# Presentation: 067655

## First Responder EHR

- American Health Information Community Electronic Health Record Workgroup
- May 2, 2006
- Edward Barthell MD MS
- American College of Emergency Physicians

## First Responders

- Fire Departments
- Police Departments
- Emergency Medical Services (EMS)
- Hospital Emergency Departments

## Different Scenarios - 

- 	Different First Responders -
- 		Different Data Needs
- Routine daily care
- 	Geriatric situations, impaired pts
- Kinetic energy trauma
- 	Plane crash, explosion
- Toxic or radiologic exposure
- 	Tokyo subway sarin
- Emerging infectious disease - pandemic
- 	Crypto, Monkey pox, SARS, influenza

- Flexible Systems Required

## Discrete Data Needs –

- Communication
- Prehospital EMS
- Hospital EDs

- Routine

-  Disaster

- Demographics – PMD
- Meds – Allergies
- Problem List
- Advanced Directives
- Previous EKG
- What’s coming?
- Available inpatient space?

- Demographics
- Meds – Allergies
- Problem List
- Advanced Directives
- Destination?

- Patient ID#
- Red – Yellow – Green
- Destination?

- Demographics - ID#
- Meds – Allergies
- What’s coming?
- Available destinations?

## Mechanisms to make data available

- Prehospital EMS
- 	Radio notification from dispatch
- 	Pagers – Cell phones commonly available
- 	Paper based charting predominates
- 	Patient tracking systems evolving, est <15%
- 	Electronic charting systems evolving, est <15%
- 	Wireless network access evolving
- Hospital EDs
- 	Registration / ADT systems, est >95%
- 	Internet access now available, est >95%
- 	Web based capacity / diversion systems common, est >50%
- 	Electronic tracking systems becoming common, est >30%
- 	Electronic physician charting still evolving, est <15%

## Barthell, E, Kulick S, Felton CW, Silva JS, Schwartz RJ, Reece GA:  Session 107:  The National Information Infrastructure Health Information Network NII-HIN.  Proceedings of the 1996 Annual HIMSS 	Conference, Atlanta, GA, March 3-7, 1996; 4:157-167.

Cordell WH, Overhage JM, Waeckerle JF for the Information  Management Work Group:  Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs.  Annals of Emergency Medicine 1998; 31:172-178.

Barthell EN, Cordell WH, Moorhead JC, Handler J, Feied C, Smith MS, Cochrane DG, Felton CW, Collins MA:  The Frontlines of Medicine Project:  A Proposal for the Standardized Communication of Emergency Department Data for Public Health Uses Including Syndromic Surveillance for Biological and Chemical Terrorism.  Annal of Emergency Medicine 2002; 39:422-429.

Barthell EN, Pemble KR:  The National Emergency Medical Extranet Project.  The Journal of Emergency Medicine 2003; 24:95-100.

Barthell EN, Foldy SL, Pemble KR, Felton CW, Greischar PJ, Pirrallo RG, Bazan WJ:  Assuring Community Emergency Care Capacity with Collaborative Internet Tools:  The Milwaukee Experience.  J Public Health Management Practice 2003; 9:35-42.

- Cordell WH, Overhage JM, Waeckerle JF for the Information  Management Work Group:  Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs.  Annals of Emergency Medicine 1998; 31:172-178.
- Barthell EN, Cordell WH, Moorhead JC, Handler J, Feied C, Smith MS, Cochrane DG, Felton CW, Collins MA:  The Frontlines of Medicine Project:  A Proposal for the Standardized Communication of Emergency Department Data for Public Health Uses Including Syndromic Surveillance for Biological and Chemical Terrorism.  Annal of Emergency Medicine 2002; 39:422-429.
- Barthell EN, Pemble KR:  The National Emergency Medical Extranet Project.  The Journal of Emergency Medicine 2003; 24:95-100.
- Barthell EN, Foldy SL, Pemble KR, Felton CW, Greischar PJ, Pirrallo RG, Bazan WJ:  Assuring Community Emergency Care Capacity with Collaborative Internet Tools:  The Milwaukee Experience.  J Public Health Management Practice 2003; 9:35-42.

- Standards activities

- References

- HL7 – Technical workgroup developing EDIS functional model and V2.0 of Data Elements for Emergency Department Systems (DEEDS)
- NHTSA Uniform Prehospital Dataset V2.0  for EMS, see also NEMSIS.org
- OASIS EDXL – CAP and HAVE specifications for alerting and hospital capacity reporting