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. 2006 Dec 12;3:10.

Table 4.

CCR Summary

Term ASTM Continuity of Care Record (CCR)
Purpose “The goal is to create a CCR that will enable the next provider to easily access the information … at the beginning of a first encounter and easily update the information when the patient goes on to another provider, in order to support the safety, quality, and continuity of patient care. The CCR may be used as a vehicle to exchange clinical information among providers, institutions, or other entities. It may also be used by the patient as a brief summary of recent care.”1
Owner (who enters information) “The CCR will be completed by physicians, nurses, and ancillary providers (e.g., social work, physical therapy, occupational therapy) upon referral or transfer or other transition of a patient from one caregiver to another, whether it is outpatient, inpatient, or community based.”2
Information included

  • Provider information

  • Patient identifying information

  • Patient insurance and financial information

  • Health status of the patient

    • Diagnoses, problems, conditions

    • Adverse reactions, alerts

    • Current medications

    • Immunizations

    • Vital signs

    • Laboratory results

    • Procedures/assessments

    • Optional extensions

  • Care documentation

  • Care plan recommendations3
Interoperability The CCR supports full semantic and computational interoperability (object-oriented data model using an XML-defined data object-attribute approach).4
Accessibility XML coding is required when the CCR is created in a structured electronic format. The XML coding “provides flexibility that will allow users to prepare, transmit, and view the CCR in multiple ways, for example, in a browser, as an element in a Health Level 7 (HL7) message or CDA compliant document, in a secure email, as a PDF file, as an HTML file, or as a word processing document. It will further permit users to display the fields of the CCR in multiple formats.”5
1

Medical Records Institute. “Continuity of Care Record: The Concept Paper of the CCR—Version 3.” Available at http://www.medrecinst.com/pages/about.asp?id=54.

2

Ibid.

3

Ibid.

4

Ibid.

5

ASTM E2369-05 Standard Specification for Continuity of Care Record (CCR). Available at http://www.astm.org/cgi-bin/SoftCart.exe/DATABASE.CART/REDLINE_PAGES/E2369.htm?E+mystore (accessed July 18, 2006).