EDXL Tracking of Emergency Patients

May 19, 2010

Presented to the:Emergency Interoperability Consortium

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TEP & TEC Messaging Standards

Requirements definition for Tracking of Emergency Patients and Tracking of Emergency Clients is occurring in two phases. TEP is in-process with the Practitioner Steering and Working Groups (PSG / SWG).

Phase I - Tracking of Emergency Patients (TEP): An XML standard for exchange of emergency patient and EMS tracking information; to increase the effectiveness of emergency medical management, patient tracking and care, and family notification.

Phase II - Tracking of Emergency Clients (TEC): Expands Phase I scope to support clients across the general population. TEC is aimed at more effective evacuation and services management, client tracking, Regulation, Re-unification, and use of assets for all Emergency clients.

Client: Generic term for any person displaced, evacuated, sheltering in place, expired, and/or requiring medical attention – i.e. Clients or customers of Emergency ServicesPatient: A type of client requiring medical attention, being medically evaluated; or a fatality .

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LN FN Organization Represented

Mann Clay, Dr.NASEMSD, National EMS Information System (NEMSIS)

Mears Greg, Dr. UNC Chapel Hill EMS Medical Director

Donohue John Maryland Institute for EMS Systems (MIEMSS)

Sexton JeffTennessee DOH Office of Information Technology Services, HITSP

Moreland Joe Kansas Board of EMS

Whitney Jolene Bureau of EMS State of Utah

McGinnis KevinJNEMSLC, NASEMSO, Vice-Chair-OIC PSG, National Association of State EMS Officials-NASEMSO

TEP Steering Committee

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TEP Stakeholders – Practitioner-Driven Approach

Incumbent Practitioner Steering Group (PSG) & Standards Working Group (SWG) EMS, Law Enforcement, Fire, Emergency Management, Health, Public Safety, States, Counties, Cities

Over 80 Newly Added Stakeholders plus Vendors – Examples: Health Information IT Standards Panel (HITSP) Gap-Filler National Association of State EMS Officials (NASEMSO) Joint National Emergency Medical Services Leadership Conference (JNEMSLC) DoD Health & Medical Defense Support of Civil Authorities – OASD(HD&ASA) HHS-Agency for Healthcare Research and Quality (AHRQ) HHS-Assistant Secretary for Preparedness and Response (ASPR)

National Disaster Medical System (NDMS) American Hospital Association (AHA) American Red Cross LA R-7 Hospital Disaster Preparedness/Emergency Nurses Association-ENA Association of Public Safety Communications Officials (APCO) National Emergency Numbering Association (NENA) Federal Emergency Management Agency (FEMA) State of Tennessee

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Emergency Data Exchange Language Tracking of Emergency Patients (EDXL-TEP) – Status Update

• Final Stakeholder review period completed March 1 – March 31, 2010; extended to April 14, 2010

• Additional comments received from:• National Institute of Health (NIH) / US National Library of

Medicine “Lost Person Finder (LPF)” effort. • Multiple DoD reviewers including the Health & Medical Defense

Support of Civil Authorities.

• Draft TEP Piloted and Improved: National Disaster Medical System (NDMS) live exercise April 29, 2010 at the Tennessee Air National Guard 164th Airlift Wing in Memphis

• Excellent TEP participation and inputTotal Issues submitted: 289

• Project Initiation Document (PID): 156• Requirements and draft Messaging Specification: 133

• EIC Submission May 14, 2010

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Emergency Data Exchange Language Tracking of Emergency Patients (EDXL-TEP)

Documentation may be found at the following website:  http://www.evotecinc.com/TEP/

 • Requirements and Draft Messaging Specification: 

“EDXL-TEP-Rqmts&draftMessagingSpecFinalV2.2_05-05-2010.pdf”Stakeholder issues list:  “TEP-Stakeholder-IssuesRev2.2_05-7-2010.xls” 

(Filtered for “open” or “in-process” for review of resolutions)

• Data Dictionary:  TEPdictionaryV2.1.xls

(Excel version provides mappings to NEMSIS and NIEM)

• Project Initiation Document:EDXL-TEP Project Initiation Document (PID) v4.3.pdf

• Subject Matter Expert listEDXL-TEP-Participants-FullList5-12-10.pdf

(Steering, Stakeholders, Vendors, and PSG / (SWG)

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TEP Scope EDXL-TEP is an XML

messaging standard for exchange of emergency patient and tracking information across the EMS emergency medical care continuum.

TEP provides real-time information to responders, management and care facilities in the chain of emergency care and transport.

Patient tracking information is exchanged from patient encounter (possibly re-using dispatch information) through admission or release.

TEP also supports hospital evacuations and day to day patient transfers.

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Tennessee National Disaster Management System Patient Reception Exercise

• DHS Office for Interoperability and Compatibility (OIC) supported the Tennessee Department of Health (TN DOH) and many other organizations in the 2010 National Disaster Medical System (NDMS) Patient Movement Exercise

• A live exercise driven by objectives of federal, state and local agencies and NDMS partner hospitals.

