ECON Query Profile

1. Proposed Profile: Automotive ECON Query Profile for Emergency Responders

• Proposal Editor: Lawrence Williams
• Profile Editor: Lawrence Williams
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: IT Infrastructure

Summary

There is consensus among the emergency healthcare community that the widespread adoption of health information technology by the automotive industry will lead to safer, more effective health care for crash victims following a motor vehicle traffic crash. The quid pro quo for investing in such systems is the improvement of patient care and safety for the 250,000 crash victims (6,000,000 worldwide) who sustain life-threatening injures annually as a result of motor vehicle crashes.

Specifically, there is a challenge is to get crash victim-specific health information, [e.g.; Emergency Contact / Next-Of-Kin (ECON) data and/or Personal Health Record (PHR) info.], into the hands of on-site emergency responders quickly and securely to support a fully interoperable and mutually supportive response through the continuum of emergency healthcare.

The relevant standard is (IHE PDQ). The CD-TC working on HITSP’s Emergency Responder Use Case has discussed the possibility of a simple IHE PDQ NOK/Emergency Contact extension that would enable emergency responders (Patient Demographics Consumer) to query / retrieve emergency contact / next-of-kin data from a national ECON directory (Patient Demographics Supplier) of motor vehicle owner emergency contact information.

2. The Problem

Contrary to popular belief, emergency responders cannot quickly gain access to a motor vehicle crash victim emergency contact and/or next-of-kin data following a traffic crash, especially in immediacy-type situations.

Typically, emergency responders resort to searching personal belongings (e.g. wallet, glove compartment, cell phone, etc.) for leads to the identity of an emergency contact and/or next-of-kin. Still, many instances involve obstacles, such as unlisted phone numbers which might require a warrant for release in certain jurisdictions. Meanwhile, hours elapse as family members are not notified and crash victims enter the emergency healthcare system without the benefit of family members to advocate on their behalf and/or provide added-value information (medical history, medications, allergies) to enhance the medical care and safety of crash victims.

3. Key Use Case

Due to the absence of an IHE PDQ NOK/Emergency Contact query process enabling on-site emergency responders (Patient Demographics Consumer) to rapidly and securely access the ECON directory (Patient Demographics Supplier), the CD-TC working on HITSP’s Emergency Responder Use Case has listed the ECON query as a capability GAP and is currently seeking the assistance of an appropriate SDO to help harmonize a standard for the ECON query process. The CE-TC has discussed several possibilities for standard harmonization, including the creation of a simple PDQ NOK/Emergency Contact extension for the ECON directory.

The CD-TC believes IHE is the most logical SDO environment to provide the standard harmonization, detailed implementation and testing process (i.e.; 2009 Connectathon) critical for the ECON directory validation and standards-based interoperability for the Emergency Responder Use Case.

The following CD-TC Emergency Responder Use Case workflow and associated sequence diagram explain the emergency responder requirements for the ECON directory as it relates to on-site care at the scene of a motor vehicle crash:

1. On-Site care providers (police, EMS, fire) arrive.

2. Crash victim is seriously injured and unconscious. EMS focus is on the delivery of medical care and police are responsible for confirming the identity of the unidentified crash victim and notifying an emergency contact / next-of-kin.

3. Police query an automotive-based Emergency Contact Registry (ECON) [6.1.3.1 – GAP]. The ECON query is successful and police are able to obtain the motor vehicle owner emergency contact name(s) and phone number(s) to assist with crash victim identification, expedite family member reunification and next-of-kin notification

4. Crash victim identification is confirmed, police pass the crash victim ID information to EMS. EMS sends a query to a Patient Identification Service (PID Service) to determine the crash victim’s ID for the Personal Health Record (PHR) and/or Electronic Health Record (EHR) [HITSP Patient ID Cross-Referencing Transaction Package (HITSP/TP22) (IHE PIX Query). After obtaining the proper ID for the PHR/EHR, EMS queries/retrieves the needed documents [6.1.3.1 – HITSP Manage Sharing of Documents Transaction Package (HITSP/TP13) (IHE XDS)

4. Standards & Systems

The relevant standard is (IHE PDQ). The CD-TC has discussed the possibility of a simple IHE PDQ NOK/Emergency Contact extension that would enable emergency responders (Patient Demographics Consumer) to query / retrieve emergency contact / next-of-kin data from the ECON directory (Patient Demographics Supplier) of motor vehicle owner emergency contact information.

5. Technical Approach

An operationally logical technical approach to this problem is possible today because of the existence of a North America-wide secure multi-directional communications network for public safety called the National Law Enforcement Telecommunications System (Nlets).

Specifically, the technical approach could work as follows: On-site emergency responders (Patient Demographics Consumer) would be able to run a NOK/Emergency Contact PDQ extension query of the ECON directory (Patient Demographics Supplier) over the Nlets network based upon the Vehicle Identification Number (VIN) and/or Registration Plate as a unique identifier. Nlets will return within seconds (provided the vehicle owner pre-registered their emergency contact / next-of-kin data with the ECON directory) vital data (i.e., emergency contact name(s) phone number(s) to help accomplish unidentified crash victim identification, next-of-kin notification and family member reunification.

This would facilitate rapid acquisition and exchange of data from the ECON directory and give possibility for emergency responders to accomplish family member notifications and reunifications in a timelier manner.

Furthermore, utilizing the same IHE PDQ NOK/Emergency Contact extension query of the ECON directory at Nlets the capability could be expanded at some point in the future to provide the authorization and authentication mechanism for emergency responders to query for a motor vehicle owner’s Personal Health Record (PHR), which has also been identified by HITSP as a capability GAP for the Emergency Responder Use Case.

Existing actors

Patient Demographics Supplier & Patient Demographics Consumer

New actors

None

Existing transactions

<Indicate how existing transactions might be used or might need to be extended.>

New transactions (standards used)

Patient Demographics Supplier NOK/Emergency Contact Extension Patient Demographics Consumer NOK/Emergency Contact Extension

Impact on existing integration profiles

Minor update to PDQ

New integration profiles needed

None

Breakdown of tasks that need to be accomplished

TBD

6. Support & Resources

There is a collaborative effort underway between the automotive manufacturers, emergency health IT, and public safety stakeholders to enable standards-based access and exchange of key health information, (i.e., ECON, PHR) at the scene of a motor vehicle crash to enhance patient care and safety.

In addition, it is important to note that legislation has been passed in California and Illinois requiring reasonable efforts be made to contact next-of-kin of motor vehicle crash victims within 24 hours. Similar legislation in Minnesota, Texas, Utah and Hawaii has been passed regarding a timetable for notification. Federal legislation is pending.

7. Risks

The risk associated with IHE not proceeding forward is that a fully interoperable and mutually supportive response through the continuum of emergency healthcare for motor vehicle crash victims will not be achieved. Silos of health information with no standards-based connectivity will emerge creating further obstacles to the delivery of safe and effective emergency healthcare for motor vehicle crash victims.

8. Open Issues

None identified at this time

9. Tech Cmte Evaluation

<The technical committee will use this area to record details of the effort estimation, etc.>

Effort Evaluation (as a % of Tech Cmte Bandwidth):

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA