Difference between revisions of "Prehospital Care Report"

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==1. Proposed Profile: ''Prehospital Care Report – Integration of Motor Vehicle Crash Victim ECON / PHR Data''==
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==1. Proposed Profile: ''Prehospital Patient Care Report – Integration and Reporting of Emergency Responder Electronic Health Record (ER-EHR) Data''==
  
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* Proposal Editor: ''[[User:Kboone|Kboone]]''
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* Proposal Editor: ''[[User:Kboone|Keith Boone]]''
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* Profile Editor: ''TBD''  
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* Profile Editor(s): ''[[User:LWilliams|Lawrence Williams]], [[User:Trothenh|Todd Rothenhaus]]''  
 
* Date:    N/A (Wiki keeps history)
 
* Date:    N/A (Wiki keeps history)
 
* Version: N/A (Wiki keeps history)
 
* Version: N/A (Wiki keeps history)
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==2. The Problem==
 
==2. The Problem==
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There is consensus among the emergency healthcare community that the widespread adoption of Health Information Technology (HIT) by the automotive industry will lead to a faster and more appropriate response.  This will lead to safer, more effective health care for crash victims following a motor vehicle crash.  
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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 investing in such 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.
+
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.
  
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Persistent deficiencies in the quality of emergency healthcare 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.   
+
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.
−
 
+
   
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Under a worst-case scenario, an emergency room clinician in an out-of-town emergency room trying to treat an unconscious crash victim would have no idea what other 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.
+
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.
−
 
+
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Specifically, the current HIT challenge is 1) Emergency Responder real-time access and exchange of crash victim ECON / PHR data at the scene of a motor vehicle crash**, and; 2) Electronic integration of ECON / PHR data into Ambulance Information System (AIS) pre-hospital care reports 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.
+
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
  
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** See Automotive ECON System infrastructure profile proposal in ITI
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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==
 
==3. Key Use Case==
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Current Use Case:
 
Current Use Case:
  
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1. A patient is involved in a motor vehicle crash.
+
 +
1.) A patient is involved in a motor vehicle crash and rendered unconscious.
 +
 +
2.) Police are first to arrive on the scene and attempt to identify patient by searching motor vehicle registration records.
 +
 +
3.) An EMS unit is dispatched to the scene.
 +
 +
4.) EMS personnel stabilize unidentified, unconscious patient and treat for injuries.
 +
 +
5.) Unidentified, unconscious patient is transported to the nearest hospital emergency department.
 +
 +
6.) Upon arrival of the unidentified, unconscious patient to the Emergency Department, treatment for injuries continues.
 +
 +
7.) EMS personnel complete the run report, and provide a paper copy to the Emergency Department.
 +
 +
8.) Emergency Department personnel attempt to identify patient by searching personal effects for clues to patient identity to help track down family members to obtain more information about the patient and facilitate family member reunification.
 +
 
  
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2. Police are first to arrive on the scene and begin process of patient identification.
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Improved Use Case:
  
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3. An ambulance is dispatched to the scene.
 
 
   
 
   
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4. Ambulance personnel treat the patient for trauma and shock, and note signs of internal injuries.  
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1.) A patient is involved in a motor vehicle crash and rendered unconscious.
 +
 +
2.) Police are first to arrive on the scene
  
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5. Patient is transported to the emergency room at the nearest hospital.
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(a) Police utilize the vehicle identification number (VIN#) as a unique identifier to query a federated emergency contact registry operated and managed by the National Law Enforcement Telecommunications System (Nlets) to obtain the vehicle owner emergency contact name(s) and phone numbers(s) (i.e., ECON dataset). Vehicle owner emergency contacts provide assistance in identifying unidentified crash victims, as well as, provide additional knowledge about certain aspects of victim-specific health information, such as pre-existing conditions, allergies, medications, primary care physician, etc. (See HITSP Emergency Responder Electronic Health Record Interoperability Specification “ER-EHR IS-04”)
  
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6. Police attempt to notify family members.  
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3.) An EMS unit is dispatched to the scene
 +
 +
(a) Police electronically pass gathered patient-specific ECON dataset and historical health information to EMS.  The gathered information includes an electronic pointer to the availability and location of a Personal Health Record (PHR).
 +
 
 +
(b) EMS electronically records the Patient ID, ECON, and PHR ‘pointer’ information in the Pre-Hospital Patient Care Report (PCR) system, enabling EMS to send a query (or automatically query a Patient Identification Service) to determine the location of the PHR and/or EHR data. (See IHE ITI ID/ECON White Paper “Template for Law Enforcement to Hand Over Crash Victim Identity (ID) and Emergency Contact Information (ECON) to EMS Providers Following a Motor Vehicle Crash").
  
