nurse, could go online, find that patient's record, print it out and stick it on the chart for that physician. That will have on it what medications the patient's on, what laboratory results, which doctors they've seen, what health maintenance alerts are they behind on, what chronic diseases do they have.

It's going to have a wealth of information about the patient in a common format, the same format no matter where you go in the United States. That same printout will come out no matter where you go. That's the advantage of having one kind of standard for sharing information.

Robert:  What you're saying is that the standard has been selected, and it is CCD.

Mark:  From all indications we've seen, yes, the CCD is the standard moving forward. But again, it's really only capturing summary information about the patient. When you ask doctors what they want, about 90 percent of what they really need is in the summary document. It's not capturing everything. It doesn't capture the complete medical record, but it captures the information that the doctors traditionally want to pass on to another. So, yeah, it's very strong for the doctors' needs to understand how to treat the patient today.

It's a great starting point. Ten years from now, we'll have something different probably. But it is the starting point moving forward.

Robert:  Does anyone, right now, have CCD compatibility?

Mark:  There are about 30 EMR vendors that we've tracked right now of the 400 that have the capability of producing a CCD report and then passing it on to another there. What we don't see today, [inaudible 8:34] another EMR vendor and it's not really working. They're essentially in the sandbox.

The way it's been working is that EMR Vendor No. 1, will send information up to the HIE, a community portal offered by potentially another company. Then that information is sent down to the EMR Vendor No. 2. So typically what you see is some pretty good EMR vendors that can exchange the data and what they portal in between that information can be exchanged.

And we think that's probably the best model because rarely are you going to get every single doctor in the community using the exact same EMR. And I like to have a vendor‑neutral HIE sitting on top.

Now, if every doctor in this community has one EMR vendor, then it makes sense. You can just have one thing. But I think we're going to have a lot of communities where multiple EMR vendors are going to win out, probably all the specialties. We need that neutral community vendor to tie everything together going forward.

And, again, that's what's going to be required to meet the stimulus money. Remember, the goal of the stimulus in high tech, is to eliminate silos of information.

Robert:  And a silo of information would be for instance, what?

Mark:  Any doctor who has an EMR in their office that's not connected with anybody else, is really a silo. A doctor that has paper charts that's not connected to anybody else is a silo of information. We want to find out that Hayden had a lab report and you're a treating physician, you want to get access to that report, at least be able to read it.

We know that that helps reduce the duplicate paid entry by about 72%. It's also proven to eliminate a lot of duplicate tests. It's going to help save costs, it's going to help provide much better heath care because now we have real information about the patient at the point of care.

How about that patient showing up at the emergency room? Right now you show up there, the ER doctor knows nothing about you. Now, the EMR doctor's going to have a history of what's going on with you, which physicians you've seen, what medications you have had, if you have had heart problems in the past, if you're a diabetic. That information will be available to another physician in a nice printed a copy and they don't have to go on the computer to look at it. We can just print it out and stick it on front of the chart, just like most doctors want. I want a summary page on the front of the chart so I know the patient, I don't have to collect data myself.

Robert:  Is this what you're talking about over there in Atlanta?

Mark:  Yes, I've actually given four speeches this week alone on the subject, "Creating the Community EHR, " basically, a community EHR. I kind of call it a Grady Community EHR, we kind of joke around, are you ready for the ice age, the ice age is coming. So, what we're looking at is how can a group of physicians in a community pick different EMRs but still be able to share the information no matter where the patient goes. So, we're doing a lot of talks on it and probably about 80% of the calls I've been getting on our consulting business is how to set up a community integrated EHR with multiple EMR products.

Robert:  Would you say that it's possible for a non‑CCHIT certified EMR to be CCG compatible?

Mark:  Yes, there are a few of the vendors that we know do know about who have not gone through CCHIT certification, but they can generate a CCD record. They already can prove inner wrapper ability. They just haven't gone through in doing everything for somebody. It works really good for some of the specialties, for the dermatology, for the orthopedic doctors, so they don't need to collect everything that's been on the CCHIT requirements.

But again, I think if we can provide the right information at the right time, to the right caregiver, that's what we really need.

Now, CCHIT I think is a good starting point, but there are a number of vendors that [inaudible] CCD data exchange that have not come through the process of getting CCHIT certified. Or if they were certified, it would only be on 2006. The real determining point is going to be is what is the final decision on when to the product has to be certified to meet the High‑Tech Act so the doctors can get the money. Does that mean they have to be CCHIT 2010 or 2009 certified? Or if they only have to be certified that they can exchange data following a common format like CCD. No one really knows yet.

Robert Well, that's one question that comes up a lot in EMR update in the forum, is that there are so called anti‑CCHIT sentiments. That there's some very good small vendors who could never afford the $36, 000 or whatever they charge, is there any talk or any hope do you think, of that going down, so that a small vendor could afford it?

Mark:  That's a good question. Now that the CCHIT Office is going to be given $2 billion to create a lot of these standards, to me it would seem if they've got $2 billion they might not have to charge that much to go the standard process. They've got the money to pay for it.

Remember, when CCHIT go set up, they were only given a $5 million grant. Now, they've got $2 billion. Now, obviously, they're not going to allocate all of it, but they could allocate some of that money and bring that cost down.

The challenge ends up being, do every single specialty really need a full CCHIT server to find product or do they need the CCHIT requirements. Because every specialty doesn't need everything that's in there. And a lot of the vendors are getting [garbled], they're also going after pediatrics, the cardiology and, in the future, OB‑GYN, and dermatology and orthopedics. They're going to create standards for all of these.

I think it's a good point to have but we've got to go back and what is the reality? We need to share common data. You have to be CCHIT certified to share common data. We'll have to see what the government comes out with. They may require it.

Robert:  Well, someone once said that the greatest accomplishment of technology has been connectivity, that it is the thing, the single‑most, society changing advancement in technology. And you are bearing that out in what you're saying about the EHR, the EMR, the personal health record. It all seems to come together into that concept of connectivity.

Mark:  Right.

Robert:  And that is exactly what you do not have with paper records.

Mark:  And even standalone EMRs were not connected. Think of another three letter initial, ATMs. I can go to any bank ATM machine now, put my little card in and get access to my money and bank. It doesn't matter which bank I'm connected to, the ATMs all connect everybody. We need the same type of health care ATM and we're calling those Healthcare Information Exchanges, HIEs.

Robert:  That's the best analogy I've heard all day, Mark. I think it's a good place to end until our next meeting.

Mark:  And I'll see you next Friday.

Robert:  Let's do that. We've had a few sound problems, but I think we've got it all down.

This is Mark Anderson with the AC Group. Mark, I want to give your cell phone number, as I often do, (281) 413‑5572, if you want to call Mark Anderson. And, Mark, thank you very much for being with me on "Casual Friday." It looks like I'm the more casual of the two today, but we have matching shirts.

Mark:  OK, talk to you later.

Robert:  Bye, bye.

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here and other EMR Interviews here.

Mark R. Anderson CPHIMS, FHIMSS
CEO and Healthcare IT Futurist 
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX  77316
(c) 281-413-5572
(f)  832-550-2338
email: mra@acgroup.org
web: www.acgroup.org