David Magnino EMS Coordinator MagninoD@saccounty.net (916) 875-9708

1. w r G o ingForward with HIE in 2014 David Magnino EMS Coordinator MagninoD@saccounty.net (916) 875-9708

2. Educational Objectives: • Can Health Information Exchange (HIE) use by healthcare professional strengthen the delivery of EMS in CA? • Each level of HIE depends on actions of individual clinicians – education is paramount • Accept & adapt to changing electronic medical record technologies in workplace • Embrace new patient care workflow with positive mind-set • Contribute to growing ecosystem of real-time, regional public health surveillance by HIE at the point of care

3. What is Health Information Exchange? • Statewide electronic PCR • Real-time exchange

4. WHY?US DHHS – electronic movement of health-related information among organizations according to nationally recognized standards

5. WHY?US DHHS – electronic movement of health-related information among organizations according to nationally recognized standardsGoal: facilitate access to and retrieval of clinical data to provide safer, timelier, efficient, effective, equitable, patient-centered care.

6. BENEFITS? HealthIT.gov - list some of the benefits: • Improving quality and safety of patient care? • Reducing medication and medical care • Increasing efficiency? • Eliminating unnecessary paperwork • Creates a potential loop for feedback? • Health-related research and actual practice

7. patient EMR hospital ED response team EMS provider

8. patient EMR hospital ED response team EMS provider

9. patient EMR hospital ED response team EMS provider Inpatient specialtyteams

10. patient EMR hospital ED response team EMS provider Inpatient specialtyteams patient follow-up visit

11. patient EMR hospital ED response team EMS provider Inpatient specialtyteams patient follow-up visit

12. 2013 HIE ProjectAimed to explore the State’s EMS level of readiness to exchange pre-hospital EMS information between hospitals:Local EMS Agencies EMS providers CA Hospitals Systems

13. Aimed to explore the State’s EMS level of readiness to exchange pre-hospital EMS information with hospitals Local EMS Agencies EMS providers CA Hospitals Grant funding CA Office of Health Information Integrity (CalOHII) Funding: August 1, 2013 to January 15, 2014

14. Two Elements of Grant:EMS Readiness Assessment and Gap Analysis for HIELocal EMS Agency Demonstration Projects

15. EMS Readiness Assessment and Gap Analysis for HIEContract vendor : Lumetra Healthcare Solutions

16. What: Baseline evaluation of current EMS workflow and EMS health information sharing between LEMSA, EMS providers and hospitals

17. What: Baseline evaluation of current EMS workflow and EMS health information sharing between LEMSA, EMS providers and hospitalsHow:‘Best practices’ that highlight electronic exchange of EMS informationAssessment of readiness of current status, plans for phased implementation and expected gaps

18. How to move EMS Readiness into HIE?Identify:Key barriersGapsCost considerations

19. RESULTS? Top 3 Issues: • Standardized processes, data and systems throughout the 33 LEMSAs • Relationships with Hospital systems • HIPAA has a barrier for data sharing

20. How to Solve Issues? • Standardize workflow by mapping the processes used. Common points and best practices. • Workgroup to establish relationships and agreements with hospital systems regarding HIE. Work with California Associations of Health Information • Exchanges to establish interface with community HIE • Evaluate HIPAA requirements further to see if barriers truly exist. Implement standard use agreements and standard security policy between providers, agencies and hospitals

21. Three LEMSA projects

22. Contra Costa

23. Gaps in IT support and recommend corrective actionsFeasibility of pilot project to link ePCR to single hospital EMR platform to obtain outcomes for EMS patients1 year timeline and monitoring process for future development of specific implementations.

24. OUTCOMES: Working with hospital in the development of a dashboard and establishment of the necessary interface with the hospital

25. Monterey

26. QI committee continue exploring software solutions to fully integrate field ePCRs into hospitalsLEMSA lead purchase and installation of software programReview improvements of pre-hospital and hospital communication

27. OUTCOMES: • Identified, purchased and installed software for Salinas Fire, connection with American Medical Response Ambulance’s software (MEDS) and NativadadMedical Center. • Ran test data during the week of December 15-21, 2014 • Live on December 22, 2014. Successful data has been processed through the system.

