Future historians of medicine will describe that until the early/mid 20th century, healthcare was usually provided by one physician who took care of most of the patient's medical needs. As medicine became more complex, specialization became prevalent. By the end of the 20th century more than 65 medical specialties were accredited by the American Medical Association. Today, a typical patient may be seen by several specialists. It has been reported that over 120 professionals may be involved in a complex hospital case.

Future historians will be amazed that while this specialization of healthcare spread, information systems did not change to make all these practitioners aware of others' findings, diagnoses, prescriptions, or care plans.

This long overdue step has been achieved with a standard for the continuity of care. It is a core data set called the Continuity of Care Record (CCR). The CCR is a kind of a novelty. It has not been developed by just a standards developer like all other health informatics. Rather, it has been developed in a consortium of organizations who are using the American Society for Testing and Materials (ASTM), the oldest and largest standards organization in the United States as a base. The Massachusetts Medical Society, American Academy of Family Practitioners (with almost 100,000 members), American Academy of Pediatrics, and the American Medical Association have become sponsors to support this project. Other organizations are also considering joining in.

The benefits of the CCR are so obvious that a typical response from doctors, nurses, other practitioners, health plans, and others is, "Why hasn't this been done before?" For the first time, there is a core data set of patient and provider information, insurance information, patient's health status (e.g., allergies, medications, vital signs, diagnoses, recent procedures), recent care provided, as well as recommendations for future care (an abbreviated care plan), and the reason for referral or transfer. In other words, this is the information every healthcare provider should have when a patient is arriving after being referred, transferred, or generally admitted.

This new standard is about an agreed upon data set. It is technology-neutral. The sponsors foresee that this can be sent by one provider to another by secure e-mail, fax, HL7 message, or with a portable storage device such as a smart card or USB drive. EHR vendors are keen to integrate this into their software.

The CCR will not replace the EHR. It will be an updated snapshot of seven relevant sections of a patient's health history at the time she leaves a provider for the purpose of continuity of care. The sponsors also have provided an example in XML that allows a provider to express the information for future computer-use.

The CCR has additional purposes. For one, it represents a part of future personal health records. Patients can keep copies of their CCR or store it on a device or their home computer. The most exciting parts, however, are the CCR extensions. Extensions for medical specialties, institutions, payers, long-term and home health documentation, disease management, and personal health use will create the data elements for such purposes. Once created, they will be the structure of the EHR.

A demonstration project at TEPR in May 2004 in Fort Lauderdale will show how 50 or more vendors of EHRs will use the CCR. Attendees will each get a USB drive to test a mock medical history with EHR vendors. For more information on the demonstration project, see www.tepr.com.

(C. Peter Waegemann is president and CEO, Medical Records Institute.)