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Technology Consult


No doctor is a data island

No doctor is a data island


•  The Continuity of Care Record is an electronic version of a face sheet.

• EMR vendors say they want to make programs that can talk to each other.

• The CCR could become a doctor's first EMR.

All too often, the patient on your exam table is a medical mystery—at least to you. Sure, he has a thick chart in another doctor's office, but that's the problem: The chart's not in your office.

Consequently, you don't know the patient's current diagnoses, medications, allergies, or latest lab results. You can't count on the patient to remember these details, so you're forced to make decisions in the dark or reconstruct the medical history with questions galore, phone calls, and redundant tests.

The blame lies partly with paper records, which typically don't accompany a patient as he shuttles from doctor to doctor. But electronic medical records aren't always easy to share, either. Rival software programs often don't talk to each other.

Enter the so-called Continuity of Care Record, heralded as a way to hand off patients smoothly and safely in the digital era. Like a face sheet, the CCR summarizes an electronic chart. In addition to insurance information and health-status details like diagnoses, medications, and allergies, it includes recent patient encounters and care-plan recommendations. You can print it, fax it, or transmit it from your EMR to another doctor's EMR even though they're different brands. This universality stems from a tool called XML, which allows programmers to format information so any system can read it.

The CCR was originally the brainchild of the Massachusetts Medical Society, the Healthcare Information and Management Systems Society, and ASTM International, a technical standards group based in West Conshohocken, PA. As if that weren't enough of a pedigree, the AMA, the American Academy of Family Physicians, the American Academy of Pediatrics, and the Patient Safety Institute have become backers.

This spring, these groups issued standards that EMR vendors can follow to incorporate the CCR into their software. Some early indications suggest vendors will do just that. Almost 40 companies have endorsed an AAFP initiative promoting interoperable EMRs.

"It's in vendors' best interest to offer the CCR, because it makes their programs more attractive to doctors," says FP David Kibbe, director of healthcare IT for the AAFP. "A barrier to adoption has been that systems can't exchange information. They've been data islands."

A few industry observers wonder, though, if the CCR is a pie-in-the-sky idea that will flounder in the marketplace. "The buzz from the vendors is that it's hard to be against the CCR, but nobody wants to budget money to support it," says computer consultant Rosemarie Nelson in Syracuse, NY.

In fact, the CCR's future path may take some surprising turns. Proponents say it isn't designed to be a mini-EMR, but that's what it could become for doctors cautious about computerizing. Thomas Sullivan, immediate past president of the Massachusetts Medical Society, says several companies have inquired about embedding the CCR into software for electronic prescribing, billing and scheduling, and online communications between doctors and patients. "It would be a very limited EMR, but it's a stepping stone to the real thing," says Sullivan. Its low cost would be another advertised perk.

Widespread adoption of the CCR promises not only to streamline a physician's job, but also to give patients easier access to their own medical information. A doctor could hand them printouts of their CCRs or e-mail copies to them. If the physician has a Web site, patients could look up their CCRs at the site. FP David Kibbe says one entrepreneur wants to market plug-in "thumb drives" designed to let patients download their CCRs from a doctor's computer and tote them to other caregivers.

If nothing else, the debut of the CCR is perfectly timed. Last April, President Bush declared that every American must have an EMR within 10 years. The CCR could help make that a reality.


Robert Lowes. Technology Consult: No doctor is a data island. Medical Economics Aug. 6, 2004;81:16.

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