The Zen Healthcare IT team has worked with multiple counties across the country to solve complex interoperability challenges. The obstacles can be daunting, but the benefits are huge!

First responders (EMS Providers) are tasked with making quick, life-saving decisions every day. They often have to do so without the needed health information in emergency situations. The exchange of health information is critical to ensure that when the patient arrives at the emergency room, as much information is provided to the healthcare team as possible quickly and efficiently. This is why it is absolutely essential that the EMS systems that are moving to mobile integrated care models are better integrated with the health care, public health, and public safety sectors. 

In addition, EMS providers are also capturing important clinical information about the patient.

“EMS Data [are] health care data. Information from EMS is an important part of the medical record and it has incredible value to patients and downstream health providers. Seamlessly integrating this information and making it available in electronic health records is vital to the continuum of care, but that has not yet been realized in much of the country”  

– Noah Smith, EMS Specialist, Nation Traffic Safety Administration (NHTSA) Office of Emergency Medical Services, U.S. Department of Transportation. ¹

But why is it challenging to achieve interoperability between EMS providers and other healthcare stakeholders?

EMS Acronyms Overview

First, there is a whole new set of acronyms to learn. 

EMS CAD Systems (Computer Aided Dispatch) are a key system as EMS encounters start with the dispatching process. They are often the launching point for an EMS integration since they represent the first step in the EMS encounter. EMS CAD systems include systems like Zoll, Northrop Grumman’s CommandPoint, and Hexagon. 

(ePCR), electronic patient care report is the EMS equivalent of an electronic health record (EHR) and needs to be integrated with the patient’s overall health record. Interoperability between the EMS provider and the hospital systems can help facilitate significantly better clinical care. (ePCR systems include ImageTrend Elite and HealthEMS.)

Due to a lack of incentives and funding historically (through incentives like meaningful use), this healthcare software niche tends to generally have less support for, or familiarity with, traditional healthcare interoperability messaging standards. However, due to recent increased funding for public health being made available due to the pandemic, we are seeing growth in the demand for EMS integration projects. We are also seeing some EMS vendors joining the national networks like Carequality or participating with regional HIEs. These factors are all helping ensure EMS visits are better integrated into a patient’s longitudinal health record. 

NEMSIS Framework

NEMSIS, powered by NHTSA’s (National Highway Traffic Safety Administration) Office of EMS is a national effort to standardize the data collected by EMS agencies. NEMSIS stands for the National Emergency Medical Services Information System, and it is the national database that stores EMS data from around the nation and is a universal standard for how emergency patient care data is collected. The system is designed to improve patient care through standardization, aggregation, and utilization of the EMS data at a local, state, and national level. 

NEMSIS provides the essential framework for collecting and sharing standardized EMS data from the states nationwide. The standardization of the data helps local, state, and national stakeholders assess the needs and performance of EMS departments across the nation. It is a unique format that adds additional complexity to EMS data flows.  However, the more we can close the loop between the EMS provider and the hospital provider, the more we can improve the quality of the data ultimately reported to NEMSIS.

SAFR Data Exchange Model

SAFR is a bidirectional data exchange model developed by the California Emergency Medical Services Authority, and stands for Search, Alert, File, and Reconcile. This model focuses on increasing bidirectional data exchange between EMS providers and creates a framework for establishing data flows. Its ultimate goal is to help close the loop between the EMS agency (and EMS providers) and the hospital providers.

Search: Improving clinical decision-making and patient care before the ambulance reaches the hospital by providing the ability for EMS providers to search individuals’ health information and medical history. 

Alert: Improve the receiving hospitals preparedness by providing an individual patient’s status directly into the hospital Emergency Room dashboard. 

File: File the data from the EMS patient care report (ePCR) directly into the receiving hospital’s EHR system. 

Reconcile: Improve overall patient care by updating the EMS systems information based on treatment updates in the hospital’s EHR in order to improve the EMS systems quality of data and reporting.

Second, the data formats used by CAD systems and NEMSIS are completely different from what you see in other common healthcare interoperability use cases. They are complex data formats and not easily tackled by technical staff that have spent the majority of their time building HL7 interfaces.

