Emergency Data Exchange Language (EDXL) Tracking of Emergency Patients (TEP)

August 25, 2010

Presentation to the:OASIS Emergency Management Technical Committee

Dial in: 1-888-325-3989 pass code: 561413 #Attendee URL: https://www323.livemeeting.com/cc/eiip/join?id=DHSOICSWG

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Current Status

PRESENTATION PURPOSE: OASIS Outreach and Education on the draft Standard – questions at the end

Practitioner Submission to EIC May 14, 2010 Practitioner Submission to OASIS June 8, 2010 TEP Voted within OASIS as a Work Product June 22, 2010 TEP Sub-committee Created Within EM-TC subcommittee

& Chairs Voted in (T. Grapes / D. McGarry) August 2010 Plan to Engage Sub-Committee Work Beginning of Oct. MOU in-progress between OASIS and HL7 for standard

collaboration Interagency MOU in-progress (privacy, adoption etc.)

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Background – TEP & TEC Messaging Standards

The NASEMSO with many other agencies and organizations recognized the need for standards-based interoperability to realize the potential of the numerous patient tracking systems in existence or planned

Introduced TEP to the DHS S&T Office for Interoperability and Compatibility (OIC), sponsor of the EDXL development process – a mature, proven process for developing cross-profession, practitioner-driven messaging standards

Effort was Initiated by the PSG as the next EDXL Priority Helps close HITSP ER-EHR IS04 Gaps Supports HHS & DOD AHRQ Objectives

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TEP & TEC Messaging Standards

Requirements definition for Tracking of Emergency Patients and Tracking of Emergency Clients is occurring in two phases. TEP is in-process with the Practitioner Steering and Working Groups (PSG / SWG).

Phase I - Tracking of Emergency Patients (TEP): An XML standard for exchange of emergency patient and EMS tracking information; to increase the effectiveness of emergency medical management, patient tracking and care, and family notification.

Phase II - Tracking of Emergency Clients (TEC): Expands Phase I scope to support clients across the general population. TEC is aimed at more effective evacuation and services management, client tracking, Regulation, Re-unification, and use of assets for all Emergency clients.

Client: Generic term for any person displaced, evacuated, sheltering in place, expired, and/or requiring medical attention – i.e. Clients or customers of Emergency ServicesPatient: A type of client requiring medical attention, being medically evaluated; or a fatality .

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TEP Scope EDXL-TEP is an XML

messaging standard for exchange of emergency patient and tracking information across the EMS emergency medical care continuum.

TEP provides real-time information to responders, management and care facilities in the chain of emergency care and transport.

Emergency / Disaster EMS, ED / Hospitals / Care Facilities, Emergency Management, Ops, Dispatch, Command

Patient tracking information is exchanged from patient encounter (possibly re-using dispatch information) through admission or release.

TEP also supports hospital evacuations and day to day patient transfers.

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TEP Use Case

Events / Triggers

Key Events That Trigger Messages

Description

Responders dispatched PSAP / dispatch center dispatches responders to an incident. Possible starting point for sharing of incident and patient data

Patient Encountered The first or initial meeting or contact between a given care provider and a given patient.

Patient Evaluated or Triaged Medical observation, measurement, and assessment of a patient or possible patient

Patient Treated Medical performance or administering of procedures, medications, or other treatments.

Patient moved/ transported (physical location tracking)

Patient is physically moved from one location, site, or facility to another

Patient being transferred to new care provider Patient care responsibility is transferred from one care provider to another

Patient condition changes Patient health / medical condition changes in some way

Patient vitals and monitoring taken Care Provider takes vital signs or other measurements, typically using various monitoring equipment, some of which may be electronic

Patient Released Patient is released from care, and is no longer considered to be part of the EMS incident continuum of care, and is no longer tracked using TEP

Patient Admitted Patient is formally admitted into a fixed medical facility or a temporary deployable facility capable of providing definitive care, which typically involves transfer of Care Provider and physical location.

