attention in the health care world. Currently, many EMS agencies lack the technical knowledge or capabilities to securely share electronic health information. While the electronic patient care record (ePCR) vendors sometimes can fill this role, ultimate responsibility usually lies with the agency. Many entities therefore run into roadblocks related to privacy concerns and compliance issues attributed to the Health Insurance Portability and Accountability Act (HIPAA), largely because they remain unclear as to the specifics of exactly what is or is not prohibited with new technologies, roles and collaborations. Though generally erroneous, some hospitals and other entities claim that they are unable to share outcome data (or allow real-time access to data) with EMS due to HIPAA. As discussed in the legal/ regulatory section, this issue has been addressed by NHTSA and an information sheet providing clarification has been disseminated. telecommunications equipment essential to EMS. Today over 70% of 9-1-1 requests for emergency service originate from personal cell phones, yet the current 9-1-1 system technology cannot handle text, data, images, or video. There are also challenges to accurate caller geolocation and call routing. With few exceptions, public safety answering points (PSAP) are unable to transfer calls from one center to another when volume exceeds the available resources. LIMITED DATA MANAGEMENT CAPABILITY If some of the barriers mentioned above were to be overcome, the EMS industry would still need to address limited technical capabilities of both frontline providers and administrative staff. KEEPING UP WITH CHANGES IN TELECOMMUNICATIONS Technology is rapidly reshaping the
The industry may be challenged by inadequate capabilities or resources to transform the data into worthwhile information that can be used to demonstrate the value of EMS care. Furthermore, if individual providers gain real-time access to hospital data, a potentially significant challenge will be to ensure that the information is packaged in a usable form appropriate to the experience and training of the EMS provider, so that it can best be synthesized into improved clinical decision-making in the field. STRATEGIES TO PROMOTE INNOVATION & CURRENT PROGRESS DATA STANDARDIZATION AND COLLECTION To begin standardizing EMS data collection, any remaining agencies not charting electronically should be incentivized or supported to adopt NEMSIS compliant ePCR’s. Simultaneously, the collective EMS industry should think more strategically about what questions need to be answered by the NEMSIS data and work to improve the utility of the dataset so that it may better inform decision-making, policy, and research. According to a 2013 National EMS Advisory Council (NEMSAC) report on NEMSIS, the “vision has not been fully realized nor have the necessary supporting mechanisms been available at the national, state, and local levels for EMS stakeholders to achieve the full potential of NEMSIS to improve healthcare quality.” 113 To help realize the vision, state governments and EMS agency leadership can pursue updates to the uniform standards that would facilitate inclusion in national data efforts such as the Cardiac Arrest Registry to Enhance Survival (CARES). States could also provide logistical and technical support to
113 “NEMSIS: Achieving its Full Potential for Advancing Healthcare.” The National EMS Advisory Council. Last modified January 30, 2013. http://www.emsa.ca.gov/Media/Default/PDF/NEMSAC%20Final%20Advisory%20on%20NEMSIS.pdf
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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