continuity of care document

Continuity of Care Document: What You Need to Know

Effective communication and comprehensive documentation are crucial in healthcare. Smooth continuity of care is essential as patients move through different healthcare settings. The Continuity of Care Document (CCD) addresses this need by providing a standardized patient health information summary.

A CCD ensures that healthcare providers can access up-to-date and accurate patient data, improving care quality and patient safety. The CCD is also essential to meeting Meaningful Use incentive requirements.

This article explores the importance of CCDs, their use by healthcare providers, and their benefits to patients and medical professionals. We will also address common questions and challenges related to CCDs, providing a clear understanding of this essential healthcare tool.

What is a Continuity of Care Document (CCD)?

A Continuity of Care Document (CCD) is an XML-based markup standard designed to specify the encoding, structure, and semantics of a patient summary clinical document for exchange. The CCD is based on the HL7 Clinical Document Architecture (CDA) standard. It ensures that all healthcare providers involved in a patient’s care have access to the same comprehensive and up-to-date information, facilitating better care coordination and continuity. Continuity of Care Documents are also key for Medicare reimbursement compliance.

“A continuity of care document (CCD) is basically a summary of a patient’s health record, which is shared from one healthcare provider to another electronically. As an MD, I always rely on the CCD of a patient as a way to familiarize their medical history to avoid prescribing them drugs that might bring harmful side effects,” says Dr. James Hook of Neurogan Health.

How is a Continuity of Care Document used by healthcare providers?

Beyond compliance requirements, healthcare providers use CCDs to share patient information during care transitions, such as when a patient moves from a primary care physician to a specialist or from a hospital to a rehabilitation facility. CCDs are also used in routine care to ensure that all providers have consistent information. This helps make informed decisions, coordinate care plans, and track patient progress.

“As a substance use disorder professional, I consider a patient’s Continuity of Care Record (CCR or CCD) a roadmap of past medical care and conditions.  Without this valuable tool, any doctor is left without a true baseline to establish applicable medical insight and put constructive treatment regimens into practice,” says Dr. Abid Nazeer MD, psychiatrist and chief resident at Symetria Recovery.

Why are Continuity of Care Documents important?

CCDs are a cornerstone of the Centers for Medicare & Medicaid Services EHR Incentive Program, commonly known as Meaningful Use (MU). Medical practices that do not meet Meaningful Use requirements are subject to penalties.

There are three stages of MU:

  • Stage 1: Base EHR adoption
  • Stage 2: Advanced EHR usage with a focus on continuity of care and information exchange between practices
  • Stage 3: Improved outcomes for patients

In plain English, adopting an EHR that works with CCDs is essential for Medicare reimbursements. All EHR systems should be able to import and export CCDs; some can exchange them electronically if connected to an HIE (health information exchange).

Information included in a Continuity of Care Document

A CCD contains key patient information, which can include:

  • Patient demographics
  • Medical history
  • Current medications
  • Allergies
  • Recent lab results
  • Immunization records
  • Treatment plans
  • Advance directives

A CCD should ideally be both comprehensive and concise.

Differences between Continuity of Care Document and other medical records

While electronic health records (EHRs) and electronic medical records (EMRs) store patient data within a single healthcare organization, CCDs are designed for sharing information across different providers and settings. CCDs follow a standardized XML-based format, making exchanging and understanding patient data easier, regardless of the system used by different healthcare providers.

Think of the CCD as a subset of the information in the EHR. It likely won’t contain everything, but it should include the most important components to ensure continuity of care. A CCD can exclude part or even most of the information about the patient inside the EHR, such as sensitive medical conditions.

Benefits of using a Continuity of Care Document for patients

CCDs improve patient care by ensuring all providers have access to complete and accurate health information. This reduces the risk of errors, ensures consistent treatment, and enhances overall care quality. Patients benefit from more coordinated care, fewer redundant tests, and better health outcomes.

A CCD is especially important for patients with chronic diseases or who have relationships with multiple providers and specialists.

Creation and sharing of Continuity of Care Documents

CCDs are generated from electronic health records (EHR) systems, following standardized formats like the HL7 Clinical Document Architecture (CDA). Once created, CCDs can be securely shared with other healthcare providers through health information exchanges (HIEs), direct secure messaging, or patient portals.

Challenges in implementing Continuity of Care Documents

Implementing CCDs can be challenging due to technical, logistical, and interoperability issues. Ensuring that different EHR systems can effectively exchange CCDs requires adherence to standards and robust IT infrastructure. Privacy and security concerns also need to be addressed to protect patient data.

