Infor-motion

   Broadly defined, health information exchange is the automated electronic movement of people's health information across organizations, independent of information systems or software. It's going to make your job easier, and it's going to contribute to better patient care.

   Imagine automatically receiving a patient's medical history as you're dispatched to a call. Then, on scene, data you collect with various devices feeds automatically into an ePCR that also attaches that history. That PCR focuses and simplifies your documentation as you complete it, leading you through pertinent fields. It's automatically sent ahead to your destination hospital and moves across departments there, continually being updated, and ultimately is merged seamlessly into billing systems. Later, the integrated hospital and prehospital data is available for EMS performance improvement, public education and other uses.

   There's more, but EMS leaders should already be intrigued. This is the Holy Grail of health information efforts, and it's now at hand.

   "It's important because it's going to allow patients to have all the information about them applied to whatever their current need is," says Greg Mears, MD, executive director of the EMS Performance Improvement Center at the University of North Carolina, as well as the state's EMS medical director. "Whether it's a physician or a paramedic or a nurse or a clinician anywhere, they can pull this information in, understand the care that's been provided, and take it into account when they're providing their care. That will not only improve care for the patient, but it will decrease errors and many other things."

   The key entity to know is Health Level Seven International, or HL7. They're a prominent standards-developing organization and the premier global authority on interoperability standards for health information technology. HL7's corporate members include more than 90% of healthcare information system vendors.

   EMS isn't yet encompassed within the HL7 sphere, but it's on its way. Once it's there, our care efforts and documentary data will become a fully integrated part of the healthcare continuum. HL7 approval will be accomplished by way of a multistage voting process, and the EMS data framework represented by the National EMS Information System (NEMSIS) has already received unanimous first-ballot support for inclusion. Additional balloting will follow as more elements (e.g., messaging, vocabulary) are developed. That process will continue into 2012.

Thank NEMSIS

   It's NEMSIS that has positioned EMS to join this party. EMS' data collection has developed dramatically in recent years as it provided standardized definitions and transmission for services and states to collect the same data, measured the same way. NEMSIS' new version 3 data set aligns with HL7, allowing EMS to link to the rest of the healthcare world.

   "EMS is actually more advanced when it comes to the use of standards across the industry than the rest of healthcare is," says Mears, who described the transition at July's Pinnacle EMS Leadership & Management Conference. "What NEMSIS has done is create standard definitions, so wherever you are, you use the same terminology and definitions when you document a record. That generally doesn't exist in the rest of healthcare. We also have a more advanced exchange methodology, so the information can be maintained as it moves, for instance, from a local agency to a state and then to the national level."

   That puts an onus, then, on states that aren't yet contributing data to NEMSIS to address their barriers and get with the program, and on services that haven't yet gone electronic to get moving to NEMSIS-compliant software.

   For the laggards, a lot of the barriers have been financial. And despite the importance of EMS to America's overall systems of health and emergency care, federal funding to bolster the development of health information exchange generally hasn't gone to the prehospital side--rather, it's gone to physicians, hospitals and clinics.

   There are, however, a handful of EMS-involved pilot programs testing aspects of the concept. One is in North Carolina, where EMS leaders are working with a hospital group to automatically forward them EMS ePCRs. The hospitals then flag those patients and, upon completion of their care, send updated records with outcome data back to the state EMS office. That integrated information then becomes available for local EMS agencies to use.

   "The benefit is, the hospital gets the medical record in a format that can go right into their electronic record system, and EMS gets the outcome information back so they can understand and better evaluate and adjust their care and protocols," says Mears. "That all happens in an automated way, behind the scenes, and nobody has to expend resources after it's in play."

Remaining Steps

   To take full advantage of what health information exchange can offer, EMS organizations need to be fully engaged with their prospective partners: hospitals, clinics, specialty centers, etc. With a general latitude to decide where to take patients, prehospital systems need to know which facilities are capable of what, and work at developing relationships with hospital leaders.

   There are a couple of other things to begin doing now. Number one, if you're not already there, is to start migrating toward NEMSIS-based electronic data systems. There are around 80 different compliant packages available.

   If you've already gone electronic and achieved NEMSIS compliance, start testing concepts of the version 3 data set. Version 3 has some changes. It's up to 538 elements, with added outcome information and input from billing vendors. It's also added business logic--enforced pathways by which important elements are accessed and updated. This essentially makes sure you fill in fields important to each event, but doesn't waste your time seeking nonessential information. If your patient is a male, for instance, it won't query his pregnancy status.

   That business logic will be a key aspect of guiding providers through field documentation in the health information exchange era. As much of the data process as possible--both collection and transmission--will be automatic and invisible to the operator.

   "We want to improve our level of documentation and allow technology systems to help us in some of our decision-making processes," Mears says. "At the same time, we don't want to take our hands and minds off the patient. So the more we can automate this process and integrate data management behind the scenes, then it keeps the healthcare provider focused on the patient. It also improves their experience because they don't have to redocument and retranslate a lot of information from various sources."

   This will all require a certain time and energy on the front end. But if it's done correctly, it should help improve not only care, but billing and reimbursement as well. Services will have better information up front, faster, with which to generate invoices and pursue collections. That's not the primary reason to do it, of course, but it can streamline and improve the overall efficiency of operations.

Conclusion

   Health information exchange is coming whether you like it or not. Poorer and smaller services--and just plain old technophobes--have every reason to do what they can to make the most of it. The welfare of individual patients, the care of entire populations, and everyone's bottom line will benefit from the facilitated collection and movement of vital patient information. And in doing so, the field of EMS will have its important work recognized and utilized in a way it hasn't been before.

   "Ultimately, it's finally the integration of EMS and healthcare," says Mears. "I think that's the most important thing for people to understand: We are finally at the table, we're finally being included, and we're finally being given credit for the care and service we provide. It's an acknowledgement that patients--especially those with time-dependent illnesses and injuries--require us to do our job and be part of the system. And we need to take ownership of all that goes with that."