Health IT

Innovations for the ambulance: One state’s efforts to push EMRs to EMS

When an EMS crew is dispatched to a scene where, say, a patient is unconscious in his home, the crew must often rely on information provided by the person who called 9-1-1, or in some cases, an antiquated Vial of Life method to learn about the patient’s health history — whether he has a history […]

When an EMS crew is dispatched to a scene where, say, a patient is unconscious in his home, the crew must often rely on information provided by the person who called 9-1-1, or in some cases, an antiquated Vial of Life method to learn about the patient’s health history — whether he has a history of stroke, or if he’s allergic to certain medications.

In an effort to better equip paramedics with helpful information that would improve emergency care, a team of organizations in Indiana is using a system to push out medical records in the state’s health information exchange to tablets used by emergency care workers in ambulances.

Started in 2009, the Indianapolis Emergency Medical Services Electronic Patient Care Reporting/Indiana Network for Patient Care program is a collaboration between the Indianapolis EMS, the Regenstrief Institute, the Indiana Health Information Exchange and Medusa Medical Technologies. It’s a fancy name for a simple concept — those groups took the state’s existing health information exchange infrastructure and modified the software it uses to allow paramedics to access that information from the field.

Indianapolis EMS ambulances are equipped with tablets that connect to the state’s regional health information organization database. This comes in handy in cases where paramedics don’t feel like they can trust a patient to be truthful about his or her medical history, or when patients are unable to recall or relay important health information at the scene, said John Finnell, Regenstreif Institute investigator and associate professor of emergency medicine at the Indiana University School of Medicine.

Chuck Kearns, a board member of the National Association of Emergency Medical Technicians and a paramedic for 30 years, said that kind of information is invaluable to emergency workers. “Paramedics don’t have a lot of diagnostic tools that hospitals have,” he said. “We don’t have X-rays or labs or CT scans, so we’re at a big disadvantage until we get the patient to the hospital, and anything we can have that tells us the patient’s story is fabulous.”

It also saves time when patients need to be brought back to a hospital’s emergency department because paramedics can bring in the tablet with a patient’s record pulled up upon arrival, so doctors don’t need to wait for registration and paperwork, Finnell said.

Many EMS teams across the country use computer applications that allow them to see certain information about a patient and whether he has been transported before. But what makes this particular program interesting (it was honored last month by the Computerworld Honors Program at a ceremony in Washington, D.C.) is its scope and ability to provide real-time data to paramedics in the field.

Indiana has a relatively well-developed statewide health information exchange that gives many of the state’s health systems access to records from multiple other systems — what Finnell equates to about 75 percent of the state’s health data — by connecting to just one point.

“Other places are taking baby steps, or have systems like Kaiser or VAs that aren’t also connected to local systems,” he said.

But it’s still early in the game and there are limitations to this system that will need to be worked out over time. For example, ambulances don’t have access to a patient’s full records — instead they have access to “patient data abstracts” that include information about past doctor and hospital visits, existing conditions, allergies and prescriptions.

Finnell said EMS workers provided input when the system was designed and requested some information that just couldn’t be worked into the patient data abstract. “They had requests that we hadn’t considered, like next of kin information in the case of a fatality, body fluid precautions, insurance and payer information,” he said. “Unfortunately, those things just aren’t captured or updated regularly.”

Officials also haven’t yet been able to integrate the electronic patient care report generated by the EMS into the EMR system after a visit. For now, that EMS data lives on a separate server.

“The next logical step in all of this is where the ambulance’s electronic patient care report will be able to be transmitted right into hospitals’ medical records system,” Kearns said. “There’s beta tests going on right now of systems in ambulances that are even using telemetry to send patient info to the hospital as the paramedics are collecting it, so it’s transmitted in real time in advance of the patient arriving at the ED.”

The ability to connect EMS to the EMR system is exciting in that the integration of this data could also lead to other methods of improving care. For example, if paramedics know a patient’s history, can they address other issues – like giving a vaccination – while they’re with a patient, to save a visit to the doctor?

There’s plenty of room for innovation in health IT and emergency care, but the big question mark that remains for this program and for HIEs in general is funding. Federal dollars that have been earmarked for health IT initiatives won’t keep coming indefinitely, and some states are struggling to find sustainable models to keep HIEs running. Other states don’t even have functioning HIEs, which would make it harder for paramedics to access certain patients’ complete health data.

“When patients see a computer, they think their information is available — they don’t understand that medical data is siloed,” Finnell said. “Most hospitals are moving toward an electronic interface. For us, the next step was pushing that data to paramedics.”