Infor-motion

   Broadly defined, health information exchange is the automated electronic movement of people's health information across organizations, independent of information systems or software. It's going to make your job easier, and it's going to contribute to better patient care.

   Imagine automatically receiving a patient's medical history as you're dispatched to a call. Then, on scene, data you collect with various devices feeds automatically into an ePCR that also attaches that history. That PCR focuses and simplifies your documentation as you complete it, leading you through pertinent fields. It's automatically sent ahead to your destination hospital and moves across departments there, continually being updated, and ultimately is merged seamlessly into billing systems. Later, the integrated hospital and prehospital data is available for EMS performance improvement, public education and other uses.

   There's more, but EMS leaders should already be intrigued. This is the Holy Grail of health information efforts, and it's now at hand.

   "It's important because it's going to allow patients to have all the information about them applied to whatever their current need is," says Greg Mears, MD, executive director of the EMS Performance Improvement Center at the University of North Carolina, as well as the state's EMS medical director. "Whether it's a physician or a paramedic or a nurse or a clinician anywhere, they can pull this information in, understand the care that's been provided, and take it into account when they're providing their care. That will not only improve care for the patient, but it will decrease errors and many other things."

   The key entity to know is Health Level Seven International, or HL7. They're a prominent standards-developing organization and the premier global authority on interoperability standards for health information technology. HL7's corporate members include more than 90% of healthcare information system vendors.

   EMS isn't yet encompassed within the HL7 sphere, but it's on its way. Once it's there, our care efforts and documentary data will become a fully integrated part of the healthcare continuum. HL7 approval will be accomplished by way of a multistage voting process, and the EMS data framework represented by the National EMS Information System (NEMSIS) has already received unanimous first-ballot support for inclusion. Additional balloting will follow as more elements (e.g., messaging, vocabulary) are developed. That process will continue into 2012.

Thank NEMSIS

   It's NEMSIS that has positioned EMS to join this party. EMS' data collection has developed dramatically in recent years as it provided standardized definitions and transmission for services and states to collect the same data, measured the same way. NEMSIS' new version 3 data set aligns with HL7, allowing EMS to link to the rest of the healthcare world.

   "EMS is actually more advanced when it comes to the use of standards across the industry than the rest of healthcare is," says Mears, who described the transition at July's Pinnacle EMS Leadership & Management Conference. "What NEMSIS has done is create standard definitions, so wherever you are, you use the same terminology and definitions when you document a record. That generally doesn't exist in the rest of healthcare. We also have a more advanced exchange methodology, so the information can be maintained as it moves, for instance, from a local agency to a state and then to the national level."

   That puts an onus, then, on states that aren't yet contributing data to NEMSIS to address their barriers and get with the program, and on services that haven't yet gone electronic to get moving to NEMSIS-compliant software.

   For the laggards, a lot of the barriers have been financial. And despite the importance of EMS to America's overall systems of health and emergency care, federal funding to bolster the development of health information exchange generally hasn't gone to the prehospital side--rather, it's gone to physicians, hospitals and clinics.