How Zen Healthcare IT Reduces EMS Integration Complexity

EMS services are typically provided at a county level. Zen Healthcare IT has worked directly with counties, and HIEs serving counties, to implement EMS integrations and enhanced interoperability.

Real-world Experience

Zen has implemented bi-directional data exchange from EMS CAD and ePCR systems like Image Trend, and Hexagon, to state and national entities. This real-world experience means that we can rely on prebuilt libraries as well as extensive EMS domain knowledge. This means our clients get projects completed faster and with less risk.

For example, Zen was tasked with helping a major county implement an integration that received Hexagon CAD reports, transformed data, and pushed out to ImageTrend endpoints. To ensure reliability for such an important integration, Zen’s Gemini Integration-as-a-Service platform was selected to host the integration. Gemini is monitored 24×7 and the county team is alerted if issues are seen with upstream or downstream data partners.

One issue that was identified for this particular integration was that the CAD system was pushing out a lot of duplicate messages, creating “noise” that was impacting downstream partners. The solution was to target specific event reports by setting up a database table to keep track of messages that have the same Incident Number and Originating Action – and leverage the received date to determine if a message should be processed onto the data partners. This approach helped dramatically reduce redundant information that is often an issue with healthcare integrations.

Managed Integration Hub Technology for EMS Agencies

Managed integration technology that provides a hub approach for an EMS agency wishing to better integrate across the full EMS encounter offers a significant advantage. For example, a hub approach means that a single interface with a CAD or ePCR system can be leveraged to interact with multiple data exchange partners, such as other essential public health or safety organizations such as PulsePoint. 

And when the integration hub is provided as a managed service, it significantly reduces the burden of long-term monitoring, security, and management of the integration platform, freeing up EMS agency IT staff.

For example, Zen’s Gemini Integration as a Service platform (“Gemini”) provides a fully managed integration hub, making it an excellent option for EMS agencies, counties, or vendors.

Gemini can also support workflows for each of the elements of the SAFR mode described above. We thought it might be helpful to showcase what a detailed EMS SAFR workflow might look like:

Search Workflow

 

• The EMS provider (using their ePCR system) makes an outbound patient query to Gemini. This query is sometimes automated and occurs “in the background” so that the EMS provider can focus on the patient. Gemini then routes the patient query to the applicable HIE or other designated clinical repository for that area.

• If a local or regional HIE is not available in the area, then a patient query could be made to a national network such as Carequality. (Zen is a Carequality Implementer.)

• If the patient is found, Gemini delivers a clinical summary document back to the ePCR (in such format that the ePCR can consume). Often the EMS provider desires a simplified version of the clinical summary document.

Alert Workflow

• Gemini generates an ambulance alert/encounter message triggered by the Search workflow outlined above and routes to the treating hospital (or their designated vendor). This alert message, along with other messages described below, can be formatted as a Direct Secure Message, HL7, FHIR, JSON, or other API-based exchange.

File Workflow

• To ensure that the hospital receives a complete history of the EMS encounter, the ePCR runs a Run Report (in ePCR preferred format) and sends it to Gemini.

• Other EMS generated data (such as EKG data) may also be sent to Gemini.

• Gemini then routes this data to the treating hospital (or their designated vendor). Alternatively,  the EMS data may be routed to the designated HIE for the region.

Reconcile Workflow

• To provide data back to the ePCR / EMS agency after hospital discharge, a clinical summary document can be forwarded back to the EMS agency. For example, HL7 messages for a patient discharge can trigger Gemini to query the facility via a national network or query an HIE repository to obtain a clinical summary and route to the ePCR (EMS).

These are not the only interoperability data flows that might be implemented under SAFR, but they are good examples of how bidirectional exchange might be accomplished to ensure that EMS services are fully integrated across the care delivery system. 

The Zen Team is proud to have made an impact on improving EMS agency connectivity with their local healthcare partners.  If your organization is working on an EMS-related integration project and has run into issues, or simply wants to learn more about this important healthcare interoperability use case, please contact us. 

Additional Resources:

https://nemsis.org/what-is-nemsis/

https://nemsis.org/nemsis-101/

References:

¹https://www.healthit.gov/sites/default/files/emr_safer_knowledge_product_final.pdf