COMCARE's efforts to develop an integrated patient tracking system that would operate on all platforms for all emergency responders culminated in a face-to-face "summit" of interested parties in December as the non-profit organization dedicated to improving emergency communications and response furthered its reach toward a national consensus on requirements for such a system.
The Integrated Patient Tracking Initiative (IPTI) summit, held at The George Washington University's Executive Education Center in Washington, DC, and cohosted by the Virginia Hospital and Healthcare Association (VHHA), was a continuation of a series of nationwide conference calls among some 70 or so allied healthcare providers, says COMCARE's project spokesman Michael Pariser, EMT-P.
"These included representatives from public health, disaster services, the Red Cross, EMS providers, hospital administrators, ED physicians, emergency nurses, the military and some federal programs like the CDC and the Department of Health and Human Services."
These experts were then broken up into working groups and asked questions like: What would you like a patient-tracking system to be able to do? What kind of data would you need from it? What kind of data could your service provide to this system?
"There was a lot of argument," says Pariser, with each group's needs differing drastically from the others'. "Public health is interested in data-mining, disease surveillance and trending, and less interested in tracking individual patients, while hospital-based folks are interested in collecting more complete sets of data than most EMS services can accommodate. For some groups, like the Red Cross, family reunification is important. Then there are those folks who don't see a need for integrating electronic health records into a [wider] tracking system at all."
The Phase One discussions have focused on finding common ground for a required baseline structure that would serve the needs of all groups who might be involved in patient tracking, whether for routine day-to-day use or a mass-casualty incident.
The problem here, says Pariser, is that there are many different patient tracking systems already in place around the country and more in development.
"For example, one might be using a phone with a bar code scanner built into it that puts a bracelet on a patient, scans it and sends a triage code to a hospital. Another, in San Mateo County, CA, has a system with a Bluetooth connection that uplinks information from ambulances to hospitals. And then there are a bunch of electronic medical records inside of hospitals. All these things are coming to a head in light of funding that's becoming available for telecommunications."
Pariser says he and project leader Amy deBreuler hold the COMCARE view that the future in emergency communication is in data--even more than in radio. And what funders and responders alike want to avoid is a whole bunch of incompatible patient tracking systems independently deployed and consequently useless in a disaster or even a mutual aid situation.
"By creating a set of standards, we eliminate that kind of possibility," he says.
What participants do agree on includes these parameters:
Platforms should be compatible and interoperable. Pariser uses the analogy of the World Wide Web: No matter what device or what program you're using to get online, Web pages written in html look like they're supposed to. "It's pretty amazing that you can take an ATM card from your local bank to Asia and get money out of a machine. But there's a profit incentive there and there isn't one in EMS--and there probably will never be. That's why there's a role for government to take the lead here--we can't leave it totally up to the industry."
The same device/system for day-to-day and mass-casualty type incidents. It has to be something used every day or it won't work in an MCI. The number of patients being tracked, for example, could automatically switch it from one mode to another.
The system must be flexible. The database might show different subsets of data within the same system, depending on the needs of the tracking group. But practicality must reign. "Always requiring a date of birth and social security number is perhaps impractical--you might only have time for a triage code and gender--but if you have time to take a complete history, there should be a place to record it," Pariser says.
Data must be clinically based, not research-based, no matter where the patient enters the system. While the data might be useful in research, it should not be collected as such, no matter how the patient comes into the system.
Devices and software must be configured to exchange data securely. Reminding us that the P in HIPAA stands for portability, not privacy, in the Health Insurance Portability and Accountability Act, Pariser says the law specifically allows for certain types of data exchange, especially in emergency situations. "It was never meant to be the monster it's become," he says. Data, therefore, should be transferrable, as long as it is encrypted and requires secure log-ons to access.
Each incident record will automatically generate an identifying number. "Not a national number for everyone--and not a personal number--it's an ID number for that incident, for that patient," like a transaction number, automatically generated by the system.
"Our broader goal in the project, once we get to our later Phases," says Pariser, "is to develop a full toolkit for communities to use when they're considering implementing a patient tracking system--including policy guidance, potential funding sources, and a model RFP to assist in procuring a system. We don't make, sell or promote any one system, we just set the requirements for what it should have and what it should do."
Phase Two, beginning at press time, will focus on harmonizing existing standards with the work product from Phase One.