Improving the Information Flow

The chaos that followed the 9/11 attacks in New York City dramatically demonstrated shortfalls in existing communication systems and prehospital information technology (PHIT). The most notable instance was the inability of NYPD and FDNY personnel to talk to each other via radio, due to their use of incompatible technologies. But the information disconnects ran far below the serface, hampering the most effective and timely delivery of emergency care across the entire healthcare system.

Even after 9/11, PHIT issues remain. Not only can many first responder technologies still not talk to each other, but many agencies continue to use a hodge-podge of electronic and paper-based systems that do not connect to each other.

Mindful of this, top healthcare researchers have developed a model for an open, interoperable PHIT network architecture. A team led by Dr Adam Landman, an attending physician at the Brigham & Women’s Hospital Emergency Department and Instructor of Medicine at Harvard Medical School, published their ideas in the April/June 2011 issue of Prehospital Emergency Care.

The full article can be accessed online at www.ncbi.nlm.nih.gov/pubmed/21294627. Dr. Landman recently gave EMS World a high-level view in the following interview.

What is the PHIT concept?

The PHIT network architecture is a high-level framework for the exchange of prehospital electronic data. The two core components of this architecture are a router and electronic patient care reports (e-PCR) software. The router allows all information devices on the ambulance to communicate with each other and external data sources, such as hospital information systems. The e-PCR serves as the central data repository, collecting all prehospital patient data, including CAD, patient care and medical monitoring data.

What benefits does PHIT offer?

There are a number of benefits:

• Ambulance devices can communicate and exchange information with each other, as well as external EMS information services
• This architecture is scalable, meaning that new ambulance devices can be easily connected to the router and, as new broadband communications technologies become available, the router can be upgraded to support these technologies without modifying the individual devices
• A comprehensive e-PCR stores all prehospital data in a single location for easier transmission and retrieval
• Encourages use of open standards to promote information exchange.

What problems does PHIT address?

EMS agencies have begun adopting information technology, including e-PCR and devices capable of wireless data transmission, such as monitors with 12-lead electrocardiogram transmission capability. However, few EMS agencies have developed a comprehensive plan for management of their prehospital information and integration with other electronic medical records. 

Further, many available products have proprietary data storage and transmission solutions. This could mean that an EMS agency purchasing a wireless ECG transmission solution from their monitor/defibrillator manufacturer may not be able to use this same transmission system to transmit their e-PCRs. 

Our PHIT network architecture is designed to stimulate discussion among EMS leadership and vendors to embrace an open, scalable and interoperable solution for all prehospital electronic information needs.

Why is open architecture so important to the PHIT architecture?

We use ‘open’ to emphasize the need for prehospital devices to provide interfaces to send and receive their underlying data. If the data is also stored in standard formats, device data can be meaningfully exchanged with other devices and healthcare providers. 

For example, if an e-PCR system has an open interface to receive 12-lead ECGs in FDA-HL7 format, then any 12-lead monitor/defibrillator that can transmit ECGs in this standard format could send ECGs directly to the e-PCR system. This creates an interoperable environment where multi-vendor prehospital devices can freely share data. Additional work is needed to create data standards for all prehospital data types and to encourage vendor support of these standards.

Does the technology to create PHIT exist today?

Yes, the technology is readily available and very similar to the technology being using to setup home networks. In the home, installing a wireless router with a broadband Internet connection allows you to connect household devices (computers, laptops, printers, DVD players, smartphones, etc.) to each other, as well as communicate over the Internet. In the prehospital setting, the main difference is a mobile router (or gateway) that can be installed in the ambulance.

Are any agencies/health authorities implementing the PHIT model today?

EMS agencies around the country are beginning to recognize the value and adopt this or similar PHIT networks.  One community at the forefront is San Diego—they are placing routers on all their fire and ambulance apparatus and upgrading their e-PCRs as part of a $15 million federal Beacon communities grant to enable EMS data exchange with the rest of the healthcare delivery system.

More commonly, EMS agencies are adopting 12-lead ECG wireless transmission to facilitate STEMI recognition and cardiac catheterization laboratory activation. Instead of purchasing proprietary 12-lead ECG transmission systems, EMS agencies could apply this PHIT network architecture model to enable ECG transmission and then build on the architecture as future PHIT needs arise.

Imagine a world where PHIT as your team conceives of it has been implemented, how much better is healthcare?

The PHIT network architecture has potential benefits for prehospital-hospital communication and efficiency. With real-time data exchange between hospital electronic medical record systems and e-PCR systems, prehospital providers could receive important clinical information about a patient while en route to the scene.

Similarly, with transmission of the e-PCR to hospital electronic medical record systems, ED clinicians would be able to easily find and review prehsopital records. This architecture also creates an infrastructure to which new devices and applications can be easily added (scalability), such as ambulance-hospital teleconferencing for acute stroke. Importantly, this infrastructure also comes with costs—it is expensive and requires on-going monthly fees to maintain the broadband connectivity. Additional investigation and formal evaluation is needed to determine the value (cost effectiveness) of these technologies to EMS agencies and the entire health care delivery system.

James Careless is a freelance writer with extensive experience covering computer technologies.