The Continuity of Care Document (CCD), a standardized format for clinical summaries that can be exchanged between disparate electronic health record systems, could greatly advance public health initiatives, according to a new paper in the American Journal of Public Health.
Among the public health areas that the CCD could benefit, the paper said, are public health agencies' efforts to help reduce the burden of chronic diseases; the improvement of clinical detail in death certificates to identify dangerous trends; and the improvement of biosurveillance to detect disease outbreaks.
The article provides several examples of how CCDs could help public health agencies in these categories, including:
- A New York City public health program to identify patients at risk of complications from diabetes could benefit from the increased analytical power of having CCD data. Similar programs could be extended to patients with other chronic conditions, such as hypertension and heart failure.
- Mortality studies to identify population trends could benefit from having more clinical detail on medications, lab results and diagnoses included in death certificates. Such an approach could detect a rise in deaths associated with drugs such as Vioxx earlier than is currently possible.
- Replacing manual data compilation of biosurveillance data with electronic data extracted from CCDs would provide additional, timely information about disease outbreaks with less burden on providers.
The CCD is an approved format for information exchange in Stage 1 of Meaningful Use, and its use would enable providers to meet the proposed interoperability requirements in Stage 2. Therefore, the use of CCDs in clinical practice is expected to increase. But the paper admitted that much more progress needs to be made before a large portion of the population is covered by CCDs.
In recent comments about the Meaningful Use Stage 2 proposal, the Robert Wood Johnson Foundation (RWJF) praised the proposal for its focus on public health. In a recent interview with Healthcare IT News, RWJF Senior Program Office Michael Painter cited the requirements for providers to report immunization and syndromic surveillance data to public health agencies electronically.
Painter admitted that there are technological and cultural barriers to making this happen, but said he believes they could be overcome within the Stage 2 timeframe