For an article I was writing last year, I asked Dan Smiley, chief deputy director at California’s Emergency Medical Services Authority, what happens when paramedics transport patients to the hospital for a hand-off to emergency department staff? “In the current scheme, they print out or photocopy their run sheet recorded in the field,” he told me. “Even if it is done on an ePCR [electronic patient care reporting system], they will print out a version and hand it off. The capability of hospitals using EHRs to work with a paper record is limited. It is not searchable, and there is no way of linking that data. It is not interoperable.”
But progress is being made to bring EMS providers into the loop in terms of health information exchange. Smiley recently co-authored an article for the Journal of Emergency Medical Services (JEMS) detailing the launch of a project funded by the Office of the National Coordinator for Health IT called +EMS, which supports bi-directional data flow between the EMS providers and hospitals. 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.
Each participating county is developing partnerships between one 9-1-1 EMS provider with transport capability, one receiving hospital, the regional health information organization (RHIO), and the local EMS agency (LEMSA). In Orange County, the participants are Orange County EMS, the Newport Beach Fire Department, Hoag Memorial Hospital Presbyterian, and the One California Partnership Regional Health Information Organization (OCPRHIO).
They are using a work flow model called Search, Alert, File and Reconcile (SAFR):
• 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.
The JEMS article explains that the established HIE is augmented by the alerting and bidirectional data flow capabilities in ImageTrend's Health Information Hub (HIH) and Hospital Hub to facilitate the technical interactions among EMS, the HIE and hospitals.
In February 2017, Orange County EMS, Newport Beach Fire Department and Hoag Memorial Hospital Presbyterian were the first in California to begin the implementation of +EMS and the SAFR model for HIE.
The JEMS article describes how it works: As the medic is evaluating and treating a patient in the field, they use their ePCR software, ImageTrend Elite, to search for the patient by first and last name, gender and date of birth. The field EMS data tablet connects to a cloud-based HIE through HIH, where the patient's cumulative hospital, medical provider and EMS electronic medical record is identified, allowing the medic to immediately populate the ePCR with the patient's medications, allergies, recent hospitalizations and past medical history.
Then, an alert within Hospital Hub notifies the receiving hospital of the incoming patient and receives pre-arrival field and medical record information transmitted from EMS to the ED, including: primary impression, age, gender, arrival times, vitals and procedures, including 12-lead ECGs-performed by the EMS crew. A predetermined set of rules triggers the completed ePCR information to be sent automatically in a National EMS Information System (NEMSIS) CCD (Continuity of Care Document) file to the HIE, which is then available in near real-time to the appropriate patient healthcare provider.
Also, the HIH retrieves hospital discharge, insurance and clinical information from the HIE, which then populates ImageTrend Elite for agencies to view and use for continuous quality improvement and to achieve better patient outcomes.
Smiley and co-author Samuel Stratton, M.D., M.P.H., deputy health officer and the EMS medical director in Orange County, Calif., conclude by noting that California had the foresight to create a statewide data collection system that modernizes all EMS data systems and would comply with federal HIT standards. “This allows EMS providers to exchange patient care information with other health care providers (such as receiving hospitals) who use the same standards.”
They quote Executive Director Paul Budilo of the nonprofit One California Partnership Regional Health Information Exchange: "This effort is a tremendous win for EMS and it demonstrates a profound change in the paradigm of patient care. Our organization has established beneficial partnerships and increased functionality between multiple healthcare providers and hospitals in Orange County including the Hoag Memorial Hospital Presbyterian, Memorial Care Health System, St. Joseph Health System, KPC Healthcare and others."
How long before other HIEs around the country work on similar systems to bring EMS providers into the loop?