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Grant to Enhance EMS/Hospital Data Exchange


The White House announced Tuesday that the University of California, San Diego (UCSD) has been awarded one of 15 Federal Beacon Grants to demonstrate the capacity of electronic medical records.

Selected from a field of more than 130 applicants, the San Diego application specifically requested funding to assist in the implementation of a unique prehospital medical record system that will link EMS and hospital data systems via a state-of-the-art, two-way, EMS-to-hospital and hospital-to-EMS Tapchart system developed by San Diego Medical Services, (SDMS) a public/private partnership between San Diego Fire-Rescue and Rural/Metro Ambulance.

Vice President Biden and U.S. Health and Human Services Secretary Kathleen Sebelius announced the selection of 15 communities across the country to serve as pilot communities for eventual wide-scale use of health information technology through the Beacon Community program. The White House announcement states that the $220 million in (Beacon Community Program) Recovery Act awards will “not only help achieve meaningful and measurable improvements in health care quality, safety and efficiency in the selected communities, but also help lay the groundwork for an emerging health IT industry that is expected to support tens of thousands of jobs.”

The selected communities will use health IT resources as a foundation for bringing EMS and fire responders, physicians, hospitals, community health programs, federal programs and patients together to design new ways of improving quality and efficiency to benefit patients and taxpayers.

Each Beacon Community has elected specific and measurable improvement goals in each of three vital areas for health systems improvement: quality, cost-efficiency, and population health. The goals vary according to the needs and priorities of each community.

San Diego Specifics
UCSD was awarded $15,275,115 to implement programs that will have a major impact on the delivery of EMS in the San Diego region and lay the groundwork for other EMS data systems. The San Diego grant was submitted with a high priority of the grant to enhance the ability of EMS crews and hospitals to close the loop on prehospital patient data collection and exchange.

The White House announcement states that the San Diego project will “Expand pre-hospital emergency field care and electronic information transmission to improve outcomes for cardiovascular and cerebrovascular disease, empower patients to engage in their own health management through web portal and cellular telephone technology, and improve continuity of care for veterans and military personnel through the Veterans Affairs/Department of Defense Virtual Lifetime Electronic Record initiative.”

In March, the San Diego-based Journal of Emergency Medical Services (JEMS) and Physio-Control, Inc., announced the selection of SDMS electronic documentation manager John Pringle as one of the nation’s top 10 innovators for 2009. Pringle was chosen for his role in developing a system that will allow the secure exchange of patient care data between field provider and hospitals.

Pringle, also a paramedic/firefighter, says “One of the weaknesses we see globally in what we are doing in EMS with our patient electronic care record is the inability to speak to the hospitals or have our records communicated between one another.”

Pringle and his colleagues in the SDMS system worked collectively with the city’s medical director, James Dunford, MD, to design a system that would integrate the San Diego EMS system with the local hospital system.

JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, noted in a special report on Pringle’s EMS 10 Award that “Pringle and his colleagues had the vision and conviction to design a system that could be integrated into hospital systems that already connect to multiple different satellite facilities that work outside the hospital system, such as pharmacies, radiologists and private care practitioners.”

Because these other out-of-hospital resources were already allowed to exchange information with the hospital, even though they were on different record systems, Pringle and his team felt that prehospital EMS crews, already integrated into the hospital system, could also be securely linked into the patient care system, thereby closing the patient’s health care loop.

With the technology in place, SDMS officials approached the UCSD School of Medicine with their idea for a two-way data linkage system between the field and the receiving hospital. According to Pringle, “Once the (UCSD) CEO saw the immense value of the program -- not only on their [hospital] side, but on our side as an EMS provider -- they quickly jumped on board to help us move forward.”

The partnership, and leadership by Dunford, resulted in the grant application to the federal government. SDMS believes the grant will allow them to implement and enhance the unique EMS data system and open the door for other hospitals in the San Diego region to join and benefit from the high technology system.

According to Dunford, “This is a multi-focused project that will impact much more than just EMS IT aspects. The project will involve and assist health care providers from throughout the San Diego County region in efforts to interlink and maximize their data and health care resources and assessment capabilities.”

Heightman, applauding the Obama Administration’s selection of an EMS-focused project, believes the San Diego grant will have a significant impact on the ability of EMS services throughout the nation to improve their ability to deliver emergency medical care.

“All indications are that the federal regulations developed for the new health care legislation will require hospitals to close the gap that currently exists between the transporting EMS service, the agency that starts the patient’s initial care and brings them into the hospital system, and the receiving hospital, so that a complete patient record, as well as complete review and analysis, can occur,” he says. “Experts believe that, in the future, hospitals will not receive complete reimbursement from the federal government if they do not have a complete incident-to-hospital discharge data system.”

