Prehospital Care Report

1. Proposed Profile: Prehospital Care Report – Integration and Reporting of Emergency Responder Electronic Health Record (ER-EHR) Data

• Proposal Editor: Keith Boone
• Profile Editor(s): Lawrence Williams, Todd Rothenhaus
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: PCC

2. The Problem

There is consensus among the emergency health care community that the widespread adoption of Health Information Technology (HIT) by emergency responders at the scene of a motor vehicle crash holds the promise to improve post-crash care and survivability for crash victims on our nation’s roadways.

The quid pro quo for developing and deploying emergency responder on-scene HIT systems is the improvement of safety, care, and outcomes for the nearly 250,000 crash victims (6,000,000 worldwide) who sustain life-threatening injuries annually as a result of motor vehicle crashes.

Persistent deficiencies in the quality of emergency health care for motor vehicle crash victims is attributable in part to the continued reliance by many emergency responders and emergency room clinicians on archaic, paper-based methods of communicating crash victim key health information, such as Emergency Contact Information (ECON) and Personal Health Record (PHR) data.

Under a worst-case scenario, an emergency responder at the scene of a motor vehicle crash attempting to stabilize an unconscious crash victim or an emergency room clinician attempting to treat an unconscious crash victim would have no idea what pertinent medical conditions the crash victim might have or which medications he or she might be taking, nor contact information for an emergency contact / next-of-kin who might be able to provide such data. This lack of data increases the risks of adverse reactions to treatment or medication that threaten the safety, care, and outcome for crash victims.

Specifically, the current HIT challenge is:

1) Emergency Medical Service (EMS) Responder real-time access to crash victim ECON / PHR data at the scene of a motor vehicle crash

2) Electronic integration of ECON / PHR data into EMS pre-hospital patient care reporting (PCR) systems supporting real-time messaging of crash victim ECON / PHR data to Emergency Department Clinicians

At present, ECON / PHR data obtained by emergency responders prior to arrival at the emergency room is often conveyed as a handwritten paper document or in electronic form after the fact.

3. Key Use Case

Current Use Case:

1. A patient is involved in a motor vehicle crash.
2. Police are first to arrive on the scene and begin process of patient identification.
3. An EMS unit is dispatched to the scene.
4. EMS personnel treat the patient for injuries.
5. Patient is transported to the nearest hospital emergency department.
6. Police attempt to notify family members.
7. Upon arrival of the patient to the Emergency Department, treatment for injuries continues.
8. The patient is identified in the Emergency Department information system (EDIS).
9. EMS personnel complete their run report, and provide a paper copy to the Emergency Department.
10. Emergency Department personnel attempt to contact family members to obtain more information about the patient.
11. Family members contact the hospital, and try to obtain information about the patient's status.

Improved Use Case:

1. A patient is involved in a motor vehicle crash.
2. Police are first to arrive on the scene and begin process of patient identification (See IHE ITI ECON Profile Proposal for Motor Vehicle Crash Victims).
3. An EMS unit is dispatched to the scene.
   1. Patient identity data is sent to the Emergency Responder EHR (ER-EHR) system.
   2. The ER-EHR system retrieves patient key health information from an ECON / PHR system.
4. EMS personnel treat the patient for injuries.
   1. Treatment details are recorded in the ER-EHR system.
5. Patient is transported to the nearest hospital emergency department
   1. Transport details are recorded in the ER-EHR system.
6. Police attempt to notify family members (See IHE ITI ECON Profile Proposal for Motor Vehicle Crash Victims).
7. Upon arrival of the patient to the Emergency Department, treatment for injuries continues.
   1. An electronic pre-hospital care record (PCR) of the treatment, personal health information, emergency contact info. / next-of-kin data, is provided upon delivery to the facility.
8. The patient is identified in the Emergency Department information system.
9. EMS personnel complete their run report, and information in the PCR is used to electronically update the Emergency Department Information System.
10. Emergency Department personnel attempt to contact family members to obtain more information about the patient (See IHE ITI ECON Profile Proposal for Motor Vehicle Crash Victims).
11. Family members contact the hospital, and try to obtain information about the patient status (See IHE ITI ECON Profile Proposal for Motor Vehicle Crash Victims).

4. Standards & Systems

• Emergency Responder Electronic Health Record (ER-EHR) System
• Emergency Department Information System (EDIS)
• Emergency Contact Registry (ECON) System - See ECON IHE ITI Profile Proposal
• Personal Health Record (PHR) System(s)

• HL7 CDA Release 2.0
• HL7 Version 2.X ADT
• ASTM/HL7 Continuity of Care Document
• VEDS
• LOINC
• HL7 Ambulation Attachment Implementation Guide

5. Discussion

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