Patient ID information updated Further identifying information is collected / shared about the patient

Time-driven information i.e. transfer to AHRQ National Database

Patient Tracking information is automatically or manually shared with a National Database used for consolidated tracking of patients and clients

Change in conditions requiring patient reroute (change in patient condition, receiving facility full)

Change in circumstances requiring patient transport to re-route from current destination to a new destination

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EDXL-TEP Structure and Elements

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EDXL-TEP Structure and Elements

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EDXL-TEP Structure and Elements

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Emergency Data Exchange Language Tracking of Emergency Patients (EDXL-TEP)

Documentation may be found at the following website:  http://www.evotecinc.com/TEP/

 • Requirements and Draft Messaging Specification: 

“EDXL-TEP-Rqmts&draftMessagingSpecFinalV2.2_05-05-2010.pdf”Stakeholder issues list:  “TEP-Stakeholder-IssuesRev2.2_05-7-2010.xls” 

(Filtered for “open” or “in-process” for review of resolutions)

• Data Dictionary:  TEPdictionaryV2.1.xls

(Excel version provides mappings to NEMSIS and NIEM)

• Project Initiation Document:EDXL-TEP Project Initiation Document (PID) v4.3.pdf

• Subject Matter Expert listEDXL-TEP-Participants-FullList5-12-10.pdf

(Steering, Stakeholders, Vendors, and PSG / (SWG)

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EDXL Process and Pilot

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TEP Research

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TEP Stakeholders – Practitioner-Driven Approach

Incumbent Practitioner Steering Group (PSG) & Standards Working Group (SWG) EMS, Law Enforcement, Fire, Emergency Management, Health, Public Safety, States, Counties, Cities

Over 80 Newly Added Stakeholders plus Vendors – Examples: Health Information IT Standards Panel (HITSP) Gap-Filler National Association of State EMS Officials (NASEMSO) Joint National Emergency Medical Services Leadership Conference (JNEMSLC) DoD Health & Medical Defense Support of Civil Authorities – OASD(HD&ASA) HHS-Agency for Healthcare Research and Quality (AHRQ) HHS-Assistant Secretary for Preparedness and Response (ASPR)

National Disaster Medical System (NDMS) American Hospital Association (AHA) American Red Cross LA R-7 Hospital Disaster Preparedness/Emergency Nurses Association-ENA Association of Public Safety Communications Officials (APCO) National Emergency Numbering Association (NENA) Federal Emergency Management Agency (FEMA) State of Tennessee

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Standards Development Process

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LN FN Organization Represented

Mann Clay, Dr.NASEMSD, National EMS Information System (NEMSIS)

Mears Greg, Dr. UNC Chapel Hill EMS Medical Director

Donohue John Maryland Institute for EMS Systems (MIEMSS)

Sexton JeffTennessee DOH Office of Information Technology Services, HITSP

Moreland Joe Kansas Board of EMS

Whitney Jolene Bureau of EMS State of Utah

McGinnis KevinJNEMSLC, NASEMSO, Vice-Chair-OIC PSG, National Association of State EMS Officials-NASEMSO

TEP Steering Committee

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TEP Practitioner Submission

• Final Stakeholder review period completed March 1 – March 31, 2010; extended to April 14, 2010

• Additional comments received from:• National Institute of Health (NIH) / US National Library of

Medicine “Lost Person Finder (LPF)” effort. • Multiple DoD reviewers including the Health & Medical

Defense Support of Civil Authorities.

• Draft TEP Piloted and Improved: National Disaster Medical System (NDMS) live exercise at the Tennessee Air National Guard 164th Airlift Wing in Memphis

• Excellent TEP participation and inputTotal Issues submitted: 289

• Project Initiation Document (PID): 156• Requirements and draft Messaging Specification: 133

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Tennessee NDMS Patient Movement Exercise

• Draft EDXL-TEP interoperability pilot inserted into the 2010 National Disaster Medical System (NDMS) Patient Movement Full-Scale Exercise, with follow-on analysis and presentation

• A live exercise using volunteer patients, driven by objectives of federal, state and local agencies and NDMS partner hospitals.

