Integrating EMS for Care Coordination and Disaster Response March 3, 2016

Transcription

1 Integrating EMS for Care Coordination and Disaster Response March 3, 2016 Robert M. Cothren, PhD Executive Director California Association of Health Information Exchanges

2 Conflict of Interest Robert M. Cothren, PhD Has no real or apparent conflicts of interest to report.

3 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?

4 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

5 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

6 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

7 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

8 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

9 Are we ready? Systems and Standards epcr adoption is good Providers are interested 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

10 Are we ready? Legislation AB 503 (Rodriguez) permits a hospital to release patientidentifiable 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

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12 The Grant PULSE +EMS 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

13 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

14 PULSE During a disaster 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

15 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 We know this is hard This is also a big deal How do we authenticate and authorize disaster healthcare volunteers to access health information?

16 PULSE architecture More at

17 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 More on DHV at

18 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

19 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.

20 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

21 +EMS Retrieving critical patient information During an emergency Updating the hospital while en route Maintaining a longitudinal patient record at the hospital and at the local EMSA

22 Search Alert File Paramedics and EMTs may look up and display patient problem list, medications, allergies, POLSE, and DNR in the field on epcr screen Display patient information on hospital dashboard at ED to alert and share incoming patient information to assist in time-sensitive therapies Incorporate epcr data into hospital EHR in HL7 format (using NEMSIS 3.4 CDA standards) Improve clinical decision-making Improve patient care Improve decision support Better care transitions Improve patient care Build better longitudinal patient record Reconcile Receive patient disposition information from hospital EHR to add to EMS provider patient record Improve population health

23 Demographics: Name Age Address Others Hospitals Clinics EMS epcr Search HIE Labs Radiology Limited CCD: Problems Meds Allergies Directives Pharmacies Health Sys

24 EMS epcr Alert NEMSIS 3 XML CDA to ED dashboard Emergency Department

25 EMS epcr File NEMSIS 3 XML CDA Structured data, not PDF Hospital EHR

26 EMS epcr Reconcile NEMSIS eoutcomes Measures Hospital EHR

27 +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

28 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

29 PULSE +EMS relationships Statewide During Disasters PULSE Access tools: HIE DHV Architecture Search via HIE Local Daily Operations +EMS Functions: Search Alert File Reconcile

30 On more thing POLST Physicians Orders for Life Sustaining Treatment Future component of +EMS? New initiative for an electronic repository for POLST forms Critical to meeting patients wishes during an emergency The challenge patient matching!

31 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

32 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

33 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

34 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

35 Questions Robert M. Cothren, PhD Executive Director California Association of Health