By Scott Afzal, Genevieve Morris, Stephen Palmer
Assessment of Opportunity in California and the Gulf Coast
Over the last decade, a number of significant disasters have struck the United States, including hurricanes, tornadoes, pandemic flu, and terrorist attacks. Each of these events has resulted in evacuations and/or the treatment of patients outside of where they traditionally seek medical treatment. Consequently, care is often provided with incomplete information, which may impact
the quality of care or cause harm to patients. As the nation has moved towards the digitization of patient health information, many initiatives have focused on how electronic patient data can be used during a disaster or emergency to improve care. Additionally, many have considered how health information exchange (HIE) can support healthcare professionals not only during
disasters, but also during day-to-day emergencies. While significant progress has been made since one of the U.S.’s worst disasters, Hurricane Katrina, the country as a whole was recently given a grade of “C-” for disaster preparedness and a “D-” for access to emergency care, suggesting that additional work is needed.
The Office of the National Coordinator for Health Information Technology (ONC), the federal agency that oversees the nationwide effort to transition to and meaningfully use health information technology (HIT), has sought to capitalize on the emerging HIT infrastructure. To address the challenges associated with providing care during emergencies, ONC contracted with
Audacious Inquiry (Ai) to develop a report on this topic. Ai focused its efforts on two geographic areas that are vulnerable to a high number of natural disasters: California and the Gulf Coast (Louisiana, Mississippi, and Texas). Officials in both of these areas have spent considerable time developing disaster preparedness and response plans. Additionally, hospitals and emergency
medical services (EMS) providers in both California and Louisiana are developing use cases and pilots for sharing of EMS data with hospitals. By focusing on these two geographic areas, Ai developed two initial use cases: 1) sharing of patient data between EMS providers and hospital emergency departments (EDs) through a health information organization (HIO) and 2) deployment of a disaster response medical history web portal.
Ai held virtual and in-person meetings with critical stakeholders, including: EMS providers and organizations, public health agencies, state health information technology (HIT) coordinators, health information organizations (HIOs), health systems, and emergency preparedness officials in California and the Gulf Coast. In addition, Ai met with National EMS Information System (NEMSIS) staff.2 The meetings were used to solicit feedback on the two high level use cases, and used to further refine the use cases. Based on stakeholder input as well as the belief that incremental progress can and should be made, while working towards the ultimate goal of ubiquitous health information exchange (HIE), Ai recommends ONC pursue additional activities
related to the following two use cases.
- EMS bidirectional data exchange with hospitals: EMS personnel send data from their
electronic patient care record (ePCR) to hospital EDs. The hospitals make patient data
available to EMS personnel for query while in the field. Finally, patient outcome information to support EMS quality improvement objectives is sent from the hospitals to EMS providers. The use case would be accomplished with the support of an HIO that is responsible for mapping and routing the data among EMS providers and hospitals.
- Disaster response medical history portal: Using Integrating the Healthcare Enterprise (IHE) standards, connect health systems and HIOs to an interoperability broker that can be accessed via a web portal user interface. During a disaster (the definition of which is agreed upon by participants in advance), the web portal is activated. Healthcare professionals employed by health systems or participating with HIOs would be able to access patient records through their existing systems, and other healthcare professionals, and possibly first responders, would be able to access the portal through a URL.