An Open, Interoperable, and Scalable Prehospital Information Technology Network Architecture

Abstract

Some of the most intractable challenges in prehospital medicine include response time optimization, inefficiencies at the emergency medical services (EMS)-emergency department (ED) interface, and the ability to correlate field interventions with patient outcomes. Information technology (IT) can address these and other concerns by ensuring that system and patient information is received when and where it is needed, is fully integrated with prior and subsequent patient information, and is securely archived. Some EMS agencies have begun adopting information technologies, such as wireless transmission of 12-lead electrocardiograms, but few agencies have developed a comprehensive plan for management of their prehospital information and integration with other electronic medical records. This perspective article highlights the challenges and limitations of integrating IT elements without a strategic plan, and proposes an open, interoperable, and scalable prehospital information technology (PHIT) architecture. The two core components of this PHIT architecture are 1) routers with broadband network connectivity to share data between ambulance devices and EMS system information services and 2) an electronic patient care report to organize and archive all electronic prehospital data. To successfully implement this comprehensive PHIT architecture, data and technology requirements must be based on best available evidence, and the system must adhere to health data standards as well as privacy and security regulations. Recent federal legislation prioritizing health information technology may position federal agencies to help design and fund PHIT architectures.

Prehospital Electronic Patient Care Report Systems: Early Experiences from Emergency Medical Services Agency Leaders

“…[35] Real-time information exchange may be more difficult for mobile prehospital providers operating in austere settings lacking robust wireless communication infrastructures. [6] Study participants also reported difficulty responding to mandates requiring the adoption of e-PCR systems. Other US health care providers are being encouraged to adopt HIT under federal health policy, most notably from the Health Information Technology for Economic and Clinical Health (HITECH) Act, which provides incentive funding for hospital and ambulatory EHR adoption (with penalties in subsequent years if not adopted).…”

“…[6], [9] Our research, combined with a future comprehensive, quantitative survey of US EMS agency e-PCR system capacity as well as barriers and strategies to e-PCR system adoption, implementation and use, could better characterize the unique needs of EMS agencies. Federal support for additional e-PCR systems research could help determine the impact of e-PCR systems on ambulance call times and identify efficient e-PCR system workflows.…”

“…[20] Since none of the identified EMS agencies were able to exchange electronic data with hospital electronic medical records (there are very few organizations currently with this functionality), [6] we included a hospital-based emergency physician to represent an organization with this capability. We used a purposeful sampling approach to ensure a balance of geographic locations (Northeast, Midwest, South, West, and Canada) as well as agencies using e-PCR systems and not using e-PCR systems.…”

“…[4]–[6] Current commercial e-PCR systems primarily replicate existing paper-based patient care reports with electronic fields to capture history, physical exam, assessment, and treatment rendered. A variety of commercial electronic software and hardware solutions are available and each EMS agency or region generally selects their own product.…”

Electronic Prehospital Records are Often Unavailable for Emergency Department Medical Decision Making

“…Electronic prehospital PCRs are now widely available and commonly used in many emergency medical services (EMS) systems. Despite this change, there are still barriers to timely and accurate information delivery 9. Most modern electronic prehospital PCR systems use an internet-based network and/or telefacsimile (FAX) transmission to deliver the prehospital information to the receiving facility.…”