Found in Translation

You don’t have to use ZOLL and ZOLL Data products to learn something at the company’s annual Summit data-management conference. Obviously there’s benefit if you do; speakers there guide attendees through the company’s latest devices and capabilities, sharing advances and best practices. But even if you’re just interested in emerging EMS concepts like mobile integrated healthcare/community paramedicine and the HL7 data standard, there’s plenty to whet your intellect and take home to work on. Summit 2014, with a theme of “Advancing Care Through Data,” was held May 13–16 in Denver and boasted more than 120 sessions across eight tracks. This article summarizes some of that content, with a focus on data technology that can benefit systems of all stripes. Next year’s event will be held May 12–15. For more, see https://connect.zolldata.com/summit-registration. 

Most of the healthcare world, in the U.S. and internationally, exchanges data using the HL7 standard. American EMS does its own thing. As we become more fully integrated into broader healthcare systems, that obviously has to change. We’ll need compatible languages to more readily share information about our patients. 

NEMSIS 3 is a stepping stone towards HL7 but doesn’t completely close the gap. Until NEMSIS becomes a full HL7 standard, if we’re to feed our PCR data to hospitals and health information exchanges, we’ll need a way to translate it into an HL7 format understood by electronic medical record systems. That’s the purpose of the new HL7 clinical document architecture for EMS PCRs  supported by NEMSIS and NHTSA. 

ZOLL’s HL7 ePCR Extract uses this new standard to allow EMS agencies to communicate with hospitals directly, without a middleman. It automatically converts RescueNet prehospital patient care data into a format digestible by hospitals’ EMR systems.

“Agencies are required to provide their patient care data to hospitals, but often they still use a manual fax process to do it,” notes Danielle Côté, project manager for the extract. “They fax a report to the hospital, then there’s a manual effort required for somebody on the other end to take it, look it up, do the matching, and scan and attach it. So with meaningful use and some of these other rules requiring more data integration, and because our customers would like to move beyond some of the pain points of the fax process, this lets them report the data and have it automated, so it’s more efficient and can get there in a timely fashion.” 

In addition to an actual PDF of the patient care report, the extract can provide about 150 discrete data elements related to patient care—for instance, trip times, patient information, impressions, assessment information, medications given, procedures performed, etc. Basic options include sending just the HL7-wrapped PDF vs. the whole range of data elements with or without the PCR, and a range of connectivity options depending on hospital needs. 

ZOLL has a long-term timetable to move its EMS products to the HL7 standard; on the way it’s rolling out ePCR products this year that are compliant with NEMSIS version 3. CAD and medical devices come next year. Simultaneously, it’s already successfully executed an HL7 data exchange with the Poudre Valley system in Colorado and is working with other partners to further that. 

But like EMS systems, not all hospitals are ready to move forward. 

“I think a lot of it’s a bandwidth issue,” says Côté. “At least 80% of the hospitals we talk to are interested in exchanging data with EMS, but they have to work with competing priorities, so it’s a slower process. They’ve been pretty tied up over the last year or so with meaningful-use requirements; a lot of facilities have to upgrade their EMR systems to meet those standards. We’re sort of hearing now, probably in the last 6–8 months, that hospitals are getting to the point where they can have discussions. It’s just slow-moving.” 

At Summit 2014, Côté and product manager Steve Deckrow urged EMS leaders to find champions at the hospital level to help drive mutual progress toward data compatibility. That’s someone who can motivate and engage the needed resources, and who appreciates the benefit to be had by robust data exchange. 

The key concept here is exchange. Eventually, with a common standard uniting hospitals and EMS systems, patient outcome data will be able to flow just as seamlessly back to EMS, completing its care picture and allowing better evaluation of its efforts. 

“I think the data set will continue to grow; there’s only going to be more data people are interested in,” says Deckrow. “Potentially there’s going to be more interest in getting real-time data from EMS into the hospital, but I think really our next big push will be getting the outcome data from the hospital put back into our ePCR system, so it really kind of finishes the picture documented in the patient care report. That’s what all of us really want to know: What actually happened to that person I was just taking care of?”