Improving the Information Flow

The chaos that followed the 9/11 attacks in New York City dramatically demonstrated shortfalls in existing communication systems and prehospital information technology (PHIT). The most notable instance was the inability of NYPD and FDNY personnel to talk to each other via radio, due to their use of incompatible technologies. But the information disconnects ran far below the serface, hampering the most effective and timely delivery of emergency care across the entire healthcare system.

Even after 9/11, PHIT issues remain. Not only can many first responder technologies still not talk to each other, but many agencies continue to use a hodge-podge of electronic and paper-based systems that do not connect to each other.

Mindful of this, top healthcare researchers have developed a model for an open, interoperable PHIT network architecture. A team led by Dr Adam Landman, an attending physician at the Brigham & Women’s Hospital Emergency Department and Instructor of Medicine at Harvard Medical School, published their ideas in the April/June 2011 issue of Prehospital Emergency Care.

The full article can be accessed online at www.ncbi.nlm.nih.gov/pubmed/21294627. Dr. Landman recently gave EMS World a high-level view in the following interview.

What is the PHIT concept?

The PHIT network architecture is a high-level framework for the exchange of prehospital electronic data. The two core components of this architecture are a router and electronic patient care reports (e-PCR) software. The router allows all information devices on the ambulance to communicate with each other and external data sources, such as hospital information systems. The e-PCR serves as the central data repository, collecting all prehospital patient data, including CAD, patient care and medical monitoring data.

What benefits does PHIT offer?

There are a number of benefits:

• Ambulance devices can communicate and exchange information with each other, as well as external EMS information services
• This architecture is scalable, meaning that new ambulance devices can be easily connected to the router and, as new broadband communications technologies become available, the router can be upgraded to support these technologies without modifying the individual devices
• A comprehensive e-PCR stores all prehospital data in a single location for easier transmission and retrieval
• Encourages use of open standards to promote information exchange.

What problems does PHIT address?

EMS agencies have begun adopting information technology, including e-PCR and devices capable of wireless data transmission, such as monitors with 12-lead electrocardiogram transmission capability. However, few EMS agencies have developed a comprehensive plan for management of their prehospital information and integration with other electronic medical records. 

Further, many available products have proprietary data storage and transmission solutions. This could mean that an EMS agency purchasing a wireless ECG transmission solution from their monitor/defibrillator manufacturer may not be able to use this same transmission system to transmit their e-PCRs. 

Our PHIT network architecture is designed to stimulate discussion among EMS leadership and vendors to embrace an open, scalable and interoperable solution for all prehospital electronic information needs.

Why is open architecture so important to the PHIT architecture?

We use ‘open’ to emphasize the need for prehospital devices to provide interfaces to send and receive their underlying data. If the data is also stored in standard formats, device data can be meaningfully exchanged with other devices and healthcare providers. 

For example, if an e-PCR system has an open interface to receive 12-lead ECGs in FDA-HL7 format, then any 12-lead monitor/defibrillator that can transmit ECGs in this standard format could send ECGs directly to the e-PCR system. This creates an interoperable environment where multi-vendor prehospital devices can freely share data. Additional work is needed to create data standards for all prehospital data types and to encourage vendor support of these standards.