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The Health IT Evolution

A man waiting for a train at a station notices a woman on the platform beginning to have what appears to be a seizure. The man uses his cell phone to dial 9-1-1, and the emergency dispatcher asks him to describe the problem and give his location. He describes the woman’s behavior and apparent condition to the best of his ability, but he’s not a clinician and can’t communicate with the patient, who is now unconscious. He’s also new to the city and doesn’t know the exact street address of his location.

The dispatcher is able to obtain his location using an enhanced 9-1-1 system. The EMS unit arrives within three minutes. After managing the patient’s airway and taking cervical spinal precautions, the crew initiates an IV, completes a rapid test for blood glucose, and administers 50% dextrose solution. They attempt to contact the nearest emergency department, but for some reason their own communications are down. So, they continue on to the hospital, not realizing that the facility is on diversion because a large structure fire has brought in several dozen burn victims in the past 30 minutes.

A case like this could happen anywhere in the country, with any number of scenarios.

When minutes can make a difference between life and death, the flow of communication and data is critical. The unfortunate reality is that we’re currently unable to share real-time data in video, voice and discreet vital information between EMS, hospitals, local public health departments and the Centers for Disease Control and Prevention (CDC) in a manner that’s fast enough to prevent and prepare for—rather than simply respond to events once they occur.1

The Need for Connectivity
The U.S. has some of the most comprehensive and progressive communication technologies and IT infrastructure in the world, but our EMS systems don’t yet reflect similar advances that have been made in the sectors of banking, telecommunications, hospitality, retail and energy. In order to do so, the EMS community requires large investments in new technology to truly respond to current and future disasters or emergency situations.

The communications network in an EMS system should provide an organized response to emergencies and disasters, and this requires an extremely intricate but flexible platform. However, in many cases, these disjointed systems are evolving without any well-planned, strongly enforced state EMS guidelines. One of the key issues that we learned from Hurricane Katrina was the need for a "common operating picture," which provides real-time situational awareness across a number of agencies to support this higher-level decision making.2 In order to develop and maintain such a way to process information and make it readily available and relevant, we need structured data connectivity.

In the public health arena, the citizenry relies heavily on the reporting and communications from hospitals, local and state health departments, other state officials, the CDC and the media. The recent outbreak of the H1N1 flu virus is a perfect example of how information can change rapidly during an epidemic or outbreak, and how the community may react depending on the information, or lack thereof. Schools, public facilities, governments and other organizations all need to be part of the communication loop so that everyone is getting the same information at the same time and in a consistent manner. That assists the community and those who handle the event, but it also directly impacts how EMS and other first responders allocate their resources in order to be prepared for the worst scenarios. With effective communications and IT systems in place, disasters and other types of emergencies can be mitigated with effective and efficient communications tools.

More and more EDs are realizing they can’t manage their crowded waiting rooms, trauma units, or even schedule enough staff to handle patient surges unless they invest in better and more sophisticated IT systems that can also gather data from EMS, local and state officials, public health departments, and other sources such as pharmacy data. EMS must follow suit.

The Future of EMS Communications
Some states, such as Colorado, Maryland and Vermont, have implemented sophisticated systems—and more importantly, integrated emergency preparedness plans—that include the use of technologies that integrate dispatch, global positioning systems, hospital bed availability, diversion updates, medication supply and other critical information, including the use of electronic health records for demographic and vital information.

Now is the time to harness the proliferation and increasing adoption of these new technologies to better serve our patients and EMS professionals alike. As electronic medical records become the rule rather than the exception, vendors will offer solutions that will more readily integrate legacy systems with newer technologies to provide single access points and user-friendly interfaces for EMS. As these technologies become more widespread, efficient and effective ways of communicating through the EMS community will become the "gold standard."

Innovative solutions currently available to EMS professionals and their organizations provide more seamless transfer of information through any crisis. Some examples of this technology include the following key features and functionality:

  • CAD software;
  • Dispatching software;
  • Searchable indexing software for output of dynamic reports;
  • Call-center software that allows data entry into central databases residing on either wide-area or local networks using a SQL server;
  • Software that tracks the status of EMS units, patient care reports, ETA status, employee hours, unit hours, delay and prompt status, response times, 9-1-1 calls, pending appointments and other measurable data;
  • Software that reports communications between dispatch, billing and each individual mobile medical unit;
  • Reporting software that captures response detail, pick-up location, chief complaint, unit hours utilization, hourly demand and caller type; and
  • Software that integrates vitals, history of present illness, status, medications, allergies and other critical patient information to the ED before arrival.     

We are on the cusp of many breakthrough advances! As a collective medical community, we must take advantage of these resources so we can deliver the highest quality of care to communities across the country. Further investment in these technologies is the key!


Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.

1. Davis RM: "Six Minutes to Live or Die." USA Today. May 20, 2005.
2.  www.whitehouse.gov/reports/katrina-lessons-learned.pdf


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