Project Synapse: Continuity of Care Document Design


Most patient health records today are hard for consumers to understand. CHCF asked high-end designers what a "human-centered" approach would look like.

May 2012

To help make electronic health records (EHRs) more "human centered" and easy to use, CHCF partnered with design and innovation firm IDEO to improve the Continuity of Care Document (CCD). The mandated CCD is becoming a critical digital summary that medical providers use to communicate information about a patient's health status.

In November 2011, representatives from leading EHR vendors, along with stakeholders such as the US Department of Veterans Affairs, met to explore ways to improve the usability of EHRs, including the development of new prototypes for CCDs.

The workshop had these goals:

  1. To understand the unmet needs of patients
  2. To learn how human-centered design can be used to create patient-centered CCDs
  3. To identify models of collaboration and additional areas for future work together

The following resources were generated at the workshop and are available as Document Downloads.

Workshop Summary: Presents background about the workshop, research findings on patients' needs, insights from participants, and designs for human-centered CCDs. The summary introduces two CCD concepts: "Accordion" and "Collage" approaches.

CCD Concepts: This ZIP download includes PDFs of the Accordion (the Health Card Deck) and Collage examples, as well as the HTML code, JavaScript code, CSS, and graphic files to incorporate some or all of the information display methods into a provider's system as desired.

(To view these files: copy either concept folder to your desktop; double-click on the folder to open it; double-click on the index.html file to display the concept in your browser. The CCD concepts are interactive; click on various sections to view additional information.)

Resource Kit:

  • The "Insight Posters" present four key concerns raised at the workshop and takeaway messages.
  • The "CCD Interaction Metaphors" present CCD approaches from the viewpoint of the patient. Each may be adapted for one-way communication with a patient or to share information back and forth. These are examples of how the CCD might be organized and rendered.
  • The "CCD Components" are example wireframes of information design to provoke designers to think differently about how to present which data. Each health component includes a description, the "voice of the patient" to help understand how this meets patient needs, and a checklist of patient needs. Physician needs are also listed. In many cases, these components push the boundaries of the current CCD specification and call for additional, more patient-centered data elements or suggest new ways of combining data to better match patients' expectations of their health information.

CHCF continues to collaborate with industry stakeholders to improve the usability of EHRs, such as with the Creating Usable EHRs: A User-Centered Design Best Practices Workshop and the Health Design Challenge.

Reader Comments

Thanks, Cal Health Found, for making these prototypes available. A key benefit here is the suggestion of additional, patient-centered data elements & new ways of combining data to better match patients' expectations of their health information -- based on research with patients.
The abundant and disorganized diagnostic test results being displayed by EHR, PHR and HIE platforms are another good example of clinical data that is hard for physicians and patients to read and understand. The reason is the antiquated design of the variable reporting formats still being used to display cumulative test results as incomplete and fragmented data.

The practical solution is creating a patient-centered, standard reporting format that can display complete, integrated and easy to read information on up to 80 percent fewer screens.

Creating fully interoperable health information exchange is the most challenging aspect of achieving meaningful use and improving clinical quality. Enabling efficient viewing and sharing of the "data tsunami" of disorganized test results is an important interoperability challenge that can be overcome by standardizing the reporting format.