By Christopher Jason
– Home healthcare facilities should implement and further develop Continuity of Care Document (CCD) standard codes to enhance patient data exchange, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).
The CCD standard, a current yet underutilized data standard, successfully transferred much-needed admission documents for nurses at three diverse home healthcare agencies.
Medical providers transfer over 12 million US adults into home healthcare facilities on a yearly basis. Home healthcare nurses are required to assist patients with recovery and chronic disease. Nurses need adequate and timely patient data, yet it remains difficult for caregivers to access.
Researchers intended to analyze missing patient data at admission by determining the necessary information, the capability of the data standard to exchange data, and comparing the impact of interoperability of the data standard items in the admission documents.
Researchers analyzed three Pennsylvania home healthcare agencies in rural, suburban, and urban locations with diverse EHRs and interoperability capabilities.
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The research team dissected four critical clinical decisions from nurse respondents, based on the type of health information needed at admission: medication reconciliation and patient medication self-management, problems to include in the plan of care, visit timing and frequency, and inclusion of other services, such as physical therapy.
Using this information, researchers aimed to select the respondents’ ideal data standard and utilized the CCD standard for patient summary information.
Researchers found the CCD standard supported the four key clinical decisions at admission.
“Based on these findings we recommend using the existing CCD standard augmented with the CCDS code, Assessment, to electronically transfer the needed codes from the referral source to HHC,” explained study authors. “The intent is to improve the amount and quality of information available at the HHC admission.”
In order to attain data completeness, the research team recommended additional information about medication self-management capabilities. Including this data could make it easier for nurses to assess the patient. At this time, medication self-management data is not integrated into the USCDI standard.
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The research team found this information is needed to support all four clinical decisions. The lack of this information could result in patient harm, like missed medications or wrongful dosage.
“The lack of medication self-management information in referral documents was an important finding,” explained the study authors.
“Our study highlights the importance of this missing CCD concept, and that it be made explicit in the CCD instead of possibly being recorded in a subsection such as ‘medication instructions’ or ‘plan of care.’ Explicit CCD specification would support data transmittal from the hospital EHR.”
The lack of medication self-management information indicates a need for effective communication of data across settings. The quality and amount of information available to clinicians impacts patient outcomes and quality of care.
“The less than universal availability of information related to each CCD code needed for all 4 important clinical decisions indicates an information deficit during the transition in care to HHC,” the study authors said. “This deficit is of concern because making appropriate clinical decisions and providing safe patient care depends on having adequate and accurate information.”
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While the nurse respondents did not mention roughly half of the CCD standard codes that exist, researchers did not recommend removing them. Instead of removing the codes, researchers suggested future research to identify the potential uses for additional CCD standard codes.
Researchers did not discover a difference in information availability from home healthcare facilities with high interoperability and those with poor interoperability.
According to the study authors, the study may not have had the resources to detect the difference. Although the research team observed different levels of interoperability at each home healthcare facility, the study did not guarantee the completeness of the data exchange.
As an example, the urban health system was able to communicate structured clinical data, but only transferred the medication list to the home healthcare facility.
“Therefore, the urban hospitals’ EHR did not make available to the HHC EHR all structured data essential for the 4 clinical decisions,” explained the study authors. “This unavailability of structured clinical information was not due to interoperability, as the communication was functionally possible. Instead, this unavailability likely resulted from a decision constraining the data to be communicated along the transition in care.”
Researchers said data standard integration trumps interoperability when examining data exchange in the transition of care to a home healthcare facility.
“We suggest that the expanded CCD (or USCDI) be communicated from hospitals to interoperable point-of-care EHRs in HHC as structured data to support communication across the transitions-in-care chasm,” concluded the study authors.