Indianapolis EMS Pioneers Accessing Patient EKG Records in Ambulances

Indianapolis Emergency Medical Services (IEMS) ambulances can now access EKG records from a patient's hospital medical files, an accomplishment IEMS believes to be the first of its kind.

This capability allows EMS providers who are measuring a patient’s current EKG to compare the results against historic EKGs, thereby improving the chances of spotting anomalies and addressing them while on the call. This comes just two years after IEMS ambulances were first equipped with electronic medical record technology, letting them access patient in-hospital medical records while in service.

“Our goal as an EMS agency is that we get the right care to every patient, every time,” says Tom Arkins, IEMS’ chief of information technology and informatics. “By adding this feature to our system, we are arming our providers with as much information about the patient as possible, to help ensure we are getting them the right care.”

"This technology that allows us to look up EKG records will help us improve the quality of care, increasing efficiency of healthcare delivery,” adds Dr. Charles Miramonti, chief of Indianapolis EMS. “It is key for our paramedics and EMTs on the street to have as much information about a patient’s medical history as possible.”

Here’s how the IEMS EKG access system is built: Computers in the IEMS ambulances run Medusa Medical Technologies Siren ePCR software. Meanwhile, the back-end hospital infrastructure uses the Regenstrief INPC (Indiana Network for Patient Care) patient record database. Together, the two platforms provide in-ambulance record access.

To access a patient’s EKG record, an EMS provider creates a request in which they type in the patient’s last name, first name, date of birth and gender.

“The request is then translated into an HL7 format and sent through our servers to the Regenstrief servers,” Arkins says. “Once there, the algorithm in place matches the information sent by the EMS provider to the data set and then returns back either a message of no match or the PDF to the provider.”

IEMS began EKG record access to its ambulances in December 2011 after spending seven months to develop this capability. Already the results of in-ambulance EKG record access have been substantial. In addition to allowing EMS providers to make more accurate treatment decisions, “they have been able to call in a person having a STEMI (ST-elevated MI) and have the old EKG ready for the emergency department,” says Arkins.

By being able to use this approach, IEMS providers eliminate the time historically spent in the emergency department calling up and comparing the old EKG record to the current EKG data. Instead, if problems are detected, the patient can be taken directly to the cath lab for treatment, thus reducing damage to the heart. Likewise, if no differences are seen, resources are saved by not activating the cath lab unnecessarily, without compromising patient care.

The good news: Arkins says EKG in-hospital record access is within the capability of many U.S. EMS units. To make it happen, “the first step is to evaluate what resources you have available to you as a provider,” he says. “Reach out to your local hospitals to find out how they manage data and if it is shared with a health information exchange (HIE).” Next, decide what information would be of use to EMS providers and how it can be shared with them electronically. “Finally, talk to the vendor supplying electronic patient care records for the agency and see if they can help develop the interface,” says Arkins. 

“We are more than happy to help any agency looking to move in this direction,” Arkins adds. “It can be a tough road to go down because data is so valuable and several agencies don't want to share their piece of the pie, but once you convince other stakeholders that by combining our efforts we can work together to offer better healthcare to our patients, it benefits everyone.”

IEMS’ pioneering EKG record access is in line with this service’s tradition of innovation. It began operations 125 years ago, when the first ambulance was dispatched from Wishard (then City Hospital) to retrieve sick and injured patients. In 1943, Wishard became the first hospital in the U.S. to use two-way radio communication for ambulance dispatch. In 2010, Indianapolis EMS became part of a partnership between the city of Indianapolis and Health and Hospital Corporation of Marion County (HHC), with Wishard serving as IEMS’ supervising hospital.

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James Careless is a freelance writer with extensive experience covering computer technologies.