While healthcare waits for the expanded data interoperability that FHIR promises, the industry needs an immediate solution for accessing and using disparate data from across the continuum of care. With FHIR potentially several years away, continuity of care documents (CCDs) are the best option for acquiring the ambulatory clinical care data health systems need to close quality gaps today. Because organizations that rely only on claims data to drive quality improvement risk missing out on more that 80 percent of patient information, CCDs are the current must-have answer to interoperability for successful quality improvement.

1. Continuity of Care Documents:
Today’s Top Solution for Healthcare
Interoperability Demands

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ACOs, clinically integrated networks (CINs),
and those seeking to increase exposure to
value-based payment (VBP) models and
take on risk need more data interoperability
to achieve desired outcomes.
Organizations that continue to rely solely
on claims data to drive quality improvement
may lack more than 80 percent of available
critical patient information.
Continuity of Care Documents

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This presentation considers health data’s
current interoperability limitations and why
using only claims and acute clinical data
can’t close quality gaps.
It poses using ambulatory clinical data in the
form of continuity of care documents (CCDs)
as today’s best interoperability solution.
Continuity of Care Documents

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Because healthcare consumers today are
much more likely to receive care in an
ambulatory setting versus the acute care
setting (which claims data represents),
organizations must have the interoperability
to access ambulatory data.
Quality Measurement Today Demands a
New Data Standard

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Data interoperability drives insights behind and takes
steps towards significant quality improvements,
including the following:
Project quality performance
Perform quality initiatives
(e.g., reduce readmissions)
Accurately stratify patients according to risk
Prioritize patients who will benefit the most
from prompt care
Track clinical performance in near real time
(versus retrospective claims data)
Quality Measurement Today Demands a
New Data Standard
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With a variety of healthcare delivery settings, it’s important to understand
some of the key limitations and differences, including identifying where most
of the valuable clinical data resides (Figure 1).
Quality Measurement Today Demands a
New Data Standard
AMBULATORY VISITS
883,725,000 per year ER VISITS
145,591,000 per year
HOSPITAL STAYS
24,138,000 per year
Patient data from
ambulatory visits is
available via CCDs
An ambulatory visit is 36x more common than an overnight
hospital admission and 6x more common than an ER visit Source: CDC National Center for Health Statistics
8.7% of ER
visits admitted
to the hospital
Figure 1: Where to find most of the valuable clinical data.

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Health systems have used claims data to
inform quality measurement and calculate
required metrics.
But as the industry evolves further towards
population health and value-based care
(VBC), organizations need more timely,
comprehensive, and higher quality data.
Quality Measurement Today Demands a
New Data Standard

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CCDs, which contain patient-centric clinical
data, are not an ideal solution.
As the industry finalizes interoperability
standards and removes the hurdles to
sharing data, CCDs are today’s most
capable and broadly adopted healthcare
clinical data source.
Quality Measurement Today Demands a
New Data Standard

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Organizations that overlook CCDs and wait for a
more comprehensive data solution (i.e., FHIR) will
miss out on years of improvement opportunities
and fall behind industry benchmarks, as they’ll rely
on delayed or incomplete data:
Claims data is often delayed or incomplete
Clinical data is the best current solution
Quality Measurement Today Demands a
New Data Standard
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Claims data is often delayed or incomplete
Quality Measurement Today Demands a
New Data Standard
Claims can provide retrospective analysis of
financial and operational performance but is
too delayed or incomplete to support near real-
time evaluation of implemented interventions.
Claims processing can be delayed up to 90
days or more, lack clinically relevant data (e.g.,
blood pressure, body mass index, and lab
result), and provide an incomplete data set
for evaluating clinically driven quality
measures (QMs), custom measures, and
identifying gaps in care.

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Clinical data is the best current solution
Quality Measurement Today Demands a
New Data Standard
CCD data quality can vary based on the
contributing source system; however,
it can be available near real-time, providing
timely operational and clinical insights.

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Clinical data is the best current solution
Quality Measurement Today Demands a
New Data Standard
CCDs alone lack the ability with complete fidelity
to effectively monitor key operational and financial
metrics in value-based contracts, they can provide
leading indicators that performance is trending in
the right, or wrong, direction before claims are
processed, adding the key capabilities:
1. Delivering directional metrics in real-time.
2. Blending into a patient centered longitudinal
clinical record.
3. Sharing with any Meaningful Use Stage 2
compliant system to support transitions of care.

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Quality Measurement Today Demands a
New Data Standard
The 21st Century Cures Act sets the stage for
FHIR, however, it is several years away, and many
EMRs do not currently offer an effective way to
ETL (extract, transform, and load) data.
FHIR is likely the preferred method of the future,
but its standards were out for commentary until
May 2019 and not expected for release until
the fall of 2019.
The release date for the latest and fourth version
of FHIR also has one- to two-year grace period,
meaning it may not happen until 2021 or 2022.
While healthcare waits for FHIR, CCDs may be
the best available solution to interoperability.

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Quality Measurement Today Demands a
New Data Standard
By providing a standard way to document and
transmit clinical data, CCDs provide
interoperability between multiple acute and
ambulatory providers, pairing retrospective
analytics (e.g., claims) and robust near real-
time clinical analytics.

