As we’ve discussed in earlier posts (What Does Integration into the Healthcare System Look Like for EMS?) realizing the Triple Aim goals of improved patient satisfaction, improved population health, and controlling/decreasing the cost of care will require that EMS achieves a much higher level of integration with the broader healthcare system.
One crucial element to the success of that tighter integration is better mechanisms for the electronic exchange of health information. There’s general agreement that both EMS and healthcare providers can realize key benefits from such an exchange of health information: improved care and patient outcomes, streamlined operational efficiencies, reduced time to reimbursement.
The Office of the National Coordinator for Health Information Technology (ONC) has provided a model for what such an exchange might look like in its SAFR (Search, Alert, File, Reconcile) model. But progress still seems slow, leaving many on the EMS side to wonder, “Why is this so hard?” Today we’ll take a look at 5 of the key challenges our industry faces as it grapples with becoming a more tightly integrated partner in the chain of care.
Flavors of Health Data
Given their shared concerns during the delivery of care, you’d think there’s a ton of overlap in the type of data EMS and providers capture. While there’s certainly data common to both (demographics and payor information, for example), the data captured in an EMS patient chart (PCR) is quite different from the data captured in a provider chart – in each case the data supports the unique nature of the care provider’s workflow.
Here’s just one example: charts created by EMS often contain a robust set of location data and response timestamps that are less relevant (in the moment) to a physician in the Emergency Department. Those underlying differences in the types of data present challenges during an exchange: efficient exchange requires that each side have access to data that is relevant and fits their workflow, but mapping the data effectively between both sides is hard. The first step in any exchange initiative is to assess the needs of both parties and identify what data needs to go to whom.
The goal of healthcare interoperability has given rise to a diverse set of standards over the years, both within EMS and on the provider side. EMS in the US has a single standard for documenting and reporting patient care in NEMSIS, but as more and more states introduce new elements, that standard is becoming more fragmented.
Providers on the healthcare side grapple with a similar challenge, but with greater diversity: competing versions of standards like HL7, new standards like FHIR (Fast Healthcare Interoperability Resources), common messaging protocols like ADT (Admit, Discharge, Transfer).
Lacking a single standard, vendors on both sides have baked in support for all the standards, which in turn introduces a high degree of variability from one set of partners to another when setting up an exchange. It’s not just a problem of how to transfer data electronically, it’s a problem of making sure the data sent to each recipient is in the format they need/expect.
Different Software Systems
EMS has its software, the hospital has its software, each provided by a set of vendors that serves a specific industry. Because these systems are conceived, deployed, and used in siloes relative to each other, at a fundamental level they’re not generally designed for direct integration. Interoperability standards help to bridge that gap, but still don’t address some of the larger obstacles towards improved exchange.
In terms of the data itself, these systems don’t typically share common patient or encounter identifiers – unique IDs critical in both systems, and equally critical when exchanging health information. Each software vendor introduces options for how health information can be displayed within their product, once again introducing wide variability when attempting to set up an exchange.
Due to the episodic and time-sensitive nature of the care provided by EMS, patients are often treated and transported with very little access to existing demographic data or clinical history. Data collection at an accident scene, for example, prior to EMS arrival is often incomplete – John Doe is transported multiple times a day in every city across America.
Even in cases where good demographic information is available, paramedics rarely have the luxury of time on-scene to query and review patient history. Healthcare system providers often have recurring interactions with patients over time, interactions that are carefully documented in systems designed more for long-term management of care than for critical episodes.
Those differences in workflow require different software solutions, but those solutions are often unaware of the needs of the other side. Software systems need to be flexible enough to accommodate workflows for both EMS and healthcare to realize the full benefits of interoperability.
One of the larger obstacles to interoperability between EMS and healthcare is one of competing priorities. While both sides can find ROI for implementing a health information exchange (no more faxes, sharing payor information, sharing clinical data), finding the time to implement these complex solutions can often present a significant scheduling challenge.
Projects can often stall when one side isn’t prepared or doesn’t have the bandwidth to participate in a timely fashion. Before starting on any interoperability initiative, it’s important that both sides come to a clear understanding of and respect for the project goals, and commit the resources necessary to make the effort a success.
Despite the challenges, reaching the goal of true interoperability between EMS and healthcare will be critical to improving patient care going forward. The standards continue to evolve to break down some of these barriers, ushering in new and more efficient ways to enable health information exchange to help realize a vision of connected partners.