ASTM Continuity of Care (CCR)

The ASTM Continuity of Care Record (CCR) was developed in response to the need to organize and make transportable a set of basic information about a patient's health care that is accessible to clinicians and patients. The CCR is intended to foster and improve continuity of care, reduce medical errors and ensure a minimum standard of secure health information transportability. Adoption of the CCR by the medical community and IT vendors will be a great step toward achieving interoperability of medical records.

What is the ASTM CCR standard?

The ASTM CCR standard is a patient health summary standard, a way to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another. It contains various sections (such as patient demographics, insurance information, diagnosis and problem list, medications, allergies, care plan, etc,) that represent a "snapshot" of a patient’s health data that can be useful, even lifesaving, if available when patients have their next clinical encounter. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record software program (EHR) at the end of an encounter.

Because it is expressed in the web standard language known as XML, the CCR can be created, read, and interpreted by various EHRs from various software companies. The ability to share information across different software is known as “interoperability.” The CCR can also be printed out in user-friendly paper formats, such as PDF and as a Microsoft Word document.

Who has developed this new standard?

The ASTM CCR standard has numerous “sponsors” who have participated in its development, including the American Academy of Family Physicians, the American Medical Association, the American Academy of Pediatrics, the Massachusetts Medical Society, the Patient Safety Institute, and Health Information Management Systems Society (HIMSS), among others. Many practicing nurses, physicians, and other health care providers have worked together collaboratively to decide upon the core content within the CCR standard.

Only non-profit organizations are permitted to be sponsors of ASTM standards. However, personnel from many leading IT companies, including Microsoft and Siemens, and others who make EHRs, such as GE Medical and NextGen, have contributed their skill and expertise to the development of the ASTM CCR standard.

Who or what is ASTM?

ASTM International, originally known as the American Society for Testing and Materials, is the standards development organization (SDO) under whose auspices the CCR’s technical workgroup, Healthcare Informactics E31.28, and its members have operated and been convened. ASTM International is one of the world’s largest and oldest voluntary and accredited standards development organizations, with headquarters located outside Philadelphia, PA. In addition to developing health care IT standards, ASTM International develops and manages standards in over 150 industries, including aviation, petroleum, and fiber optics.

Why did the AAFP and other physician organizations get involved in this standard development effort?

In 2003-4, there was a collaborative project of the family medicine community looking at the future of our discipline and specialty. As part of this project, a new model of care was constructed to meet the potential needs of patients in the future. This model necessitates the use of health information technology (HIT) to improve quality, enhance patient safety, and increase efficiency. The electronic health record software application (EHR) is viewed as the “central nervous system” of this new model of family practice. The federal government also believes that the future of the health care system needs EHR adoption, as does industry.

However, and surprising as it sounds, most EHRs today cannot exchange patient data. It is very important that EHRs used in doctors’ offices are able to "talk to" one another and share important clinical information: otherwise each doctor’s office or clinic is simply an island of data without the means of accessing or exchanging the stored patient information it contains. Patients do not gain much from the use of EHRs if their personal health information cannot travel with them from care setting to care setting, and doctors find it difficult to justify the expense of EHRs if they aren’t interoperable.

The ASTM CCR standard is an elegant and simple solution to this problem, and to the need for both portability and interoperability of patient health information. As such, it makes it possible for the New Model of family practice to go from concept to reality at an accelerated pace, and for physicians to see increased value in the purchase and use of EHRs in their practices.

Thus, it was a very logical and easy decision for the leadership of the AAFP to become involved as a sponsor of the ASTM CCR standard, along with its sister associations, the AMA, the AAP, and the Massachusetts Medical Society.

What will be the main uses and benefits of the ASTM CCR standard?

The ASTM CCR is not a panacea. The main benefit of the widespread use of the ASTM CCR standard will be the improvement in the quality of care that results from more, and more accurate, summary patient health information being accessible when treatment and diagnostic decisions need to be made. Safety of care will also be improved, as patients and doctors benefit from immediate access to patients’ lists of medications and dosages, allowing all parties to avoid the sometimes very dangerous duplication of medications and other kinds of errors associated with illegible or incomplete drug information. Finally, we think that the ASTM CCR standard will have a significant impact on efficiency, as errors due to missing or incomplete health information are very costly to patients, insurance companies, and other payers of medical care in the U.S.

We also expect that being able to know with confidence that patient health information can be compiled or exported in a standard fashion from an EHR software application will give physician purchasers of EHRs a measurable benefit, freeing them from the real worry of “what will happen to the data in my EHR if the company that makes it should be bought or go out of business?”

Does this new standard compete with other, similar standards for interoperability, or is it compatible with messaging standards like HL7?

There is nothing quite like the ASTM CCR. It does not compete with HL7 or NCPDP or any of the existing standards, in large part because the ASTM CCR standard is all about clinical content rather than message format, and it can accommodate itself with messaging standards, such as HL7 and the HL7-CDA. It is quite likely that the ASTM CCR standard will perform and be useful both in a simple stand-alone version, and as a document within the more complex CDA. The process of working through how the ASTM CCR standard and a more universal interoperability standard for messaging health care documents, possibly the HL7-CDA, work together is known as “harmonization.” The two organizations, ASTM International and Health Level Seven (HL7) have signed a memorandum of understanding committing both organizations to this process.

CCR Acceleration Group

This group was started by members of the Partners for Patients; its mission is to promote CCR interoperability. The group represents providers, EHR vendors, PHR vendors, telecommunication vendors, and many other stakeholders.

AAFP's Center for Health IT facilitates the group. The Acceleration Group's email discussion list is very active and provides members with a forum in which to discuss issues and share their experiences with health information exchange.

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