A discussion at the HIMSS 2023 Interoperability Showcase highlights the barriers to data transfer between ambulances and hospitals.
As healthcare organizations learn to use technology to gather, store, and analyze data, interoperability is fast becoming a crucial tool. Health systems need a common framework and standards to share data with other healthcare providers and sites.
That includes EMS providers, which are often overlooked in the national effort to create a nationwide healthcare exchange. They're on the front lines of emergency care, and it's crucial that they be able to share information with a hospital before and during transport. New and improved tools and technologies are making that process easier, but interoperability issues are still common.
As an example, "consider prescription medications and substance use challenges," says Jonathon Feit, MBA, MA, co-founder and chief executive of Beyond Lucid Technologies. "Substance use challenges [can] fester into overdoses due to a lack of visibility into patients’ encounters with care settings across jurisdictional lines. If a patient in Ohio sees a doctor in West Virginia, Kentucky, or Indiana, there is presently no mechanism for the Ohio-based fire or ambulance crews, or hospitals, to know what medications the patient should have been taking, which makes it much harder to surmise what she or he likely took."
In 2021, the National EMS Information System Technical Assistance Center (NEMSIS), which sets the standards for EMS data, began collaborating with the IHE (Integrating the Healthcare Enterprise) International to create a framework for EMS providers to participate in initiatives like the Trust Exchange Framework Common Agreement (TEFCA). Those meetings have included the six entities recently named as applicants for qualified health information network (QHIN) designation.
"A takeaway from these meetings is that data-sharing tools exist," says Feit. "The desire to share data exists. Data-sharing agreements are well-worn policy landscapes. And yet, why are resource-rich hospitals unable to close the mobile medical data gap?"
Feit notes that in 2020, the Cleveland Clinic, Essentia, and Sanford Health reported they were unable to integrate ambulance-based data into the Epic platform, even though Epic had published the data import specifications on its website.
Feit sought answers to that dilemma at the HIMSS 2023 conference and exhibition this past April in Chicago, where he visited the HIMSS Interoperability Showcase and talked with executives from Epic and ImageTrend who were demonstrating EMS-to-hospital interoperability. He asked them how data collected on ImageTrend's ePCR (electronic patient care report, similar to an ambulance-based electronic health record) could transfer discretely into the Epic EHR.
"The results were enlightening," Feit says. "And more than any other conclusion, they proved the dire need for a shift toward nuanced messaging in technical advertising."
Feit says he asked whether discrete data was showing up in the right places within the Epic EHR. Two Epic software developers, Patrick Kastelik and Michael Donnelly, told him the EHR platform wasn't recognizing discrete data from ImageTrend, including EMS-specific CDA templates.
"The distinction of discrete versus PDF transmission matters," Feit says. He noted several jurisdictions are waiting on discrete data import and interoperability, including the state of California, which was singled out by the Office of the National Coordinator for Health IT for its SAFR (Search, Alert, File, and Reconcile) model, and New York City Health + Hospitals, which in 2021 announced that its interoperability goals would depend on a city-wide model for automated matching and sharing of ambulance-based records from the Fire Department of New York and other medical transportation services with EHRs and regional health information organizations (RHIOs).
"Their goal is to have access to discrete data for a range of mutual benefits," Feit adds, "including the ability to query data for demographics (for example, identification of patients), missing billing information, and the clinical goals that ImageTrend Director of Strategic Development Doug Butler described as 'taking patients directly to CT, handing off the labs, pre-registering the patient, [and] all those things [that are] going to reduce that time and improve those patient outcomes.'"
According to Feit, ImageTrend has been able to create a PCR, validate, and post the chart, which then automatically creates an ADT (admission, discharge, and transfer) record in the Epic EHR. This gives the hospital notice that patient data is available in real-time, so that staff can begin preparing for the patient's arrival.
According to Feit, Butler said that while the process is automatic, some EMS providers still don’t chart their data until after the transport is concluded. In some cases, Butler said, EMS providers scan a patient's driver's license before charting.
Feit says EMS providers need to send that data immediately, not wait until the end of a call. That's especially true during 911 calls and other emergencies, when a hospital needs as much information on a patient as it can get before that patient arrives. Information that is added to the patient's record later on might not be useful by then, and it may have been important enough to affect patient care.
From his time at HIMSS, Feit offers two conclusions.
"First, the barrier to optimization of information sharing—the realization of a grand vision for connected healthcare—is often not about the technology itself," he says. "Indeed, the bits, bytes, and APIs may be the easy part. The hitch is more frequently in the design: If maximation of interoperability means that systems must be deployed in the field, at the patient’s side, as ImageTrend and Epic showcased together, then the user interfaces must be built for ease of use in the field."
"We know that, for example, approximately half of the ambulance services in Oregon use ImageTrend as their documentation system," Feit says, "but … nearly half do so only at their desktops—not in the field—which has major implications for the ability to present critical health data. Mobile medical agency leaders have to ask themselves: How important is it that they be able to capture and share data in real-time and, as a result, improve clinical intervention, patient identification, billing, response to a range of emergencies including those involving social determinants of health and harmful substances, respect for end of life wishes, care for chronic care patients, and syndromic surveillance?"
"Second," Feit says, "organizations like the State of California, whose SAFR model is far from ubiquitous, should not only trumpet successes but also failures. If the NEMSIS Technical Assistance Center and IHE aim to promote innovation, citing examples like SAFR as advances worth replicating, then it is essential to understand not only why and where those worked, but also, where applicable, why didn’t they work better?"
Feit's point is that EMS providers, health systems, and tech companies have to work together to solve the pain points that make interoperability such a challenge. This includes understanding why data isn't flowing into the EHR from EMS platforms, as well as making it imperative that data be entered and sent immediately, not when the call is over or the shift ends.
“A takeaway from these meetings is that data sharing tools exist. The desire to share data exists. Data-sharing agreements are well-worn policy landscapes. And yet, why are resource-rich hospitals unable to close the mobile medical data gap?”
— Jonathon Feit, MBA, MA, co-founder and chief executive, Beyond Lucid Technologies
Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, Telehealth, Supply Chain and Pharma for HealthLeaders.
In 2021, the national organization overseeing data from EMS providers began collaborating with IHE to create a framework around data transfer from EMS vehicles to hospitals.
Jonathon Feit, co-founder and chief executive of Beyond Lucid Technologies, discussed interoperability with representatives from Epic and ImageTrend at the HIMSS 2023 Interoperability Showcase.
Feit says there are technical challenges with transferring data between EMS vehicles and healthcare sites, but some EMS providers also aren't doing their best to facilitate real-time interoperability.