Integration of Electronic Health Records (EHRs) with Continuity of Care Documents

Integrating CCDs with EHR systems enhances data sharing and care coordination. EHRs generate CCDs based on the standardized XML format, allowing seamless provider data exchange. This integration ensures that all relevant patient information is readily available, improving the quality of care.

“The format of CCDs is almost perfect with various features like past alerts, family history, the plan of care, vital signs, and other critical medical directives. However, the electronic format has some challenges, like the repetition of unnecessary diagnostic tests, the prescription of irrelevant medications, and some practitioners ignoring preventive care, assuming it was provided initially. These faults can leave patients’ conditions unaddressed,” says Dr. Hook.

Patient access to Continuity of Care Documents

Patients can access their CCDs through patient portals provided by healthcare organizations. This access allows patients to view their health information, share it with other providers, and take an active role in managing their health.

“From a legal perspective, CCDs are a crucial tool in securing better safety for patients, serving as a full record of treatment that empowers patients to advocate for themselves,” says attorney Mark Pierce.

Role of Continuity of Care Documents in managing chronic conditions

CCDs are particularly useful in managing chronic conditions, as they provide a comprehensive and up-to-date record of a patient’s health status, treatments, and progress. This information helps providers monitor and adjust treatment plans, ensuring effective management of chronic diseases.

Facilitating transitions of care with Continuity of Care Documents

CCDs play a crucial role in transitions of care by ensuring that all providers involved have access to the same patient information. This continuity is vital when patients move between different care settings, such as from a hospital to a rehabilitation center or from a specialist back to a primary care physician.

CCDs must comply with privacy laws and regulations, such as HIPAA in the United States, to protect patient information. Healthcare organizations need to implement robust security measures to ensure that CCDs are shared securely and only with authorized personnel.

Impact of Continuity of Care Documents on healthcare costs

By reducing redundant tests and procedures, CCDs can help lower healthcare costs. They also improve care coordination, leading to more efficient use of resources and better patient outcomes, which can ultimately reduce overall healthcare expenditures.

Best practices for maintaining accurate and up-to-date Continuity of Care Documents

Healthcare providers should establish protocols for regularly updating CCDs, ensuring that all relevant information is included and accurate. Leveraging technology and training staff to maintain up-to-date records can help achieve this goal.

What is an example of a Continuity of Care Document?

Here is an example CCD in XML format. This is only to show you what the file format looks like. It does not reflect real patient information:

<?xml version="1.0" encoding="UTF-8"?>
<ClinicalDocument xmlns="urn:hl7-org:v3">
  <realmCode code="US"/>
  <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
  <templateId root="2.16.840.1.113883."/>
  <id root="2.16.840.1.113883.19.5.99999.1" extension="12345"/>
  <code code="34133-9" codeSystem="2.16.840.1.113883.6.1" displayName="Summarization of episode note"/>
  <title>Continuity of Care Document</title>
  <effectiveTime value="20230501"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="en-US"/>
      <id root="2.16.840.1.113883.19.5.99999.1" extension="67890"/>
        <administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1"/>
        <birthTime value="19800101"/>
        <id root="2.16.840.1.113883.19.5.99999.2"/>
        <name>Sample Health Organization</name>
    <time value="20230501"/>
      <id root="2.16.840.1.113883.19.5.99999.3" extension="112233"/>
        <id root="2.16.840.1.113883.19.5.99999.4"/>
        <name>Sample Health Organization</name>
        <id root="2.16.840.1.113883.19.5.99999.5"/>
        <name>Sample Health Organization</name>
          <templateId root="2.16.840.1.113883."/>
          <code code="11348-0" codeSystem="2.16.840.1.113883.6.1" displayName="History of Past Illness"/>
          <title>History of Past Illness</title>
          <text>Patient has a history of hypertension and diabetes.</text>
          <templateId root="2.16.840.1.113883."/>
          <code code="10160-0" codeSystem="2.16.840.1.113883.6.1" displayName="Medications"/>
              <item>Lisinopril 10mg once daily</item>
              <item>Metformin 500mg twice daily</item>
          <templateId root="2.16.840.1.113883."/>
          <code code="48765-2" codeSystem="2.16.840.1.113883.6.1" displayName="Problem List"/>
          <title>Problem List</title>
              <item>Diabetes Mellitus Type 2</item>
          <templateId root>


Continuity of Care Documents are essential for improving communication and care coordination in healthcare, and they’re a must if your practice depends on Medicare reimbursements. By providing comprehensive and standardized patient information, CCDs enhance the quality of care, ensure patient safety, and reduce healthcare costs. Implementing and maintaining accurate CCDs can be challenging, but their benefits make them a valuable tool in modern healthcare.