integrating ems for care coordination and disaster ......•improve decision support •better care...
TRANSCRIPT
Integrating EMS for Care Coordination and Disaster Response
March 3, 2016 Robert M. Cothren, PhD Executive Director California Association of Health Information Exchanges
Conflict of Interest
Robert M. Cothren, PhD
Has no real or apparent conflicts of interest to report.
Agenda
• What led to the project?
And for disaster response and EMS integration…
• What are the challenges?
• What are the potential standards?
• What are the benefits?
Learning Objectives
1. Identify why it is important to integrate EMS into the continuum of care
2. Recognize the special challenges of pre-hospital care and disaster response
3. Discuss how can existing capabilities be leverages to address pre-hospital care and disaster response and list them
4. Describe what a replicable disaster response system might look like
An Introduction of How Benefits Were Realized for the Value of Health IT
S Consumers are more satisfied with the continuity of care
T Treatment is improved because providers are better informed
E Makes extensive use of electronic health information when paper not available
P Populations are better served, especially in disaster response
S Better informed care can decrease costs, especially in emergency settings
http://www.himss.org/ValueSuite
What is the vision?
EMS and disaster workers are full participants in HIE with the ability to securely send, receive, find, and use relevant patient information
Why do this?
• Better patient outcomes and experiences
• Improved transitions of care
• More complete longitudinal patient record
• Greater ability to aggregate and analyze system data
• Resilience in the face of disasters
How do we get there?
Develop the technical and administrative infrastructure to enable EMS providers and hospitals to securely share electronic patient information via health information exchange organizations
Are we ready?
Systems and Standards
• ePCR adoption is good
• Providers are interest
• HIE is becoming more available and more capable
• Hospitals support the transition
• EHR implementation of content standards is improving
• NEMSIS 3 implementation and adoption is increasing
Are we ready?
Legislation
• AB 503 (Rodriguez) permits a hospital to release patient-identifiable medical information to an EMS provider, to the LEMSA, or to EMSA
• AB 1129 (Burke) requires an EMS provider, when submitting data to a LEMSA, to use an electronic health record system that is compliant with CEMSIS and NEMSIS standards
• SB 19 (Wolk) requires EMSA to establish the California Physicians Order for Life Sustaining Treatment (POLST) eRegistry Pilot, if funding is available
The Grant
California’s Emergency Medical Services Authority (EMSA) received $2.75 million from ONC to advance HIE
1. statewide during a disaster and
2. regionally in daily emergency medical services
PULSE
+EMS
This is not new statewide HIE
• Will be locally operated using existing health information exchange programs
• Will allow for (and depend upon) peer-to-peer exchange connections using nationally recognized standards
PULSE
• Multiple data sources
• Messaging broker to orchestrate searches
• Search functions for several use cases
• Enabled by the California Trusted Exchange Network (CTEN)
• Integrating the Healthcare Enterprise (IHE) standards
During a disaster
PULSE use cases
1. Patients displaced from their care settings
2. New victims of an event
3. Providers away from their home systems
During a disaster
This is also a big deal
How do we authenticate and authorize disaster healthcare volunteers to access health information?
We know this is hard
PULSE architecture
More at http://wiki.ca-hie.org/PULSE+Architecture
PULSE challenges
• Patient identification and matching when displaced from their normal home for healthcare
• Record location during system and network stress
• Authentication and authorization of health care professionals far from their home systems on which they are credentialed
Plus sustainability of a system only used when “the big one hits” !
More on patient matching at http://wiki.ca-hie.org/Patient+Identification
More on DHV at http://wiki.ca-hie.org/PULSE+DHV
CTEN – the basis for exchange
California Trusted Exchange Network
Using a multiparty data sharing agreement…
…and lightweight technical infrastructure…
…to facilitate standards-based, trusted, peer-to-peer exchange.
More on CTEN at http://www.ca-hie.org/projects/cten
DHV – the Secret Sauce
Disaster Healthcare Volunteers, California’s implementation of
Emergency System for Advance Registration of Volunteer
Health Professionals (ESAR-VHP)
Continuously curated database of disaster healthcare workers…
…and credentials…
…providing the basis for authentication and authorization.
