Prehospital Care Report

1. Proposed Profile: Prehospital Patient 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 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

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