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The New Age of Electronic Patient Data Sharing
Author: Scott Streicher
Copyright: 9-1-1 Magazine, Feature Content
Picture this scenario. EMTs rush into the emergency room with a patient they transported after responding to a 9-1-1 call. He’s immediately directed to a CT scan room; his pulse and blood pressure are rapidly dropping. At that precise moment the doctor needs to know several things, including what pre-hospital interventions were performed along with the medications given by the medic crews in the last hour. He looks around for the chart only to realize that it is still in the ER or with the Medic crew finalizing their written reports. Time is of the essence, and the doctor now realizes that he needs to take some quick actions but he’s about to make a decision without full details on this patient. The only remaining option is to exhaust precious minutes by having the triage nurse or ER teams repeat the entire series of events that lead them to this point.
This scenario all-too-common, especially in an environment when pre-hospital emergency providers use paper and illustrates how effective care can be interrupted simply for lack of easy access to pre-hospital data that is needed for treatment. Thankfully, this situation in which doctors and hospital staff too often find themselves is quickly becoming a problem of the past. Patient outcomes are improving because electronic reporting systems are giving doctors and hospital staff near real-time access to patient history and other critical information that accounts for nearly all facets of the care given to the individual from the moment the EMS service provider arrives on scene.
Increasing Interest Exists
Technological advances in clinical data exchange between EMS service providers and hospitals are of growing importance. Decisions made in the ER are only as good as the information they receive and the ease of access they have to that data.
In 2011, Vice President Biden and U.S. Health and Human Services announced a pilot program for wide-scale use of health information technology through a $220 million grant to a number of recipients across the country. The use of health IT technology is bringing EMS, fire responders, physicians, hospitals and patients together to improve quality and efficiency at a lower cost to taxpayers. This could equate to significant savings. In 2010, the Congressional Budget Office noted that, on average, EHR implementation costs for hospitals alone were approximately $14,500 per bed for implementation, with annual operating costs running about $2,700 per bed per year. These expenditures could be double or even triple that for physician groups, according to the same report.
The Need For Patient Data Before They Arrive To The Hospital
Even if such systems are employed, emergency room doctors require additional technology support. That’s because patient care rarely begins in the hospital, but instead upon the arrival of the first responders. Enter Electronic Patient Care Reporting (ePCR) systems. These platforms allow EMTs and paramedics to collect and utilize incident and patient EMS data not only for their own agency, but for the hospital on the receiving end. ePCR systems accurately generate pre-hospital patient care documentation in the field in real-time and provide EMS agencies with everything they need in order to enhance the operation of the entire department. With the right application programming interface (API), a hospital can position themselves to easily receive and access patient data on-demand.
Benefits to Hospitals and EMTs
From the perspective of the field provider the benefits to such technology interfaces is largely in the form of precious time savings. EMTs and paramedics no longer have to print or fax a field report when they arrive at the hospital. They may drop the patient off, provide their signature and get back on the job ready to take the next call that comes in from dispatch. ePCR platforms and their associated API’s also lessen the burden of proving documents and files that the hospital requests after the fact. All the information is seamlessly transmitted to the provider’s EHR system and made instantly available to the doctors.
ePCR Interface in Action
The concept of ePCR and API deployments is not theoretical, but in use today. Two Boston-area hospitals are currently using this type of technology to automatically import data to their electronic management system for all patients transported to their hospitals.
Dr. Nathanson, Director of Emergency Medical Informatics for the Department of Emergency Medicine at Beth Israel Deaconess Medical Center (BIDMC), led the efforts to adopt this new technology at BIDMC. The interface rapidly transmits information obtained from the EMTs at the site of their call to the hospital’s information system to help ensure continuity of care for some of their most vulnerable patients.
This alleviated what once was a lengthy process to recover a patient report from the EMS provider who delivered the patient. The integration enables BIDMC to call up the report in their system allowing for the continuum of care to go uninterrupted. It allows real-time access to whatever was done pre-hospital, again, allowing for more sound decision on the hospitals end.
Boston’s Brigham and Women's Hospital, a world-renowned, 777-bed teaching hospital of Harvard Medical School, also recently implemented the same API. According to Adam Landman, MD, MS, MIS, Director of Clinical Informatics at the Department of Emergency Medicine for the hospital, “The tool allows us to import vital information on individuals about to be admitted for critical care right into our information systems so we can focus even more on patients when time is of most essence.” Information obtained and entered into the ePCR platform by Paramedics and EMTs is available to authorized hospital personnel to view all of the treatments, patient history, medications and other critical data that helps ensure a continuum of care.
More hospitals will most assuredly follow suit, particularly since systems like this are often easy for staff to use, thereby giving such systems the best chance for widespread adoption Many technology providers like us will offer the APIs free to hospitals as an added service to their EMS clients..
For healthcare providers needing additional systems integration support, there remains a surprisingly abundant availability of grants to offset these costs. Be sure to follow those specific grant instructions and requirements. Many of the federal and state grant programs will provide applicants with assistance through documents and workshops. Play close attention also to any stipulations that your department must be either a non-profit or municipal-based or non-affiliated EMS agency; that you must have a DUNS number; and that you must comply with all NIMS and NFIRS requirements. There are folks in your department who have likely researched grant processes or find a reputable company or organization that specializes in grants to assist you. Solid narratives are critical in the grant write up as well. Agencies should pull together information how the grant could be best utilized. Build a strong case for your department by explaining how this new software equipment will enhance your department’s response capability. It may also be beneficial to explain how a lack of funding might negatively operations.
What The Future Of Data Sharing Looks Like
The impact of ePCR will only grow more in importance in the coming years. Today the systems are largely “push” technology - sending information one-way to the hospital. What we imagine is more a two-way sharing and real-time receiving information between hospitals and EMS providers in order to share the complete picture with all parties involved. Doing so will appropriately divide the responsibility in providing high levels of patient outcomes to all the parties involved. Currently, when the provider drops a patient off, they don’t necessarily find out what ultimately happened to the individual for which they offered care unless they go out of the way to find it out; typically a very time-consuming process. Answering this question in an automated electronic fashion can allow EMS agencies to identifty best practice techniques and improve upon how patients are treated in the field.
Moving forward standardizing methods of communication between hospitals and EMS agencies is going to become increasingly important. Institutions that embrace these trends will be at the forefront of delivering better outcomes at lower costs; a very real goal for anyone in healthcare.
Scott Streicher [above right] is a volunteer Fire/EMS Officer, NREMT-I with the Stonewall Jackson Volunteer Fire Department (www.sjvfd.org) and Director of Operations for OPEN, Inc., makers of SafetyPAD® suite of technology products for Fire and Emergency Medical Services. He can be reached by email here. More information at www.safetypad.com.