• DHS OIC objective to “test-run” the Emergency Data Exchange Language (EDXL) Tracking of Emergency Patient (TEP) specification in a field exercise before submitting to the standards approval process

• DHS OIC provided program management and technical support to all participants

• Key Take-Aways:• Patient registration timeframes dramatically

reduced – hours to 30 minutes• First Electronic Patient Manifest for TN Air National

Guard

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The NDMS Patient Movement Exercise

• Draft TEP interoperability pilot inserted into the 2010 National Disaster Medical System (NDMS) Patient Movement Full-Scale Exercise, with follow-on analysis and presentation

• A live exercise driven by objectives of federal, state and local agencies and NDMS partner hospitals.

• The exercise simulates a hurricane making landfall resulting in mass casualties requiring professional treatment.

• The exercise made use of air and land transports, volunteer patients, and support personnel.

• Patients were tracked utilizing five independent Patient Tracking systems from Maryland's BWI airport, to a Memphis triage area where an actual C-130 landed and deplaned patients. Patients were then tracked through triage and ambulance boarding, through arrival at one of 5 Memphis area hospitals.

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EvacuationPatient Receiving Area (PRA) Maryland (MIEMSS)

1- Tag and Transport patient to NDMS DMAT at BWI Thurgood Marshall Airport

Begin tracking patients via DE-TEP(100 Patients for on-load to air transport.

To be moved by NDMS to another State for Hospitalization and/or Treatment)

DE-TEPDE-TEP

JPATSCOG 6978(Apprio)

JPATSCOG 6978(Apprio)

DM OPEN

DM OPEN

First TrackCOG 6975

(DM Solutions)

First TrackCOG 6975

(DM Solutions)

Patient TrackingCOG 6974

(UPP Technology)

Patient TrackingCOG 6974

(UPP Technology)

HAVECOG 6976

(EM Systems)

HAVECOG 6976

(EM Systems)

HC StandardCOG 6977(GER911)

HC StandardCOG 6977(GER911)

DE-TEPDE-TEP

2 – Load patients to aircraft and provide TEP

updates (JPATS update all)

Tennessee – Memphis Shelby:3 -Offload patients from aircraft (First Track update all)4 - Patient ambulance transport (First Track update all)

DE-TEPDE-TEPLocalHospital

NDMSHospital

NDMSHospital

LocalHospital

EMSystemsEDXL-HAVE

TNCRN/WebEOC(No Message

Exchange via DM OPEN)

5 – Patients received at

hospitals (First Track update all)

First TrackCOG 6975

(DM Solutions)

First TrackCOG 6975

(DM Solutions)DM

OPEN

DE-TEPDE-TEP

DM OPEN

DE-TEP UpdatesDE-TEP Updates

Landing

Take-off

WebEOCWebEOCDE-HAVEDE-HAVE

…Hospitals provide HAVE

updates

HC StandardCOG 6977(GER911)

HC StandardCOG 6977(GER911)

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NDMS Patient Movement Exercise OrganizationsDHS Office for Interoperability and CompatibilityDHS Tech Support - Evolution TechnologiesHHS / ASPR / NDMSMaryland Institute for Emergency Medical Services Systems (MIEMSS)Memphis / Shelby County Health DepartmentMemphis / Shelby EMAMemphis FireMemphis Shelby Regional Hospital CoordinatorMethodist Hospital CorpVendor - Disaster Management Solutions (DMS)Vendor - EMSystemsVendor - Global Emergency Resources (GER)Vendor - HHS Joint Patient Assessment & Tracking System (JPATS) Vendor - UPP TechnologiesTN DOH Exercise Coordinator & State Response CoordinatorTN Air National GuardVeterans Administration

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Post Exercise Analysis, Improvement and Outreach

• EDXL-TEP draft Requirements and Messaging Specification improved from planning and conduct of the exercise

• Improved federal, state and local patient tracking requirements• Changed and validated Required and Optional Elements• Validated applicability and value of EDXL standards approach

for patient tracking across locations, organizations, jurisdictions, and across independent systems already in place.

• Messaging data analysis• Validate messaging and data passed and develop statistics

• Outreach• Poster session presentations at the 2010 Integrated Medical,

Public Health, Preparedness and Response Training Summit June 3 & 4.

• “After-Action” Report • A description of what happened, what worked, what didn’t,

recommendations for improvement to the standard(s), and a recommended action plan

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Identification of Future Implementation Opportunities

• Pre-Implementation- Greater Coordination with Publisher/Subscribers and Supporting Organizations

Sequencing of Messages Security/Protection of Information Event Type Drives Optionality

• Agreements with other Standard Development Organizaitons like HL7

• How do we address system errors i.e. A patient gets designated “Black (Morgue)” what if they are not moved or re-triaged because someone made a mistake early in process?