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The Promise of the Continuity of Care Document: Challenges and Opportunity for Quality Improvement and Population Health

Author: John D'Amore

Primary Advisor: Roberta B Ness, MD MPH

Committee Members: M Sriram Iyengar, PhD; Dean F. Sittig, PhD

Masters thesis, The University of Texas School of Biomedical Informatics at Houston.


Interoperability is a requirement of recent electronic health record (EHR) adoption incentive programs in the United States. One approved structure for clinical data exchange is the continuity of care document (CCD). While primarily designed to promote communication between providers during care transitions, coded data in the CCD can be re-used to aggregate data from different EHRs. This provides an opportunity for provider networks to measure quality and improve population health from a consolidated database. To evaluate such potential, this research collected CCDs from 14 organizations and developed a computer program to parse and aggregate them. In total, 139 CCDs were parsed yielding 680 data in the core content modules of problems, medications, allergies and results. Challenges to interoperability were catalogued and potential quality metrics evaluated based on available content. This research highlights the promise of CCDs for population health and recommends changes for future interoperability standards.