EDXL Tracking of Emergency Patients

1. EDXL Tracking of Emergency Patients May 19, 2010 Presented to the: Emergency Interoperability Consortium

2. 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 Services Patient: A type of client requiring medical attention, being medically evaluated; or a fatality .

3. TEPSteeringCommittee

4. 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

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

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

7. 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.

8. 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 Tennessee National Disaster Management System Patient Reception Exercise

9. 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. The NDMS Patient Movement Exercise

10. NDMS Hospital NDMS Hospital Local Hospital Local Hospital Evacuation Patient 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) EMSystems EDXL-HAVE HC Standard COG 6977 (GER911) TNCRN/WebEOC (No Message Exchange via DM OPEN) HC Standard COG 6977 (GER911) DE-TEP DM OPEN …Hospitals provide HAVE updates 2 – Load patients to aircraft and provide TEP updates (JPATS update all) Patient Tracking COG 6974 (UPP Technology) DM OPEN DE-HAVE WebEOC JPATS COG 6978 (Apprio) DE-TEP DE-TEP First Track COG 6975 (DM Solutions) Tennessee – Memphis Shelby: 3 -Offload patients from aircraft (First Track update all) 4 - Patient ambulance transport (First Track update all) Take-off Landing DM OPEN First Track COG 6975 (DM Solutions) HAVE COG 6976 (EM Systems) DE-TEP 5 – Patients received at hospitals (First Track update all) DE-TEP Updates DM OPEN

12. 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

13. 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?