Home Health Agency First to Send CCDs to VHIE

A Continuity of Care Document (CCD) contains a set of medical facts about a patient who may need to transition from one care setting to another, such as from a hospital to long-term care facility. A CCD does not contain a patient's entire medical record, but does include important clinical information so the patient will continue to receive appropriate care when transferred. As a part of Meaningful Use attestation, providers must demonstrate that they can exchange a patient summary record as a CCD.

One typically thinks of a transition of care situation as happening from a hospital or provider practice to a home under the care of a home health agency, but the reverse situation also happens. Recently VITL accomplished a significant project that will enable electronic transfer of health information as CCDs from the Franklin County Home Health Agency (FCHHA). They are the very first home health and hospice agency to send CCDs to the Vermont Health Information Exchange (VHIE), which will be available for shared viewing in the VITLAccess provider portal. This gives primary and specialty care providers important medical information about the in-home treatments. The CCDs will also be used for reporting and data analysis by the Accountable Care Organization (ACO) OneCare Vermont.

Partners and stakeholders that were very important in achieving this milestone include:

  • The Department of Vermont Health Access - provided grant funding for the project.
  • Executive Director Janet McCarthy, Franklin County Home Health Agency
  • Suzanne Garrow - VITL project manager responsible for the  implementation
  • Jennifer Starling - VITL project manager responsible for CCD redesign efforts with Medicity.
  • Michael Potts, IT manager, Franklin County Home Health Agency - FCHHA project manager
  • Volodymyr Sydorov, Allscripts senior technical consultant responsible for integration with FCHHA’s electronic health record system.
  • Chris Sweeney and Kat Meyer – VITL eHealth specialists who work statewide with VNAs of Vermont including FCHHA.

Lead Project Manager Suzanne Garrow provided technical oversight of this project, which actually began over a year ago with FCHHA sending prerequisite ADT data (admits, discharges and transfers) to the VHIE. FCHHA and other home health agencies are unique in that they consistently send a rich set of diagnoses in these ADTs. This helps the VHIE because they are able to provide data that might not be sent by other providers, and creates a more robust community patient record for the VITLAccess portal and ACO data analysis. 

Technically the CCD is a document standard, based on the HL7 (Health Level 7) Clinical Document Architecture (CDA). The standard ensures that a core set of health information is contained in the document, and organized a certain way so it can be sent to and from a provider's electronic health record system or a health information exchange without loss of meaning.

The CCD establishes a rich set of templates representing the typical sections of a clinical summary record, and expresses these templates as constraints on CDA. These same templates for vital signs, family history, plan of care, and so on are reused in other CDA document types, establishing interoperability across a wide range of clinical use cases.

The CCD interface sends a secure encrypted XML based HL7 v3.0 message via the internet to the VHIE gateway. The message is then stored in the VHIE, and once processed the CCD becomes part of the patient community record that can be viewed in VITLAccess. Furthermore the VHIE enriches and transforms the CCD with additional information to successfully send messages to other systems such as electronic health records, OneCare Vermont, and eventually to the Vermont Blueprint for Health.

What does the electronic exchange of continuity of care documents mean for patients? Realizing that a compilation of this much medical information was (and still is in some cases) sent by FAX or postal service, electronic transfer is faster and more efficient. If a patient needs to be seen by their primary care physician or readmitted to the hospital, those treating providers have more complete information about the care the patient received from FCHHA. Overall, an electronically transferred CCD will allow for the continuation of proper care to be delivered, although the care setting has changed.