28. ICEMA

29. Continue work to develop process to allow hospital to access and append EMS ePCR information related to medical control Process allows :Record orders making them part of patient’s EMRMark for review and add QA/QI comments on care issues for medical control evaluation

30. Identify and evaluate processes needed for inclusion of record into base and receiving hospital medical recordsDemonstration of linkage between ePCR and a web enabled hospital data collection device

31. OUTCOMES: • Installed and testing Enhanced Base Hospital (eBHR) software within ICEMA to correct problems before rolling out to hospitals. • Working with two base hospitals with either mouse entry or touch entry software. • Assisted Northern California, North Coast, Sierra-Sacramento Valley EMS agencies and Tuolumne County EMS agency. • Four LEMSAs have moved forward • in their progress with ePCR and HIE • development.

32. ‘Planting the HIE Seed, Growing an EMS Solution for the Future’ SummitTHE WESTIN LOS ANGELES AIRPORT

33. ‘Planting the HIE Seed, Growing an EMS Solution for the Future’ SummitNovember 19 & 20, 2013 • Educational opportunity for all involved with EMS • Attended by approximately 240 of EMS and Hospital communities members • National, State and Local presenters • EMSA, CalOHII, Vendor sponsored

34. Where do we go from here?

35. Look towards the future of continuum of careHow do we get EMS to fit into the overall care of the patient and electronic medical records?First step in a series of many to move CA EMS in that directionReal-time exchange at care level will leads to real-time QI and prevention

36. CA Association of Health Information Exchanges • Relationship with Hospitals and HIOs • Community-level examples of HIE moving toward pilot phase development

37. CA Association of Health Information Exchanges Mission: Develop California’s version of the Data Use and Reciprocal Support Agreement (DURSA) to clarify policies and procedures to conduct HIE in CA. Expand HIE to all aspects of healthcare beyond clinical medicine.

38. CAHIE Mission:All providers of health-related services have the opportunity to participate in exchange and interoperate with other providers of care for patients in common. Ensure HIE is secure and respects the privacy rights of individuals.Support the technological innovation needed to establish infrastructure for California to enable inter-HIO exchange.

39. Relationship with Hospitals and HIOs • Identify minimum requirements to fostering ‘Meaningful Use’ between pre-hospital providers and hospitals: • Work with CAHIE, CA Hospital Council, hospital systems • Develop meetings with hospitals to discuss HIPAA concerns, software barriers (NEMSIS 3 vs HL7) and Federal and State regulations that assist in breaking through these concerns • Work with legislators and hospitals to pass AB1621 in first version (1797.119 H&S)

40. CA Progress on EMS and HIE • December 10, 2013: • Conference call with Kaiser Hospital, AMR, CAHIE and EMSA • Possible pilot project in 2014 to integrate AMR ePCRs into Kaiser’s electronic health records. • January 13, 2014: • Follow-up conference call with AMR, Kaiser, Bay Area Health Share Regional HIO and EMSA.

41. patient EMR hospital ED response team EMS provider

42. patient EMR hospital ED response team EMS provider Inpatient specialtyteams patient follow-up visit

43. WHY EMS? • EMS needs to be part of the Care Continuum • Improving pre-hospital patient care by improving health-related research and actual practices • Reducing health related costs

44. RESOURCES: CA Association of Health Information Exchanges: David Minch: President and Chairman of the Board http://www.ca-hie.org/about-us/goals CA Office of Health Information Integrity: David Nelson: Cal OHII SME on HIPAA/HIE/Privacyhttp://www.ohii.ca.gov Health Information Technology: http://www.healthit.gov/HIE

45. QUESTIONS? • David Magnino • EMS Coordinator • MagninoD@saccounty.net • (916) 875-9708