Continuity of Care Maturity Model (CCMM)
The HIMSS Continuity of Care Maturity Model (CCMM) helps healthcare leaders worldwide assess, implement and scale the seamless coordination of patient care across a continuum of care sites and providers.
Continuity of care is much more complex than implementing information and technology in a single care setting. Multiple stakeholders must act in concert to provide an environment that facilitates the best care and value. The CCMM assigns responsibility for critical aspects of coordinated care across administrators/governance leadership, clinical leadership, and IT/technology leadership. Organizations can leverage the CCMM to improve the interoperability, governance and workforce, and predictive analytics dimensions of digital health.
Implement Effective Health Information Exchange
Aggregate patient health data into a comprehensive presentation that includes information across the care continuum from acute settings, external providers, home care, social care, patient-created data and other sources.
Coordinate Patient Care
Fully integrate a shared care plan that is able to include multiple care pathways/protocols for multiple chronic conditions, and to share data items between the protocols (e.g., elderly patients with multiple complex health/social care needs based on the personal goals for the patient and their individual needs and abilities).
Advance Analytics Capabilities
Integrate internal and external de-identified longitudinal clinical, financial and other data, and non-patient-specific data. Analytics infrastructure enables automatic identification and reporting of gaps in data across all care providers.
Improve Patient Engagement
Put the patient in control of their health data and goals. Allow patients to electronically give consent on or deny care provider access to their medical record or parts thereof across the care continuum. Automate tracking of achievement for the patient and alerts/reminders to patients triggered from the organization's care team and other coordinated care providers.