IMPROVING END-OF-LIFE CARE
the ability to securely access one’s own data. Blue Button, 114 developed in 2010 by the Department of Veterans Affairs, currently provides this capability to the Departments of Defense, Health and Human Services, and Veterans Affairs beneficiaries, and numerous health plans and personal health record vendors are expected to join. The ICEBlueButton app allows EMS personnel and physicians to download the personal health information with the patient’s permission. 115 States and National EMS associations should support and advocate for such changes that would enhance the ability of the secure access to and movement of data across platforms. To overcome the “digital divide” that sometimes exists between behavioral and physical health data, “Trust Networks” need to be established. State and national EMS authorities should provide guidance to local EMS agencies in forming or participating in these networks. The Office of the National Coordinator for Health Information Technology (ONC) directs the federal effort in support of the adoption of HIT and the development of a nationwide health information exchange (HIE). Beginning in 2011, physicians and hospitals that could attest to meaningful use (MU) of electronic health records (EHRs) qualified for incentive payment. MU requires that the use of data improves healthcare quality, safety, efficiency, health disparity, patient engagement, care coordination or population health. 116 While EMS was not included in MU funding, ONC does recognize the value of EMS data as demonstrated by its recent grant award to the California EMS Authority to develop increased utility of information from several health information INCENTIVIZING & FACILITATING THE EXCHANGE OF INFORMATION
exchanges. Even more importantly, as of February 2016, the ONC made MU funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act available to states for expenditures related to HIE integration for a much broader group of providers including EMS (see Appendix). Unfortunately, few states have accessed this opportunity. To unlock the potential of EMS-HIE exchange, states may want to craft enabling legislation. In 2015, California (CA) AB 503 specifically authorized health facilities to release patient-identifiable medical information to a defined EMS provider, agency, or local EMS authority “… to the extent specific data elements are requested for quality assessment and improvement purposes.” The bill also authorized the development of minimum standards for the The role of EMS HIE to improve end-of-life care is receiving increasing attention. Currently Oregon, Idaho, New York, West Virginia, and Utah maintain statewide registries for Physicians Orders for Life- Sustaining Treatment (POLST) . In October 2015, California SB 19 (Wolk) authorized a pilot test for an electronic registry (POLST eRegistry), mandating that providers in the pilot locations submit completed forms to this registry and identifying the CA EMSA as the lead agency for the pilot. In June 2016, the California HealthCare Foundation, in collaboration with the EMSA and the Coalition of Compassionate Care in California, awarded Alameda County, San Diego Health Connect and vendor Vynca a $350,000 grant to develop a pilot, cloud-based ePOLST registry. 1 1 http://www.chcf.org/projects/2016/polst-eregistry
114 “Your Health Data.” HealthIT.gov. Accessed June 28, 2017 https://www.healthit.gov/patients-families/your-health-data 115 “The Easiest Way to be Prepared for an Emergency.” ICEBlueBotton . Accessed June 28, 2017. http://www.icebluebutton.com/ 116 “Meaningful Use Definition.” HealthIT.gov . Accessed June 28, 2017. https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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