NDoc® and the CCD: A Case Study in Interoperability

Over the past several decades, advances in health information technology (HIT) have moved the healthcare industry from hand-written referrals and paper charts to computer-generated referrals and electronic medical records (EMR). HIT software solutions have been developed to meet nearly every documentation need within the healthcare continuum: intake and referral, clinical notes, billing and scheduling, imaging, medications, and more. These solutions have automated processes and procedures…saving valuable time, increasing accuracy, and offering potentially life-saving checks and balances.

The Good and the Bad 

The benefits of electronic patient records notwithstanding, the problems and inconveniences are apparent. The days of freestanding operations and independent documentation are behind us. More and more, quality healthcare relies on connectivity between provider organizations. It is no longer sufficient to have a quality EMR solution. Your EMR system must be part of a larger electronic health record (EHR), and this connectivity does not come easily.

An integrated and accessible EHR requires that each provider organization have access to the same patient data, which means that data must be input from one HIT system into another. Time saved on one end can often lead to more time spent on the other.

This is especially true for post-acute care (PAC) providers such as home health agencies (HHAs) and hospice, where most patient referrals are accompanied by substantial sets of health information from the patient’s previous provider agency or facility. Data from a referral source or agency can include demographics, medical history and physical, allergies, medications, and discharge summaries.

Viewing and understanding this patient data is critical to a comprehensive understanding of the patient’s health situation. Government mandates such as the looming reality of PDGM make the intake process even more critical, and increasingly time-consuming. 

Usually, PAC agencies must manually enter referral data into their own systems at intake or Start of Care (SOC), which can mean dozens of hours each week of data entry. Most home health intake and clinical professionals can relate to the frustration of too much time spent (and often clinical time wasted) at a keyboard, entering patient data into their system. Manual data entry is time-consuming at best, and dangerous at worst. Each entry takes time away from the patient or other responsibilities, and each entry offers too many “opportunities” for entry errors such as typos and missed data.

It doesn’t have to be that way. The solution is interoperability: software solutions need to talk to each other.

Interoperability and the CCD

One of the more important advancements in healthcare interoperability is the Continuity of Care Document or CCD. A CCD is a concise electronic patient summary designed to communicate pertinent patient data from one provider to another in both human- and machine-readable formats. The CCD is not a complete medical history; rather, it contains the information deemed critical to continuity of care across the healthcare continuum. CCD data includes patient demographics, problems, functional status, family and social history, allergies and alerts, medications, Advance Directives, and more. 

CCDs conform to one of the most commonly used interoperability standards in healthcare: Consolidated Clinical Document Architecture (C-CDA). C-CDA is a standard set of rules that specifies the structure and encoding semantics of a wide range of clinical documents for the purpose of exchange between healthcare providers and organizations. The CCD is the most common C-CDA document.

It would be nice to say that with CCDs, time-consuming duplicate data entry at intake and SOC is a thing of the past. However, CCDs alone do not solve the problem. Interoperability means that HIT software systems must be able to both export and import C-CDA data. That is, your EMR software vendor must be able to both produce and “consume” CCDs. In theory, this ability is prevalent; in practice, it is rare. With Thornberry and NDoc®, it is a proven reality

NDoc’s seamless interoperability capability is just one of the reasons the EMR has been rated #1 for six years in a row. With the push of a button, NDoc® instantly imports a new patient’s CCD data, automatically reads and processes the information. NDoc can even build the medications profile from the CCD, further streamlining the intake and SOC process by reducing data entry time and ensuring consistency and accuracy in the patient record.

CCD interoperability dramatically cuts down the time at SOC, allowing clinicians to focus more of their time on patient assessments, treatments, and teaching, and enabling more timely completion of the plan of care (POC).  This will be even more important with the advent of PDGM, scheduled to become effective on or after January 1, 2020.

NDoc and OSS: A Case Study in Success

OSS Health at Home is a Pennsylvania HHA that has been using NDoc for about six years. As with most HHAs, OSS patients are referred from a variety of area providers using a variety of HIT systems:

  • The OSS parent hospital uses CPSI, a hospital EMR vendor based in Alabama.
  • OSS clinic physicians use Medent, a top-rated physician practice management system.
  • Three unaffiliated UPMC hospitals in the area use Epic, a large HIS vendor out of Wisconsin.

Each of these referral sources produces and exports patient CCDs in standard C-CDA format to support the transition to OSS Health at Home. The next step is intake, which used to require the manual input of CCD data into NDoc. Within the past year, however, OSS implemented NDoc’s CCD import capability, automating the intake and SOC processes for OSS clinicians and intake professionals. Now when a CCD is exported from a referring organization, the data is electronically imported into OSS NDoc.

We have seen increased efficiency and accuracy in both the intake and the SOC processes,” said Jade Grunden, DPT, Director of OSS Health at Home, “and it has significantly decreased the time we have to spend entering demographics and other patient data.” She estimates that NDoc’s CCD import is saving OSS clinicians and intake professionals about 30-45 minutes per patient. 

For NDoc at OSS, it doesn’t matter whether a CCD is generated by the parent hospital CPSI system, by Medent, or by Epic. The other vendors produce them; NDoc consumes them, seamlessly and efficiently. Demographic and clinical information are passed along the continuum of care, increasing data accuracy and saving both time and money. No longer tied down by data intake, clinicians can focus on doing what they do best: caring for their patients.