No More Hide-and-Seek for Patient Histories
Whether a patient is uncooperative, has a language barrier or is simply unable to communicate, EMS providers are often faced with too little knowledge about their patients and even less time to get all the information that could prove the difference between life and death.
But healthcare information exchanges (HIEs) present an opportunity to change the game for the EMS community. With a HIE in place, detailed, accurate patient histories could be at a paramedic’s fingertips within seconds. That’s not science fiction; HIEs are cropping up around the country in increasing numbers, and they’re a critical step forward in patient care.
“First and foremost [people] need to realize healthcare information integration is vitally important for our future,” says Frank Gresh, chief information officer of the Emergency Medical Services Authority (EMSA), which covers central and northeast Oklahoma.
SMRTNET
Gresh says EMSA decided to get in on the ground floor of HIE integration because its leaders realized hospitals were already communicating information back and forth about patients, and EMS providers were getting left out in the cold. He began speaking with colleagues at area hospitals, and an ED director in Oklahoma City asked if he’d ever seen SMRTNET—the Secure Medical Records Transfer Network.
Gresh learned a lot of the hospitals in the greater Oklahoma City area were using SMRTNET, an HIE based in Oklahoma, in their emergency departments. “I started talking to the folks at SMRTNET,” he says, “had a couple of meetings, and (I) said ‘This is going to make my life easier, because now I can integrate to one health information exchange versus integrating to 13 different hospitals.’”
‘Easy’ Isn’t Always
Gresh quickly found out that just because joining SMRTNET’s HIE would make his life—and the lives of numerous EMTs—easier didn’t mean the process of integrating it into an existing framework would be as simple.
“I’ll be honest,” Gresh explains, “we’re still having challenges. We started working on two complete phases of this project. Phase No. 1 was, ‘Let’s just get some easy integration at the street level for the paramedics so they can look at the information on their tablets.’ That’s the part that we’re still working on. We’re trying to integrate it directly into the electronic patient care report (ePCR), but we found out that the HL7 ‘standard’ isn’t really a standard yet. And everybody kind of has their own flavor of HL7—at least that’s the way we’ve encountered it.”
HL7, or Health Level Seven International, is 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. But what Gresh found, he says, was that even the standards aren’t necessarily standard.
“The thing is, dealing with the healthcare information exchange, it essentially gets raw data from all these hospitals and keeps it in that format,” he says. “So Hospital A might call it a first name; Hospital B might call it a surname or a proper name; and Hospital C might put the whole name together in just one field. So we’re struggling with data formats at this time and trying to figure out how to best incorporate those.”
Worth the Trouble?
This is the part where the reader may wonder if it’s even worth it. After all, EMS providers have gotten on well enough with status quo, and this sounds like an unnecessary headache. Gresh paints a different picture entirely.
“In the sampling of paramedics whom we’ve [given] the ability to just look the patients up on a website, they did find value to it,” Gresh says. “They found value in being able to look up patients, especially ones who couldn’t communicate well or appeared to be poor historians, and got really good validated information about 50% of the time. For them that was a big win.”
According to Gresh, EMSA started the integration process in the fourth quarter of 2010. Despite having to change its initial projection in order to get something useful in paramedics’ hands, EMSA expects to have something solid for paramedics in the field as soon as the first quarter of 2012.
“It certainly has taken longer than I was hoping,” says Gresh, “but it’s a technology integration project that’s not been done before, so it was destined to be fraught with peril. The first people who are going to be attempting to do this are going to find all the challenges. The people coming along behind—we hope we will have paved the way to make it much easier for them. The key thing is to just not be deterred, because it really is game-changing technology for providers in the field.”
