- An EMS organization in Orange County, CA has begun efforts to engage the recently published ONC Search, Alert, File, and Reconcile (SAFR) model for instant health information exchange that will grant access to patient EHR data at the scene of an emergency.
In July of 2016, San Diego Health Connect received a $592,000 grant from California’s Emergency Medical Services Authority (EMSA) along with One California Partnership Regional Health Information Exchange to implement the ONC SAFR functionality for San Diego, Orange, and Imperial Counties.
To allow for instant access to any patient health record, the EMS organization must first connect to an established HIE.
EMS personnel then use ImageTrend’s Health Information Hub (HIH) as the conduit to allow for bidirectional data exchange between EMS and the HIE. This allows the EMS to alert the HIE when they need a patient’s record.
HIH facilitates these interactions between EMS, the connected HIE, and area hospitals.
EMS use ImageTrend software to search for patients based on demographic information. The EMS tablet is connected to a cloud-based HIE through HIH, which stores the patient’s EHR data.
Access to the patient's EHR allows EMS personnel immediate access to the patient’s medications, allergies, recent hospitalizations, past medical history, and end-of-life decisions allowing for more accurate care delivery and a reduction of patient harm.
"Providing patients' current medical information to all medical providers is essential to provide accurate and high quality care. EMS must often make rapid treatment decisions on the streets or in homes and need access to critical medical history to provide the best care,” said EMSA Director Howard Backer, MD, MPH.
Uninformed initial care decisions can cause serious threats to patient harm. Specifically, inaccurate knowledge of allergies, medications, and pre-existing conditions can cause negative long-term health outcomes.
Distressed patients and families at the scene of an incident may not be equipped to accurately communicate patient health information that could impact care delivery.
The ONC SAFR model emphasizes a longitudinal patient health record to compensate for these patient safety threats and encourage more EMS providers and organizations to establish connections with health information exchanges capable of providing more reliable information.
Once EMS personnel have the patient information necessary to deliver the appropriate care, Hospital Hub alerts the emergency department of the chosen receiving hospital of the incoming patient’s arrival.
Emergency department providers receive pre-arrival information including data gathered from the field in prehospital care reports (PCR) after EMS arrived as well as the patient’s existing medical record.
The complete information is sent automatically in a National EMS Information System (NEMSIS) Continuity of Care Document (CCD) file to the HIE, which forwards this information to the corresponding hospital care provider.
To allow for ongoing quality improvements, HIH receives hospital discharge, insurance, and clinical information from the HIE following patient care. This consistent review of information and care delivery encourages better patient health outcomes.
EMS access to health information exchange improves transitions of care at a pivotal point in care delivery.
The statewide California EMS Information System (CEMSIS) meets national HIT standards for EMS as well as its own standards requiring additional data to meet state regulations.
Presently, California’s EMSA requests all 33 local EMS agencies submit EMS data from their areas to the CEMSIS data repository.
EMSA projects the repository will receive up to four million patient health records each year.
With a robust repository of patient data fueling EMS health organizations, California intends to improve patient health outcomes and avoid detrimental instances of patient harm in prehospital care.