Future of EDXL Standards

www.oasis-open.org

Presented by: Kevin McGinnis, Program Advisor, National Association of State EMS Officials (NASEMSO) & PSG Co-Chair

John Donahue, Chief of Regional Programs and Emergency Operations, Maryland Institute for EMS Systems (MIEMSS)

Jeff Sexton, Tennessee Department of Health, Office of Information Technology Services, Preparedness and Response Systems, HITSP

Dr. Greg Mears, Medical Director & UNC Chapel Hill EMS, HITSP

Capt. F. Christy Music, Program Director, Health & Medical Defense Support of Civil Authorities OASD (HD&ASA), Department of Defense

Timothy Grapes (moderator), VP, Evolution Technologies, OASIS EM TC Voting Member , NIEM EM Domain Support

>> Isn’t proliferation of one-off system interfaces and proprietary solutions just paving over the

cow path? You bet it is. Fact is, there’s no lone system or solution to interoperability.

>>>> You’ll always have your own systems and they’ll be different - requiring data sharing across systems using common protocols.>>>>>> Cross-profession collaboration, open

systems and interfaces, and standards-based exchanges are the easy-to-implement, low-cost solution across local, state and federal

lines. These panelists don’t believe in paving the same old cow path…

Payload routing

The Emergency / Disaster Interoperability Challenge

Responders often cannot talk within their own agencies—let alone other agencies — or across cities, counties, and states. Ineffective communications risk the lives of responders in the field, and for those awaiting help.

There is no one “Silver Bullet” to solve

interoperability challenges.

The interoperability landscape consists of 60,000 state and local public safety agencies, Federal agencies and other stakeholders.

60,000 agencies means 60,000 different sets of procurement regulations, budgets and equipment lifecycles — CANNOT MANDATE

The challenge is to provide ALL stakeholders (Federal, state and local), with the right mix of policies, tools, methodologies and guidance

EDXL Current and Future

You’ve heard about existing OASIS EDXL standards today – Capability exists to support Alerts and warnings, seamless Routing of information, Hospital availability to know where to route patients, and to request, commit, track, status and return Resources.

The DE and CAP standards are available through NIEM adaptors today, followed by the other EDXL standards.

Moving forward, practitioners have prioritized other standards under development. In particular for Situation Reporting about any incident and its response (SitReps - in OASIS), to track patients (TEP), and expansion of TEP to track all victims of any scale incident (TEV).

EDXL-Situation Reporting (SitReps)

EDXL-SitReps standardizes incident operational picture — information about the situation and cross agency/jurisdiction response —

between responders, government officials, coordinating entities and the public.

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Diagram content courtesy of the Department of Defense, TelemedicDiagram content courtesy of the Department of Defense, Telemedicine & Advanced Technology Research Centerine & Advanced Technology Research Center

Wireless Patient MonitoringWireless Patient Monitoring

Electronic Health RecordElectronic Health Record

Speech RecognitionSpeech RecognitionInputInput

Portable PSCD Type Platform

http://wam.umd.edu/~mvandani/pda/lowfi3.html

MERCY HOSP.

CITY TRAUMA CTR.

LIFE FLIGHT

To MVC

UNITED AMB.

UNITED CCT

United Wheelchair

MVC

CARDIAC

EMSREMS

DOTREMS

RIDGEWAY HOSP.

Specialist Call List

Service Call List

JONES MEM. HOSP. (DIVERT)