• DHS OIC pilot the draft EDXL-TEP specification in a field exercise before submitting to the standards approval process

• A hurricane makes landfall resulting in mass casualties requiring evacuation and medical treatment.

• Patients were tracked utilizing five independent Patient Tracking systems from Maryland's BWI airport, to a Memphis triage area where an actual C-130 landed and deplaned patients. Patients were then tracked through triage and ambulance boarding, through arrival at one of 5 Memphis area hospitals.

• Patient registration timeframes dramatically reduced – hours to 30 minutes

• First Electronic Patient Manifest for TN Air National Guard

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NDMS Patient Movement Exercise OrganizationsDHS Office for Interoperability and CompatibilityDHS Tech Support - Evolution TechnologiesHHS / ASPR / NDMSMaryland Institute for Emergency Medical Services Systems (MIEMSS)Memphis / Shelby County Health DepartmentMemphis / Shelby EMAMemphis FireMemphis Shelby Regional Hospital CoordinatorMethodist Hospital CorpVendor - Disaster Management Solutions (DMS)Vendor - EMSystemsVendor - Global Emergency Resources (GER)Vendor - HHS Joint Patient Assessment & Tracking System (JPATS) Vendor - UPP TechnologiesTN DOH Exercise Coordinator & State Response CoordinatorTN Air National GuardVeterans Administration

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EvacuationPatient Receiving Area (PRA) Maryland (MIEMSS)

1- Tag and Transport patient to NDMS DMAT at BWI Thurgood Marshall Airport

Begin tracking patients via DE-TEP(100 Patients for on-load to air transport.

To be moved by NDMS to another State for Hospitalization and/or Treatment)

DE-TEPDE-TEP

JPATSCOG 6978(Apprio)

JPATSCOG 6978(Apprio)

DM OPEN

DM OPEN

First TrackCOG 6975

(DM Solutions)

First TrackCOG 6975

(DM Solutions)

Patient TrackingCOG 6974

(UPP Technology)

Patient TrackingCOG 6974

(UPP Technology)

HAVECOG 6976

(EM Systems)

HAVECOG 6976

(EM Systems)

HC StandardCOG 6977(GER911)

HC StandardCOG 6977(GER911)

DE-TEPDE-TEP

2 – Load patients to aircraft and provide TEP

updates (JPATS update all)

Tennessee – Memphis Shelby:3 -Offload patients from aircraft (First Track update all)4 - Patient ambulance transport (First Track update all)

DE-TEPDE-TEPLocalHospital

NDMSHospital

NDMSHospital

LocalHospital

EMSystemsEDXL-HAVE

TNCRN/WebEOC(No Message

Exchange via DM OPEN)

5 – Patients received at

hospitals (First Track update all)

First TrackCOG 6975

(DM Solutions)

First TrackCOG 6975

(DM Solutions)DM

OPEN

DE-TEPDE-TEP

DM OPEN

DE-TEP UpdatesDE-TEP Updates

Landing

Take-off

WebEOCWebEOCDE-HAVEDE-HAVE

…Hospitals provide HAVE

updates

HC StandardCOG 6977(GER911)

HC StandardCOG 6977(GER911)

Missouri / Louisiana Hospitals &Mississippi, Wisconsin & Tennessee Tracking

TEP Patient Tracking Proof of ConceptMESSAGE FLOW-ONLY VIEW

A R RShreveportCOG 6971

A R RShreveportCOG 6971

EMTrackMissouri

COG 6951

EMTrackMissouri

COG 6951

National Family Reunification Center (notional)

UPPTechnology

TennesseeCOG 6972

UPPTechnology

TennesseeCOG 6972

EMTrackShreveport

COG 6951

EMTrackShreveport

COG 6951

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1. EMTrack Missouri Hospital evacuation to the airport

• NO TEP to ARR

2. EMTrack Missouri Receipt of Patient arrival at airport

• NO TEP to ARR

3. EMTrack Missouri updated to assign 35 patients to Shreveport, LA Region 7 NDMS hospitals (JPATS assigns to appropriate flight)

4. EMTrack Shreveport patients land / received at Shreveport PRA

5. EMTrack Shreveport assign patients to ambulances at the PRA, destined to specified local hospitals

6. EMTrack patient arrival at each Shreveport hospital

7. May 16–19 SEPARATE from and parallel with the end-to-end tracking of the 35 patients above, HC Standard sends TEP updates to the Tennessee National Family Reunification Center (UPP) for up to 1000 patients during the course of their movement and tracking.

