If you are one of the EMS agencies that has already converted to electronic patient care reports (ePCRs)–congratulations. Now, get off your laurels because you have a whole lot more work to do. The next step in the patient care technological evolution is linking data gathered by the various healthcare providers to create two-way feedback.
In a perfect world, the ePCR data from EMS and the electronic medical records (EMRs) from the hospitals would be consolidated into a single data repository that could be accessed by any of the provider entities for a variety of reasons, including patient care quality improvement programs, billing and research. The problem is that, in most systems, there isn’t just one EMS agency and one hospital. There are multiple agencies and hospitals, each with different data systems that can’t interface with each other. The solution is to translate all of the data into a common language that can then be distributed to the various end users in a format they can read, providing valuable feedback of patient information.
Unfortunately, integrating digital data is not as easy as it sounds. Each software program and piece of hardware has its own issues regarding proprietary operating systems, and information technology (IT) “fiefdoms” that must be addressed. Even if these monumental hurdles are addressed, then enormous amounts of data must be effectively and securely transmitted 24/7.
The federal government has made a run at the issue by developing and provide assists hospitals in meeting state and federal mandates for patient outcome initiatives and creates a platform for reducing repetitive tests and reducing hospital visits. Both represent a pot of money that hospitals can’t ignore.
A new, pressing issue that argues for EMS participation in data sharing is healthcare reform. In the near future, not only will EMS be expected to prove that it makes a difference in patient outcomes, prehospital agencies will be required to prove they didn’t harm the patient prior to arrival at the hospital. As hospitals come under increasing scrutiny for hospital-acquired infections and complications, such as respiratory infections resulting from intubations, administrators may begin to more closely examine EMS practices. EMS agencies must be able to provide specific data regarding the care of each patient.
How does it work?
To the uninitiated, it may seem easy. Data is data, right? Not really. “The healthcare system has created a Tower of Babel,” says Jonathan Dampier, vice president of marketing at ESO Solutions Inc., an Austin, Texas-based company that offers software solutions for the prehospital healthcare industry. What is needed is a translator.
ESO is the first company to bring to market a solution for EMS agencies that connects them to an HIE hospital or hospital system. They call it the Hospital Data Exchange (HDE).
The HDE is a software platform that acts as a “universal translator” allowing EMS agencies, hospitals and other key healthcare players to share NEMSIS-compliant data. The HDE is able to pass digital patient care information, including ePCRs, EMRs and even test results, such as ECGs, back and forth from the EMS agency and hospitals, regardless of the platform used or the vendor. The HDE transforms the data into a format that can be accepted by the intended recipient in real time, and–this is important–in the system they are used to seeing it. Once an agency or hospital is linked through the translator system, it can send and receive data nationwide.
Information is securely stored in a data repository and can be accessed at any time, allowing for aggregated benchmarking and customized patient trend reports for EMS agencies; and access to raw EMS data for trauma, STEMI or stroke registries for hospitals. There is even an audit log that shows who has accessed the information.
The cost for an agency to participate is based on an annual fee that provides unlimited data and full access. A second fee is assessed per patient record.
Some EMS agencies have sought grants to help pay for the system. Others have created joint partnerships with the hospitals in their service area in order to share costs. Still others have joined forces and are working as a region, using the economies of scale to lower the price. Many EMS agencies say that simply gaining access to correct billing information will cover their portion of the cost of the program.
The first step is to connect to hospitals with a goal of eventually connecting to the rest of the local or regional healthcare community (physicians, laboratories, etc.). Using a common language within the healthcare system, EMS agencies can benchmark regionally, statewide and nationally, focusing on improvement initiatives and track progress. The final stage is what many see as the Holy Grail for EMS–applied research.
For EMS agencies that have yet to convert to ePCRS, the time is now. “Digital patient care reports are the first step in connecting into the healthcare system. It’s the foundation you will lay in getting a foot in the door and preparing for healthcare reform,” says Dampier. “It’s a fairly simple first step.”
Other companies besides ESO are working to develop programs similar to HDE. With a federal goal set for digitizing healthcare records by 2015, it is likely that these programs will be appearing soon.