RIDGEWAY EMSVERNON FD VOLUNTEER AMBULANCE

MVA

Ridgeway Hospital

MVC

Pt.1

Pt.2

Tib/Fib Fx x1/x1

AO x 4

140/90;88;18;CR+

2ary -; GCS-,TS-

- SOAP Notes

- 3/4 Lead EKG

- 12 Lead EKG

- VS Monitor

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Incident SiteTreatment Unit

Coordinator Morgue

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition and

Medical Communications

North Hospital

South Hospital

East Hospital

West Hospital

Mass Casualty Branch

Incident SiteTreatment Unit

Coordinator Morgue

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition and

Medical Communications

North Hospital

South Hospital

East Hospital

West Hospital

Garrett

AlleganyWashington

Frederick

Carroll

Howard

Montgomery

PrinceGeorge’s

Queen Anne’s

Kent

Baltimore

Cecil

Harford

Wicomico

Anne Arundel

TalbotCaroline

Dorchester

Somerset

Worcester

Calvert

Charles

St. Mary’s

Baltimore City

JPTAHAvBEDTRAC2ES

TEMARR

Healthcare Beds, Services and Staffing EMS Demographics and Patient Reports Antiviral and Vaccine Distribution Mass Clinic Programs Mass Causality/Victim Management Volunteer Management and Credentialing Alerting and Notification

TEMARRTennessee Emergency Medical,

Awareness, Response and Resources

Systems, Governance, Policies and Technologies

National Activities

Office of the National Coordinator for Health Health Information Technology Standards Panel

(HITSP) Emergency Responder-Electronic Health Record Remote Monitoring

NEMSIS HL7 DHS and FEMA - Grants and Programs

CRI, UASI CDC/HHS - Grants and Programs

Disease Surveillance Situational Reporting

TEMARR

TN TEP and TEV

3 of 5 MSAs Have Patient Tracking Systems Heavy Investment

The rest of TN without

TEMARR

Payload routing

Placeholder: DR. Greg Mears

Brief Overview of NEMSIS 2001 Funded by the National Highway

Traffic Safety Administration NEMSIS is a standardized approach to

EMS patient care data collection and reporting, including: A uniform dataset - Data Dictionary XML Schema to ensure portability of data

NEMSIS

NEMSIS

Need for NEMSIS EMS Education Standards EMS Performance Measures EMS System Evaluation & Outcomes EMS Research EMS Reimbursement Filling Gaps in Electronic Health Record

Version 3 will be HL7 based

NEMSIS

Linkage

MedicalDevice

DomesticTerrorism

Outcomes

QualityManage-

mentPersonnel

System

CardiacArrest

Trauma

Patient

Incident

Dispatch

NHTSA2.0

NEMSIS

www.NEMSIS.org

Local System

State

National

NEMSIS

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National General Population Evacuee and Patient Movement, Regulating and

Tracking System

Ms. F. Christy MusicProgram Director, Health and Medical Defense Support of Civil

Authorities Office of the Assistant Secretary of Defense (Homeland

Defense & Americas’ Security Affairs)

October 2009

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Create a National General Population Evacuee & Patient Movement, Regulating, Tracking System

Purpose: Build upon existing information systems (military, federal, State, tribal, local, commercial, etc.) and develop a National General Population and Patient Movement, Regulating and Tracking information system that is interoperable and shares data for mass disaster response and optionally, for routine use.

Goal: Federal Sector (DoD, HHS, DHS, FEMA, DOJ, DOT, etc.) provide a national system for all jurisdictions’ use.

Goal: Use a central IT platform or other technology (inter-operability) to share near real-time data among existing systems and support operational functions of tracking, regulating and movement.

Recognized by White House Officials: 2008

Definitions: National, Tracking (Locating), Regulating, Movement

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National Initiative History

Proposed by DoD (2004) and requested FEMA (via NDMS) funds

Noted as DHS Priority (2004)

Secretary Ridge’s Homeland Security Interagency Security Planning Effort

Included patient mobilization planning for catastrophic events as a long-term initiative and a high-priority (Reference: Secretary, DHS letter to Secretary, DoD, September 22, 2004).

