Emergency medical service providers have made progress to convert to electronic reporting in the field, but sharing of data with hospitals and other providers has so far been limited. The California Emergency Medical Services Authority (EMSA) has formed a Statewide HIE in EMS Advisory Committee to support efforts to develop health information exchange capability for daily EMS and disaster medical response throughout California.
California’s EMSA received a federal grant of $2.75 million over two years to advance HIE statewide during a disaster and regionally in daily emergency medical services. Eleven other states also received grants to spur the integration of EMS data with health system EHRs, as well as other HIE efforts.
As California EMSA documents note, few EMS systems are currently connected to an HIE or EHR system. Challenges to sharing EMS data include funding, proprietary systems, and a lack of collaboration. EMSA is working to overcome those challenges and support providers, health information organizations, vendors, and local EMS agencies in creating the infrastructure necessary for secure two-way exchange between EMS and other health care providers, facilities and payers.
California EMSA said it expects that EMS will become a full participant in the electronic exchange of health information in the near term with the capability to:
• Search a patient’s health record for problems, medications, allergies, and end of life decisions to enhance clinical decision making in the field;
• Alert the receiving hospital about the patient’s status directly onto a dashboard in the emergency department to provide decision support;
• File the emergency medical services patient care report data directly into the patient’s electronic health record for a better longitudinal patient record; and
• Reconcile the electronic health record information including diagnoses and disposition back into the EMS patient care report for use in improving the EMS system.
In a 2013 survey of California EMS agencies by Lumetra Healthcare Solutions, all are using some version of a patient care record (PCR) and some have started or finished the process of implementing an electronic patient care record (ePCR). The paper PCR is often not included in the hospital patient record, however, and the ePCRs typically do not get transmitted electronically to the hospital in a timely manner.
Here is an excerpt from the survey report: “The agencies were asked if their ePCR currently interfaces to Hospital EHRs. A majority of agencies (94%) indicated that the ePCR does not currently interface with hospital systems. When asked if the hospital EHR data interfaces to providers in the field, all agencies (100%) replied that they did not receive data from the hospitals. When asked what data elements needed to be interfaced between the ePCR and the hospital EHR, the most common response was that patient outcomes and discharge data were needed. Other agencies such as Monterey County would like demographic information, vital signs and patient history including medications. Los Angeles and Merced Counties responded that the entire ePCR record including all data points should be integrated. San Mateo indicated that there should be enough data integration to ensure unique patient identification. Santa Barbara County said that data integration should include time-sensitive data related to service for specialty care.”
Robert Cothren, executive director of the California Association of Health Information Exchanges, will participate on the Statewide HIE in EMS Advisory Committee, as well as the following CAHIE members:
• Paul Budilo, Executive Director and CEO at OCPRHIO
• Daniel Chavez, Executive Director at San Diego Health Connect
• Dr. Chris Jaeger, Vice President of Medical Informatics at Sutter Health
• Dave Minch, President and Chief Operating Officer at HealthShare Bay Area
• Leo Pak, Chief Technology Officer at Inland Empire Health Information Exchange
• Raul Ramirez, Division Chief, Office of Health Information Technology at the Department of Health Care Services
• Elaine Scordakis, Assistant Director at California Office of Health Information Integrity
• Sean Turner, Senior Director of Health Information Exchange & Community Care at Dignity Health
• David Watson, Chief Executive Officer at California Integrated Data Exchange.