PULSE standards
• ePCR implementing NEMSIS 3
• Transport
– SOAP based XCMP and XCA with SAML authorization
– SOAP or RESTful document access with OAuth2 and OpenID Connect
• Content
– CCD based on C-CDA
– Free-form documents as available
More on standards at http://wiki.ca-hie.org/PULSE+Standards
+EMS
• Retrieving critical patient information
• Updating the hospital while en route
• Maintaining a longitudinal patient record
– at the hospital and
– at the local EMSA
During an emergency
Search
Paramedics and EMTs may look up and display patient problem list, medications, allergies, POLSE, and DNR in the field on ePCR screen
• Improve clinical decision-making
• Improve patient care
Alert
Display patient information on hospital dashboard at ED to alert and share incoming patient information to assist in time-sensitive therapies
• Improve decision support
• Better care transitions
• Improve patient care
File
Incorporate ePCR data into hospital EHR in HL7 format (using NEMSIS 3.4 CDA standards)
• Build better longitudinal patient record
Reconcile
Receive patient disposition information from hospital EHR to add to EMS provider patient record
• Improve population health
EMS
ePCR HIE
Limited CCD:
•Problems
•Meds
•Allergies
•Directives
Demographics:
•Name
•Age
•Address
•Others…
Search Radiology
Labs
Clinics
Hospitals
Pharmacies
Health Sys
Emergency
Department
EMS
ePCR
Alert
NEMSIS 3 XML CDA
to ED dashboard
Hospital
EHR
EMS
ePCR
File
NEMSIS 3 XML CDA
Structured data, not PDF
Hospital
EHR
EMS
ePCR
Reconcile
NEMSIS eOutcomes Measures
+EMS challenges
• Patient identification and matching
1. Before reaching the scene
2. Between the scene and the hospital
3. Once on site
4. After the emergency is over
• Content translation between ePCR and EHR versions of CCD
Other HIE / EMS projects
• Poudre Valley, CO: FILE
• Indianapolis, IN: SEARCH
• Rochester, NY: SEARCH and FILE
• Ft. Worth, TX: ALERT, FILE, RECONCILE
• Tulsa and Oklahoma City: SEARCH and FILE
• Montgomery County, TX: ALERT and RECONCILE
PULSE +EMS relationships
Statewide
During Disasters
PULSE Access tools:
• HIE
• DHV
Local
Daily Operations
+EMS Functions:
• Search
• Alert
• File
• Reconcile
Architecture
Search via HIE
On more thing… POLST
Physicians Orders for Life Sustaining Treatment
• New initiative for an electronic repository for POLST forms
– Critical to meeting patients wishes during an emergency
• The challenge…
…patient matching!
Future component of +EMS?
Where we are
+EMS
• Building out in multiple regions
– Concentrating on Search, Alert, and File for now
– Understanding how to address patient matching
• Addressing standards
– Updating ePCRs to NEMSIS 3.4
– Understanding how NEMSIS CDA maps to EHR care summaries
– Creating dashboards
Where we are
PULSE
• Finalizing an architecture
• Identifying standards…
…for transport and content
…for SSO with DHV
This is meant to be a reproducible solution!
Learn more at http://wiki.ca-hie.org/PULSE
Where we are going…
• Public workgroups addressing the hard issues:
– Patient matching in emergency response, disaster response, and POLST environments
– Authorization for health information disclosure during emergencies and disasters
– Standards alignment across new domains
• Demonstration of PULSE
– A working, table-top drill in early 2017
A Summary of How Benefits Were Realized for the Value of Health IT
S Consumers and providers see smoother care delivery system; no more Katrina
T Patients get better, more appropriate care because providers are informed
E Links together new stakeholders during daily emergencies and disasters
P Populations are better served, especially in disaster response
S More appropriate care can decrease costs, especially in emergency settings
http://www.himss.org/ValueSuite
Questions
Robert M. Cothren, PhD
Executive Director California Association of Health Information Exchanges
@Info_CAIHE ● @RimCothren
https://www.linkedin.com/in/rcothren