Examples of Successful Interoperability Texas HIE Emergency Telehealth and Navigation (ETHAN)

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1 Examples of Successful Interoperability Texas HIE Emergency Telehealth and Navigation (ETHAN) Profile Element Description Responsible Entity The owner of the project Houston Fire Department Participating Entities Types of organizations participating, e.g., hospital, provider Greater Houston Healthconnect; Clinton Foundation; Verizon Wireless; City of Houston; Harris County Healthcare Alliance; numerous FQHCs; MHHS Nurse Health Line; taxi companies Description Short description of the project The City of Houston Fire Department operates one of the busiest 911 call centers in the nation. Due to a high percentage of uninsured residents and low levels of formal medical home enrollment, the city s EMS system frequently responds to calls that are not true emergencies. In fact, nationwide it has been estimated that over 50 % of all ambulance runs occur for patients that are not experiencing a medical emergency. This inappropriate use of EMS resources ties up an EMT s time and limits their capacity to respond to true emergencies in a timely manner. The inefficient use of intensive resources is also costly. Furthermore the quality of 10-20% of first responder triage decisions could be improved with access to a consulting physician. Greater Houston Healthconnect is collaborating with the City of Houston Fire Department in an innovative First Responders program, which is the first of its kind in the United States.

2 ETHAN( Emergency Telehealth and Navigation) uses the Verizon Wireless network and Panasonic tablets to triage patients with nonlife threatening, mild or moderate illnesses via telemedicine with an emergency physician at the City of Houston EMS base station. The project links residents to available health care providers within their community and to nurse case managers in the Houston Department of Health and Human Services for follow-up coordination. Using HealthPost, Healthconnect built and integrated a link to enable first responders to view available primary care appointment times and to schedule patients the same or next day. Patients are then transported in a cab, thereby avoiding a costly and unnecessary trip in the ambulance to the emergency room. The physician at the base station is also able to access prior records for that patient in order to understand the patient s medical history and preexisting conditions. In addition, ambulance run sheets are integrated into the patient s CHR if an appropriate match is made.

3 Standards Implemented What standards were implemented in the project HealthPost appointment scheduling: Traditional HL7 version 2, which can only be pushed, was converted into Restful web services to enable query exchange between HFD and HealthPost. Use of technology in this way bridges available technology within many Legacy systems to modern, lightweight agile functionality that can be leveraged by any system -such as mobile applications, smart phones much more system accessible. Community Health Record (CHR) Query Exchange: The physician covering at the Call Center is able to access the patient s prior medical history via Healthconnect s web portal. The patient s identity is matched to a master patient index(mpi) and existing records are identified within the record locator service(rls). Any records of interest can then be viewed by the ETHAN physician if they have previously opted-in at any of the Healthconnect participating providers. Access to the CHR is achieved using nationally recognized standards based on HL7 and or a combination of CCD and CCDA exchange. Integration of Ambulance Run Sheets

4 Policies Adopted What policies were implemented/adopted to support the implementation Run sheets are being pushed to the HIE in real time to be integrated into the CHR for the patient. EMS records are complex because patient identifiers are based on incidents, not individuals. Also, patient demographics can be inconsistent and most EPCR vendors are just beginning to support IHE profiles. Future enhancements: Patient matching can be improved by matching the hospital medical record to the ambulance run sheet and ascribing the run sheet to the proper patient within the CHR. ETHAN follows all standard HIE privacy and security protocols. Records cannot be accessed unless the patient is consented into the HIE. The call center physician is authorized to break glass only if a patient has already consented somewhere within the network. Timeframe Start date, key milestones Healthconnect began developing the patient scheduling system in 2014 and the first official run was in December Volumes Impacts Quantitative indicators, e.g., number of providers, number of records exchanged Quantitative results, e.g., reduction in delays, cost savings -18 part-time providers supporting EMTs through the call center - All ambulances equipped with ETHAN apparatus patients served to date -500 patients deferred to clinic/home care -Only 18% of patients ended up taking the ambulance to the emergency room. -ETHAN s present capacity is 4300 patients per year. ETHAN s cost per patient is $ versus $1600 for an ambulance transport to the emergency room.

5 Qualitative results, e.g., provider satisfaction, perceptions, testimonies Please see link to news article below References Links or attached documents Contacts Point of contact for further information Tiffany Champagne, PhD