8. May 19 2011 HC Standard now begins to send TEP updates to EMTrack today in addition to UPP

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HC StandardMississippi / Wisconsin

COG 6983

HC StandardMississippi / Wisconsin

COG 6983

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3

4

4

5

5

6

6

7 (as provided – up to 1000 patients)

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“Monitor” COG

COG 6993

“Monitor” COG

COG 6993

ALL Messages 1 - 8

EMTrackMissouri

COG 6951

EMTrackMissouri

COG 6951

Missouri / Louisiana Hospitals & NDMSTEP Patient Tracking Proof of Concept

NOTE: EMTrack is configured as a single “instance”, self-updating between Missouri and Louisiana

1- May 19, 2011 Missouri hospital enters 35 patients into EMTrack for evacuation (paper patients) to be moved to another State for

Hospitalization and/or TreatmentEMTrack

Missouri

COG 6951

EMTrackMissouri

COG 6951

Missouri Hospital Evacuation

2,3 send

1send

UPPTechnology

TennesseeCOG 6972

UPPTechnology

TennesseeCOG 6972

2 - Missouri EMTrack Receipt of Patient arrival at airport

3 - Missouri EMTrack assign 35 patients to Shreveport, LA Region 7 NDMS hospitals

IPAWSOPEN

1,2,3

HC StandardMinnesota / Georgia

National GuardCOG 6983

HC StandardMinnesota / Georgia

National GuardCOG 6983

Missouri Airport

TRAC2ESTRAC2ES

Missouri Airport

A R RShreveportCOG 6971

A R RShreveportCOG 6971

3IPAWSOPEN

EMTrackShreveport

COG 6951

EMTrackShreveport

COG 6951

IPAWSOPEN

4,5,6

4,5,6

4 – Shreveport EMTrack patients land / received at Shreveport PRA

5 – Shreveport EMTrack assign patients to ambulances destined to specified local hospitals

LocalHospitals

EMTrackShreveport Hospital(s)

COG 6951

EMTrackShreveport Hospital(s)

COG 6951

EMResourceEMResource

Hospitals provide HAVBed updates

Paper HAVE Report to VA Area Emergency Manager

Paper HAVE Report to VA Area Emergency Manager

Shreveport PRA

Shreveport PRA

National Family Reunification CenterTennessee

3 send

NDMSHospitals

6 send

4,5 sendLanding

6- EMTrack patient arrival at each

Shreveport hospital

7 & 8– May 16–19, 2011 SEPARATE from and parallel with the end-to-end tracking of the 35 patients, HC Standard sends

TEP updates to Tennessee (UPP) and later to EMTrack for up to 1000 total patients

7send May 16-19

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Manual

Mississippi & Wisconsin

IPAWSOPEN

8 send May 19 8

“Monitor”COG

COG 6993

“Monitor”COG

COG 6993

ALL Messages 1-8

EMSTATLa

EMSTATLa

Manual

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EDXL-TEC update

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TEP-TEC Jurisdictions and Systems

DoDJPTA

TRAC2ESETAS

FederalHHS (JPATS)

FEMA (NEFRLS,NMETS,

NSS),NLM (LPF)

Local / StatesTX (SNETS, TWIRP)

LATNMD

…etc.

NGO’sARC (Family Links)

HospitalsShelters

Ushahidi, SahanaiREPORTFacebook

Twitter

TEP-TEC TEP-TEC

TEP-TEC

TEP-TEC

Incident

LocalAll incidents start locally

TE

P-T

EC

TEP-TEC

TE

P-T

EC

TEP-TEC

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TEC “Generic Process”

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TEC “Generic Process”

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TEC “Generic Process”

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TEC “Generic Process”

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