developing PULSE (Patient Unified Lookup System for Emergencies) to support mobile field hospital care sites where EHR may not be immediately available. In addition, web-based technology will provide rapid authentication of credentials for health care volunteers who need rapid access to patient records during disasters. TRANSFORMING DATA INTO MEANINGFUL INFORMATION To complement technology, EMS must steward the development and adoption of meaningful measures of quality. In this respect, the EMS Compass initiative 121 is vital, as it seeks to define EMS measures relevant to agencies, regulators, and patients. More broadly, EMS leaders should advocate for incentivization of the meaningful use of EMS data, whether that be through state or federal governmental programs, or by working with health plans and potential beneficiaries of the information that might be gleaned by analyzing, connecting, and reporting EMS data. The power of EMS data to augment population- based health analysis and intervention is just being unlocked. Within the storage centers of emergency communication centers reside terabytes of valuable data. Recent studies have begun to demonstrate that geocoded, atomic clock-synchronized fire and EMS data can inform on better approaches to the management of sudden cardiac arrest, 122 major trauma, substance abuse, 123 diabetes, STEMI, and a range of other health issues. For example, when EMS data were explored with GIS analytic tools, it became evident that socioeconomic variables within communities significantly influence
implementation of data collection. In 2016, AB 1129 117 amended the CA Health and Safety Code to require that local EMS authorities use the most current version of NEMSIS and that they submit data to the CA EMS Information System (CEMSIS). The CA EMS Authority now hosts annual EMS-HIE summits to explore topics ranging from national HIT interoperability and Medi-Cal (Medicaid) funding to the use of stroke registries linked to regional HIEs to improve population health. 118 Other state and regional HIEs have initiated EMS data exchanges as well. In 2010, the Rochester Regional Health Information Organization began integrating EMS data to improve care coordination and now receives data from eighteen regional EMS services. 119 South Metro Fire Rescue Authority joined the Colorado HIE, CORHIO, to enable paramedics to receive real-time hospital and lab information via a web portal, 120 permitting query for patient information at dispatch and patient record access and data transmission to hospitals en route. In 2015, MedStar (the Metropolitan Ambulance Authority that serves Fort Worth and surrounding areas) adopted a cloud-based health care integration engine called Infor® Cloverleaf to exchange ePCR data with emergency departments. Cloverleaf converts EMS data (XML format) to a hospital-compatible (HL7) format for delivery to hospital EMRs with the eventual goal of bi- directional data exchange. Valuable use cases for EMS-HIE exchange include the potential to improve regional preparedness for disasters. For example, based upon an ONC- sponsored analysis of need, the CA EMSA is
117 “An act to add Section 1797.227 to the Health and Safety Code, relating to emergency medical services.” California Legislative Information . Last modified September 20, 2015. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB1129 118 “3rd California HIE in EMS Summit Agenda.” HIE In EMS in CA. Last modified April 5, 2016. https://hieinemsinca.com/2016/04/05/3rd-california-hie-in-ems-summit-agenda/ 119 “Provider Portal.” Rochester RHIO. Accessed June 28, 2017. http://providerportal.grrhio.org/Data%20Providers.aspx 120 “Transforming Emergency Care.” CORHIO . Accessed June 28, 2017. http://www.corhio.org/services/health-information-exchange-services/for-emergency-responders 121 http://www.emscompass.org/ 122 Lam, Sean Shao Wei, Ji Zhang, Zhong Cheng Zhang, Hong Choon Oh, Jerry Overton, Yih Yng Ng, and Marcus Eng Hock Ong. “Dynamic ambulance reallocation for the reduction of ambulance response times using system status management.” The American Journal of Emergency Medicine 33, no. 2 (2015): 159-166.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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