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7. Upon delivery of the patient to the emergency room, treatment for internal injuries is begun.  
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4.) EMS provides personalized care to stabilize patient and treat for injuries.
 +
 
 +
(a) Treatment details are recorded in the PCR system.
 +
 +
5.) Patient is transported to the nearest hospital emergency department.
 +
 +
(a) Transport details are recorded in the PCR system.
 +
 +
6.) Police utilize VIN# ECON information to expedite family member reunification and/or next-of-kin notification.
 +
 +
7.) Upon arrival of the patient to the Emergency Department, treatment for injuries continues.
 +
 +
(a) EMS (PCR) of the treatment, personal health information, emergency contact info. / next-of-kin data, is provided upon delivery to the facility.
  
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8. The patient is identified in the Emergency Department information system.  
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8.) EMS personnel complete their run report, and information in the PCR is used to electronically update the Emergency Department Information System (EDIS).
 +
 +
9.) Emergency Department personnel utilize VIN# ECON information in EDIS to contact family members to obtain more information about the patient and facilitate family member reunification.
 +
 +
10.) Family members arrive at hospital.
  
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9. Ambulance personnel complete their run report, and provide a copy to the emergency department.
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==4. Standards & Systems==
  
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10. Emergency Department personnel attempt to contact family members to obtain more information about the patient.
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National Law Enforcement Telecommunications System (Nlets)
  
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11. Family members contact the hospital, and try to obtain information about the patient status.
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Federated Emergency Contact Registry System (VIN# ECON)
  
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''<Feel free to add a second use case scenario demonstrating how it “should” work.  Try to indicate the people/systems, the tasks they are doing, the information they need, and hopefully where the information should come from.>''
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Personal Health Record (PHR) System(s)
  
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# A patient is involved in a car accident. 
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Emergency Responder Electronic Health Record (ER-EHR) System
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# An ambulance is dispatched to the scene. 
 
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#* Electronic information is sent to the Ambulance Information System (AIS) identifying the location of the scene, and the patient identity.
 
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#* The AIS retrieves patient history information from a PHR.
 
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# Ambulance personnel treat the patient for trauma and shock, and note signs of internal injuries. 
 
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#* Treatment details are recorded in the AIS.
 
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# Patient is transported to the emergency room at the nearest hospital.
 
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#* Transport details are recorded in the AIS.
 
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#* Ambulance Attendant updates treatment details in the AIS.
 
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# Police attempt to notify family members.
 
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#* See Emergency Contact Registry in ITI, not really relevant to this profile.
 
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# Upon delivery of the patient to the emergency room, treatment for internal injuries is begun.
 
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#* An electronic record of the treatment is provided upon delivery to the facility.
 
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# The patient is identified in the Emergency Department information system.
 
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#* Information already provided by the ambulance attendant is used to quickly update the Emergency Department records.
 
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# Ambulance personnel complete their run report, and provide a copy to the emergency department. 
 
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# Family members contact the hospital, and try to obtain information about the patient status.
 
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#* See Emergency Contact Registry in ITI, not really relevant to this profile.
 
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# At the same time, emergency department personnel are attempting to contact family members to obtain more information about the patient.
 
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#* See Emergency Contact Registry in ITI, not really relevant to this profile.
 
  
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==4. Standards & Systems==
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CCHIT Personal Health Record Certification Criteria
 +
 +
Emergency Department Information System (EDIS)
 +
 +
HITSP Emergency Responder Use Case (IS-04)
  
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''<List existing systems that are/could be involved in the problem/solution.>''
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HL7 CDA Release 2.0
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* Ambulance Information System
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* Emergency Department Information System
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HL7 Version 2.X ADT
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+
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''<If known, list standards which might be relevant to the solution>''
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ASTM/HL7 Continuity of Care Document
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* HL7 CDA Release 2.0
+
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* HL7 Version 2.X ADT
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LOINC
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* ASTM/HL7 Continuity of Care Document
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* NEMSIS
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HL7 Ambulation Attachment Implementation Guide
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* VEDS
 
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* LOINC
 
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* HL7 Ambulation Attachment Implementation Guide
 
  
 
==5. Discussion==
 
==5. Discussion==

Latest revision as of 13:06, 6 October 2008


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

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 and rendered unconscious.