FEMA / HHS funded; Focus: Tracking recommendations, city-based scenario studies, Mass Evacuation Transportation Model, 2005-2008

AHRQ Project Officer: Dr. Sally Phillips/ DoD Project Officer: Ms. Christy Music

Key Staff: Abt Associates, Mass General Hospital, Brigham and Women’s Hospital

National Advisory Board: HSC, DoD, AHRQ, HHS, DHS, DOT, VA, other federal agencies, State (NY and CA), city (New York, Los Angeles) and private industry representatives

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National Initiative History (continued)

Final Report Released by AHRQ: February 24, 2009:

“Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System”

Report is located at http://www.ahrq.gov/prep

National Initiative AHRQ Webcast: February 9, 2009

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Focus on Multi-Jurisdictional Incidents and Operational Functions

Incident Area

In-State Receiving Areas

Out-of-State Receiving Areas

AirfieldsAirfields

Shelters

HospitalsCasualty Collection

Points

Shelters

Hospitals

Hospitals

IncidentSite

EvacueeGathering

Points

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Sample Questions the System Could Answer

The Public: Where is my loved one? I will register to tell my family where I am.

Incident Commanders: How many victims are there? Where are they? Where are more response assets needed?

Emergency Operations Centers: How many patients and general population evacuees exist? Where is there unused capacity? Will I need outside assistance?

Federal Operations Centers: What federal transportation, medical and other assets, will be needed to supplement local and state assets to transport patients and general population evacuees? How many buses or planes are available? How many and what type of special needs general population evacuees, and medical special needs patients, need to be evacuated? Where are the available, staffed and equipped hospital beds with appropriate care for patients?

Emergency Managers: Who exactly is coming on that plane of general population evacuees and/or patients? Who are the attendants? How many service animals/pets are there?

Public Health Department / Relief Organizations: How many people are in shelters and what are their specific needs?

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National Mass Patient and Evacuee Movement, Regulating and Tracking Initiative

National Advisory Board Recommendations:

Must build on existing systems (federal, State, local, tribal, private industry)

Must incorporate general population and patient evacueesMust track and give notice of general population members as they become patients

Incorporate data and architectural standards

Maintain HIPPA compliance, as well as other regulatory requirements

Activated system – during major, multi-jurisdictional incident Optional routine use

Begin with local, State and tribal entry, Federal entry last

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National Mass Patient and Evacuee Movement, Regulating and Tracking Initiative Recommendations

(continued)

Data from point of injury or first entry into the system, through intermediate locations, through final disposition – location and audit trail

Track location & health status/ needs of any person encountering system

Track at “touch points” (e.g. evacuation centers, overnight facilities, patient collection or staging areas, vehicle loading/unloading, hospitals, shelters, etc.)

Incorporate current or planned Feeder Tracking SystemsJurisdictional, commercial, and agency specific

systems

Incorporate Feeder Institutional Records Systems (“Check-In/Check Out” Systems)

Facilities with mandatory reporting, common software platforms, within an agency (e.g. VA hospitals, DoD Military Treatment Facilities, Indian Health, etc.)

Single facility (nursing home with “homegrown” system)

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National Mass Patient and Evacuee Movement, Regulating and Tracking Initiative Recommendations

(continued)Minimum data elements to enter patient/general population evacuee data

Unique identifier (a universal algorithm for assigning IDs would be ideal)

Name, gender, DOB (if not available, substitute age range, race and notable physical characteristics to help identify the person)

Health StatusRed, yellow, or green triage colorICU, floor, or discharge ready/not Acutely ill, well with medical history (needing medical

attention), healthy

Last updated location (ID /name/ type), date, time

Build system to accept more detailed demographic and medical information

Build from person-level data, but accept aggregate (location-level) data

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National Mass Patient and Evacuee Movement, Regulating and Tracking Initiative Recommendations

(continued)

Include near real-time regulating and movement data and functions –

Match/ reserve available resources to requirements, release resources, track diverted resources

Example: Reserve ACLS/ATLS ambulance/crew & ICU hospital bed with critical patient

Example: Release bus and shelter beds after general population evacuees have left

System accessible to emergency responders, planners, authorized users

Eventually include public: web- based registration

Free for public, local, State, tribal use – more coordinated, rapid response

Use technology for easy use and interoperability (e.g. scan ID number, web-based, satellite transmission, drivers license, passport, central IT platform, open architecture, etc.), and manual entry

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Contact Information: F. Christy Music: francesca.music@osd.mil

703 697-5839

Sally Phillips: Sally.Phillips@ahrq.hhs.gov

301-427-1571