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Quality Measurement Today Demands a
New Data Standard
Interoperability is increasingly critical as QMs require certain
data that often only resides in ambulatory clinical records:
Medications
Problems/complications (e.g., hypertension)
History of procedures
Lab results
Social History
Vitals
Encounters
Immunizations
Care plan
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Three Guidelines to Help Leverage the Interoperability
of Continuity of Care Documents for QMs
The following guidelines help healthcare organizations best
leverage CCD interoperability for QMs:
1. Maximize Clinical Data Value with an
Organizational Data Quality Program
2. Measure Clinical Data Quality and Identify
Supportive Technology for QMs

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Three Guidelines to Help Leverage the Interoperability
of Continuity of Care Documents for QMs
Maximize Clinical Data Value with an Organizational Data Quality Program
An organizational data quality program drives success for quality
measures and alignment to other strategic objectives:
Perform CCD coding analysis
• Parse, map, stack and normalize coded values
• Translate into standard terminology
• De-duplicate across sources
Align coded data to strategic objectives and
defined metrics
Evaluate level of value the new data content
has for strategic objectives and KPIs.
Continuously seek improvement in data quality
and alignment to goals

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Three Guidelines to Help Leverage the Interoperability
of Continuity of Care Documents for QMs
Measure Clinical Data Quality and Identify Supportive Technology for QMs
Harmonizing quality measure data capture.
Exploring the use of APIs and shared platforms to
aggregate information.
Evaluating data quality and measurement with
pre-submission validation testing tools.
Determining options for new data capture within
workflows to support QMs.
Identifying common workflows that support QMs.
Exploring vendor options to report on all QMs
appropriate to the client base.
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Interoperability Requires Robust Analytic Platform
Interoperability to capture ambulatory clinical
data from CCDs is an essential part of improving
outcomes, but healthcare still involves a diverse
set of public and private data collection systems.
Driving better outcomes starts with blending
more data together, particularly two data types—
near real-time CCDs and retrospective claims.

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Interoperability Requires Robust Analytic Platform
To meet healthcare’s modern goals, organizations
must leverage a fully interoperable analytics
platform to acquire near real-time clinical data and
harmonize it with a range of data types from a
variety of sources.
An optimal modern healthcare data approach
includes use of a cloud-based analytics
platform, such as the Health Catalyst®
Data Operating System [DOS™].

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The Top Benefits of Interoperable Clinical
and Claims Data
Interoperable CCD clinical data and claims data
can support an effective continuous quality
improvement process in healthcare, as the
blended data more effectively measures quality,
creates new ways of evaluating impact of
interventions and evaluates applied
interventions with a dashboard that incorporates
the best of real-time clinical and claims data.

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The Top Benefits of Interoperable Clinical
and Claims Data
The top benefits of interoperable data can include, but are not limited to:
More refined population risk stratification
and impactability analysis empowers
population health programs to identify,
engage, and intervene with the right person,
at the right time and with key details.
This improves focus on populations
most in need of support and services
via enhanced risk stratification.
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The Top Benefits of Interoperable Clinical
and Claims Data
The top benefits of interoperable data can include, but are not limited to:
Enhanced care management program
effectiveness improves access to clinical
information to support care plan development,
increases focus on people most in need of
support and coaching services, and more
effectively assesses barriers to care and
identify options to address them.
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The Top Benefits of Interoperable Clinical
and Claims Data
The top benefits of interoperable data can include, but are not limited to:
Improved ability to assess and get credit for
delivering high-quality care and address
real, versus data, care gaps reduces the
amount of time to close preventive and
primary care gaps, increases the team’s
focus on real preventive and primary care
gaps, and enables real-time assessment of
opportunities to ignite new operational
measurement and impact assessment of
care team interventions.
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The Top Benefits of Interoperable Clinical
and Claims Data
The top benefits of interoperable data can include, but are not limited to:
Improved access to clinical and claims data
as well as other valuable data sources (e.g.,
social determinants of health, HL7 data such
as ADT, laboratory, radiology, pathology and
quality reporting document architecture
[QRDA]) enhances predictive opportunities
(e.g., machine learning and AI).
Clinicians can identify risks and
opportunities for intervention as soon as
possible as well as predict behaviors and
events across entire patient populations.
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A Better Data Asset Means More Opportunity to
Generate Better Outcomes
Organizations that wait for FHIR, and do not find
an interim interoperability solution for acquiring
cross-community CCDs, risk missing out on
opportunities to enhance their overall data asset.
The ability to provide different methods (e.g.,
the Health Catalyst® Interoperability Suite) to
acquire cross-community CCDs and clinical
data is critical to support care delivery
(operationally and clinically), boost confidence
around population health, and enable more
accurate performance measurement.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
Continuity of Care Documents: Today’s Top Solution for Healthcare Interoperability Demands
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Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Adam brings 20+ years of population health management experience working with payers,
providers and hospital systems to Health Catalyst. Adam's many accomplishments include
developing an Advisory Services Dept. with offerings that spanned from analyzing data (HL7
and C-CDA) for population health to clinical program enablement, leading a state-wide
Chronic Care Management Program responsible for more than 80,000 Medicaid beneficiaries that
improved quality and reduced costs, and developing a comprehensive Wellness Program for small to
mid-size commercial populations. This program included biometric screening, customized online health
risk assessment, telephonic coaching programs and reporting on outcomes.
ADAM BELL

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Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Kristen McRae is a senior product management professional at Health Catalyst. Kristen
brings years of experience focused around product managment and marketing
communications in the healthcare industry. She graduated from BYU with a Bachelors in Art
and an MBA, Marketing and Business Management.
KRISTEN MCRAE

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Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company
that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes
needed to improve population health and accountable care. Our proven enterprise data warehouse
(EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more
than 65 million patients for organizations ranging from the largest US health system to forward-thinking
physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”