2.) Police are first to arrive on the scene and attempt to identify patient by searching motor vehicle registration records.

3.) An EMS unit is dispatched to the scene.

4.) EMS personnel stabilize unidentified, unconscious patient and treat for injuries.

5.) Unidentified, unconscious patient is transported to the nearest hospital emergency department.

6.) Upon arrival of the unidentified, unconscious patient to the Emergency Department, treatment for injuries continues.

7.) EMS personnel complete the run report, and provide a paper copy to the Emergency Department.

8.) Emergency Department personnel attempt to identify patient by searching personal effects for clues to patient identity to help track down family members to obtain more information about the patient and facilitate family member reunification.


Improved Use Case:


1.) A patient is involved in a motor vehicle crash and rendered unconscious.

2.) Police are first to arrive on the scene

(a) Police utilize the vehicle identification number (VIN#) as a unique identifier to query a federated emergency contact registry operated and managed by the National Law Enforcement Telecommunications System (Nlets) to obtain the vehicle owner emergency contact name(s) and phone numbers(s) (i.e., ECON dataset). Vehicle owner emergency contacts provide assistance in identifying unidentified crash victims, as well as, provide additional knowledge about certain aspects of victim-specific health information, such as pre-existing conditions, allergies, medications, primary care physician, etc. (See HITSP Emergency Responder Electronic Health Record Interoperability Specification “ER-EHR IS-04”)

3.) An EMS unit is dispatched to the scene

(a) Police electronically pass gathered patient-specific ECON dataset and historical health information to EMS. The gathered information includes an electronic pointer to the availability and location of a Personal Health Record (PHR).

(b) EMS electronically records the Patient ID, ECON, and PHR ‘pointer’ information in the Pre-Hospital Patient Care Report (PCR) system, enabling EMS to send a query (or automatically query a Patient Identification Service) to determine the location of the PHR and/or EHR data. (See IHE ITI ID/ECON White Paper “Template for Law Enforcement to Hand Over Crash Victim Identity (ID) and Emergency Contact Information (ECON) to EMS Providers Following a Motor Vehicle Crash").

4.) EMS provides personalized care to stabilize patient and treat for injuries.

(a) Treatment details are recorded in the PCR system.

5.) Patient is transported to the nearest hospital emergency department.

(a) Transport details are recorded in the PCR system.

6.) Police utilize VIN# ECON information to expedite family member reunification and/or next-of-kin notification.

7.) Upon arrival of the patient to the Emergency Department, treatment for injuries continues.

(a) EMS (PCR) of the treatment, personal health information, emergency contact info. / next-of-kin data, is provided upon delivery to the facility.

8.) EMS personnel complete their run report, and information in the PCR is used to electronically update the Emergency Department Information System (EDIS).

9.) Emergency Department personnel utilize VIN# ECON information in EDIS to contact family members to obtain more information about the patient and facilitate family member reunification.

10.) Family members arrive at hospital.

4. Standards & Systems

National Law Enforcement Telecommunications System (Nlets)

Federated Emergency Contact Registry System (VIN# ECON)

Personal Health Record (PHR) System(s)

Emergency Responder Electronic Health Record (ER-EHR) System

CCHIT Personal Health Record Certification Criteria

Emergency Department Information System (EDIS)

HITSP Emergency Responder Use Case (IS-04)

HL7 CDA Release 2.0

HL7 Version 2.X ADT

ASTM/HL7 Continuity of Care Document

LOINC

HL7 Ambulation Attachment Implementation Guide

5. Discussion

<Include additional discussion or consider a few details which might be useful for the detailed proposal>

<Why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>
<What might the IHE technical approach be? Existing Actors? New Transactions? Additional Profiles?>
<What are some of the risks or open issues to be addressed?>


<This is the brief proposal. Try to keep it to 1 or at most 2 pages>


<Delete this Category Templates line since your specific Profile Proposal page is no longer a template.>

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