Continuity of Care Record
Recognizing that patients remain the primary vehicle for transporting basic health information between providers, JCAHO is exploring strategies related to the Continuity of Care Record (CCR). This approach acknowledges that electronic health records are—at this time—a goal rather than the norm. Patients typically transport basic health information between providers in the context of completing a basic set of information on a registration form that is attached to a medical clipboard, prior to outpatient appointments and admissions.
An accurate minimum data set, containing such items as medication lists, allergies, conditions, and procedures, would provide substantial value to providers and patients. JCAHO already requires that an accurate medication list be updated at discharge and made available to the patient and the subsequent provider of care, but other key pieces of patient data, such as diagnosis and procedures, as well as the means required to make these data available to the patient or to the next caregiver, are not currently required.
JCAHO is now considering how hospitals and other healthcare organizations could provide or update a clinically relevant minimum data set of summarized health information, such as that contained in the CCR. The CCR is a standard specification being developed jointly by ASTM International, the Massachusetts Medical Society, the Healthcare Information Management Systems Society (HIMSS), the American Academy of Family Physicians, and the American Academy of Pediatrics.
JCAHO envisions a minimum data set that includes an accurate list of demographics, medical insurance, medications, diagnosis, past procedures, allergies, and current healthcare providers. It also desires a data set that can be provided to the patient or the patient’s authorized representatives—both as paper and in a fully transportable and interoperable digital format—that could be presented to subsequent caregivers. This summary health record would permit care providers within or outside the organization to review the patient’s important clinical information at the point of care and near the time of clinical decision-making. Subsequent care providers would then be able to update the patient’s minimum data set as appropriate.
In addition to providing caregivers with the most essential and relevant information necessary to ensure safe, quality care, such an approach would minimize the effort necessary to keep such information current. Healthcare providers would have easy access to the most recent patient assessment and the recommendations of the caregiver who last treated the patient.
JCAHO has sought to help healthcare organizations in assisting patients with the discharge planning process through its Speak Up education program, which urges people to take an active role in their own healthcare. “Planning Your Recovery” provides tips to help people get more involved in their care and obtain the information they need for the best possible recovery. Patients who understand and follow directions about their follow-up care have a greater chance of getting better faster; they are also less likely to go back to the hospital.
Specifically, the JCAHO education campaign advises patients to:
1. Find out about their condition. This includes knowing how soon they should feel better, getting information about their ability to do everyday activities such as walking or preparing meals, knowing warning signs and symptoms to watch for, enlisting the help of a family member of friend in the discharge process from the hospital, and getting the phone number of a person to call at the hospital if a problem arises.
2. Find out about new medicines. It is important to request written directions about new medicines and ask any questions before leaving the hospital. Other issues that JCAHO advises patients to consider include finding out whether other medicines, vitamins, and herbs could interfere with the new drugs and knowing whether there are any specific foods or drinks to avoid. Understanding the side effects of medications and any necessary restrictions on daily activities because of the potential for dizziness or sleepiness is also crucial.