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How Would You Like Your Data?
Patient care generates medical records, and everybody has their own comfortable ways of creating, storing and utilizing them. In many cases separate care organizations can even share them. But integrated healthcare demands sharing at an unprecedented level, and not everyone is quite ready to start “speaking,” datawise, to everyone else with whom they might have cause to communicate.
That gives need to intermediary capabilities that can “translate” different providers’ systems for each other. Texas-based ESO Solutions offers that with its Health Data Exchange (HDE), which connects hospitals and other caregivers to the emergency medical services that bring them patients. HDE can connect data from any prehospital ePCR.
“HDE enables EMS agencies to send the prehospital run sheet, complete with discrete data elements, to the hospital. In the process, HDE stream-transforms the data into the HL7 or XML version the end recipient wants,” explains Chris Dillie, ESO’s CEO and cofounder. “Once the patient’s experience at the hospital is complete, HDE securely delivers demographic, billing and patient outcome data back to the EMS agency. HDE is a communication platform that drops off data in the exact way both sides want to see it. Seamlessly receiving prehospital data from initial patient encounters gives hospital and other personnel more-complete pictures of their patients and informs how they treat them. Sharing data back to EMS can keep providers updated on patient diagnoses and outcomes and lets systems evaluate and improve their care.”
HDE was recently implemented in Wake County, NC, where it connects Wake County EMS with WakeMed Health & Hospitals. It quickly returns patients’ ED diagnosis and disposition information back to Wake’s EMS providers, letting them know how their patients did and if their impressions and interventions were appropriate, thus providing a kind of fast-track quality assurance.
“It lets us make sure we can tie treatments to outcomes,” says Mike Bachman, Wake’s deputy director of medical affairs. “Then it allows, virtually in real time, a crew to look at the patient they just took in and see what their diagnosis was: ‘I thought it was x, and it was x.’ So there’s some real-time education it gives the provider. And we’re able to go back in a much more functional manner and look at aspects of our treatment for different patient types: What did we think was happening, what was happening, what was the treatment, and how did they do with it? Then we can start drawing conclusions.”
That’s a benefit to individual providers and collectively for the agency, which can hone its protocols with more agility and grounding in data. Wake’s using the capability to explore potential prehospital use of the Emergency Severity Index (ESI), a triage tool used in EDs.
For the hospital, HDE provides new resources for the quality management process. “Most hospital disease-specific certifying bodies require demonstration of loop closure with referral sources,” says Allen Johnson, vice president overseeing ESO’s HDE. “For the business office, HDE offers the ability to better understand the patient volume that comes from EMS.”
HDE also establishes a conduit that can be built on for future endeavors. “If at some point they want to do something like a 30-day discharge program,” says Dillie, “the pipeline of data’s already there, and we can just expand that with more information.” Wake County’s other hospital systems will soon join WakeMed on the ESO HDE platform, covering the entire community.
With integrated healthcare there’s a need for more players to have more data about more patients. While HDE isn’t limited to hospitals—it can be used by home health, nonemergency clinicians, and anyone with a place in the loop—there’s a question now of what data to collect. The product is based on the NEMSIS standard, but there’s no defined data set that accompanies this kind of new, inclusive form of care. Different players capture different data in different ways.
“The challenge is about how you take data that may be on different platforms and in different styles, and bring it together so it can be used across multiple platforms,” says Dillie. “How do you bring data together to be useful in an aggregated fashion?”
Aggregating the data of individual patients is the greater goal and the key to improving community health overall. ESO is working on a repository project that would allow wide-ranging contribution and benchmarking, an important step toward demonstrating value in the coming pay-for-performance world. But more generally, tying all the new and necessary players together datawise provides the fullest depiction of a patient’s health across the overall continuum of care.
“We talk about following patients from cradle to grave—from the time the call comes in to 9-1-1 to the time the patient is discharged,” says Bennie Collins, Wake’s assistant chief of technology. “Everything up to the hospital, we’ve been able to automate. Now this process opens up the resources to take it beyond that, from facility to facility, and use it for the regulated data exchanges that are put into place.”
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