Heightman adds, “Currently, in almost every EMS system, after an ambulance delivers an unconscious patient to a hospital and leaves the emergency department, it’s almost impossible for the EMS agency to learn the final discharge diagnosis of their patient. That means that the initial caregiver, the EMS agency, never learns if their patient had a heart anomaly, diabetic or chemical imbalance, or stroke. The lack of this information impedes the full review of the initial care rendered in the field and does not allow EMS training, administrative and quality management staff to analyze their system and make necessary improvements. A two-way data system will not only correct that deficiency, but pave the way for many other EMS systems and hospitals throughout the United States to enhance their delivery systems.”

SDMS ambulances are being equipped with Windows Smartphone technology. Paramedics use handheld devices to enter and send patient information, such as vital signs, to UCSD hospitals.

“Any user in the field can use the device to collect data, create a patient record, and transmit data,” Pringle says. “We have approximately 210 handheld devices that we have deployed on our ambulances and fire engines.”

Once a paramedic in the field creates a report, the record can be updated multiple times, and then given as a final report. Under the new system, the hospital where the patient is transported will also be able to get several preliminary reports and a final report.

“On the hospital side, our data input creates a new electronic record in the emergency room physician’s records system that shows up as a referral,” says Pringle says. “The physician will be able see all of that information in their patient records system and be able to complete the record. If the patient has been there before, the new information will be linked to the existing record, but it will initially show up as a referral from us before we even arrive at the facility.”

In addition, the data-collection software is set up so that insurance and billing information can be gathered and transmitted. This is designed to speed up payment, as well as lessen the need to collect that information at a much later date, saving time and money.

The goal of the SDMS system is to use the latest technology to make it easy for paramedics in the field to transmit current data on a patient directly to the hospital in real time. That will give physicians at the hospital an early look at vital statistics and the status of patients en route. It should also prepare physicians in advance for any special procedures they may encounter

More on the Beacon Communities
In his Tuesday announcement, Vice President Biden said, “These pioneering communities are going to lead the way in bringing smarter, lower-cost health care to all Americans through use of electronic health records. Because of their early efforts, doctors across the country will one day be able to coordinate patient care with the stroke of a key or pull up life-saving health information instantly in an emergency—and for the residents of these communities, that future is about to become a reality.”

David Blumenthal, MD, MPP, national coordinator for health IT says, “Communities will be expected to build on an existing infrastructure of interoperable health IT and standards-based information exchange to show the promise for health IT.

The Beacon Communities will offer evidence that widespread adoption of health IT and exchange of health information is both feasible and improves care delivery and health outcomes. The lessons learned through the program will be a roadmap for other communities to achieve meaningful use on a community-wide basis.”

The Beacon Community awards are part of a $100 billion federal government investment in science, innovation and technology the Administration is making through the Recovery Act to spur domestic job creation in emerging industries and create a long-term foundation for economic growth.

The program was significantly oversubscribed with over 130 applications submitted for the initial 15 awards. Tuesday’s awards are part of the $2 billion effort to achieve widespread meaningful use of health IT and provide for the use of an electronic health record (EHR) for each person in the United States by 2014.

An additional $30 million is currently available to fund additional Beacon Community cooperative agreement awards. An announcement to apply will be made in the near future.

Other Communities/Healthcare Organization Receiving Grants with EMS & ED Implications

Mayo Clinic College of Medicine, Rochester, Minn.
Enhance patient management and, reduce costs associated with hospitalization and emergency services for patients with diabetes and childhood asthma and address reduce health disparities for underserved populations and rural communities.

Western New York Clinical Information Exchange, Inc.
Buffalo, N.Y.
Utilize clinical decision support tools such as registries and point-of-care alerts and reminders and innovative telemedicine solutions to improve primary and specialty care for diabetic patients, decrease preventable emergency room visits, hospitalizations and re-admissions for patients with diabetes and congestive heart failure or pneumonia, and improve immunization rates among diabetic patients.

Rocky Mountain Health Maintenance Organization, Grand Junction, Colo.
Enable robust collection of clinical data from health systems, providers, and hospitals in order to inform practice redesign to improve blood pressure control in patients with diabetes and hypertension, increase smoking cessation counseling, and reduce unnecessary emergency department utilization and hospital re-admissions.

For more information, contact A.J. Heightman at 619-699-6847 or a.j.heightman@elsevier.com or James V. Dunford MD, FACEP at jdunford@ucsd.edu.


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