Clinical Document Exchange – What Is It and How Could You Use It?

The exchange of clinical documents (including care summaries) can meet specific clinical needs and fill in information gaps to help Colorado’s healthcare providers communicate better about patients.

According to the latest study by CDC, only 24.7% of Colorado office-based physicians with a certified electronic health record (EHR) system have shared patient health information electronically with external providers or unaffiliated hospitals. This lack of data sharing can create misinformation during care transitions and causes a significant amount of extra work for staff who have to hunt down the information. Clinical document exchange, sometimes referred to as care summary exchange or Continuity of Care Document (CCD) exchange, is an established method of health information exchange that expands the clinical information available to community providers. These documents, which are generated by a provider’s EHR system, can provide more pertinent details on patient care to better inform the next provider in the care continuum.  

The information included in the clinical documents exchanged by ambulatory providers is up to the provider and what they are capturing in their EHR. The documents can include longitudinal patient history information but can also be strictly visit-based. When visit-based, the clinical documents are often auto-generated from the EHR after the provider has signed off after a patient visit. The documents typically include reason for visit, procedures performed during the visit, medications prescribed, labs ordered and resulted, clinical instructions and care plans. Should the patient need to be seen at another facility, all of their recent encounter information is available immediately. 

How Clinical Document Exchange Might Work for You

Let’s explore some of the ways your organization might use clinical document exchange.

• Transition of Care/Plan of Care – receive or send important patient information, such as medications, allergies, patient history, and problem list, when a patient is being transferred from one care setting to another. For example, from a primary care physician to a specialist or behavioral health provider. Or from a hospital to a long-term care facility. Or from a rural hospital to a metro-area hospital.   
• Referrals – aggregate pertinent patient information from your EHR into a clinical document to be exchanged with your referral partners, so they have the details needed to continue care for your patient.
• In Case of Emergency – help hospital emergency departments, EMS workers and urgent care clinic providers make more informed decisions by providing your patients’ recent changes in medications, allergies, conditions, even advanced directives.

CORHIO’s Progress With Clinical Document Exchange

At this time, 21 ambulatory practices and clinics in Colorado are sending clinical documents into CORHIO’s Health Information Exchange. CORHIO has begun displaying clinical documents from a number of these organizations in our secure web portal PatientCare 360, and we continue to add more (details to come in future newsletters).

The following providers are participating in the Colorado Care Connections Program, a partnership between CORHIO, Quality Health Network and Colorado’s Department of Health Care Policy and Financing. Prior to the Colorado Care Connections Program, CORHIO did not have many ambulatory providers supplying clinical data to the HIE other than those sharing an enabled hospital EHR interface with CORHIO.

• Castle Valley Children’s Clinic
• Dove Creek Community Health Clinic
• Dr. Suzanne Rosenberg
• Head2Toe Healthcare
• Kids First Pediatrics
• Lowry Pediatrics
• Metro Community Provider Network
• Prowers Medical Group
• Pueblo Community Health Clinic
• Rio Grande Clinics  
• Rocky Mountain Medical and Health Care
• Salud Family Health Centers
  
• Southern Colorado Clinic
• Southwest Midwives
• Wheat Ridge Family Medicine

The following providers are part of a program with Community Health Partnership, the RCCO based in Colorado Springs, to enhance data exchange in the area.

• Dr. Lawrence Wang
• Dr. Sean O’Donnell
• Prairie View Family Health Care
• Sunrise Health Care PC  
• The Family Practice

In addition, as part of the Colorado Advanced Interoperability Initiative program, Professional Home Health Care is sending OASIS documents to CORHIO. These documents include patient information specific to home healthcare, including therapies done in home and functional assessments (ADLs, IADLs).

CORHIO is utilizing the CCD format to enable exchange with Colorado’s western slope health information exchange, Quality Health Network. We are currently sending Castle Valley Children’s CCDs to Quality Health Network, which is an important milestone in Colorado’s overall ambulatory data exchange efforts.

For more details on Continuity of Care Documents (CCDs), see our article Continuity of Care Documents (CCDs) – What Are They and How Are They Useful?