Performance Measurement Network

Question: Continuing Care Plan Document Questions

For all of the continuing care plan questions, does the information have to come from one source only or can it come from a combination of any of the suggested data sources in the medical record? Does the care plan have to be sent to all future care providers? And, how are other facilities documenting if a care provider has access to the EMR?

Answer:

The information can come from any number of sources in the medical record, whether it is a form specifically designed for that purpose OR multiple documents. It is up to the hospital to define what document(s) constitutes a continuing care plan (CCP) and follow that policy.

For the purposes of HBIPS-7, the CCP should be sent to the next level of care provider that is responsible for managing their medications.

It should be clear to an outside reviewer that the next level of care provider has access to the EMR. For example, documentation that the patient will follow up with Dr. Jones after discharge, who has access to ABC Hospital's EMR.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical, Related Manual - Data Quality Manual
Related documents: HBIPS, Continuing Care Plan-Reason for Hospitalization,
File:

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