As we’ve been traveling around the state talking with people about the PULSE+EMS Project, a common discussion point has been the potential challenge of achieving hospital participation in a local PULSE+EMS effort. In order for any HIE in EMS proposal to meet the grant requirements it must include at least one LEMSA, at least one emergency ambulance service provider, at least one health information exchange and at least one hospital.
We’ve heard from local agencies and HIEs that the governance and legal agreements required to ensure that all parties are comfortable with sharing patient health information may be a significant hurdle. It seems that hospitals have expressed concerns with regard to broadening the universe of those with whom they share information.
Strong privacy and security policies and technological effort will address some of these concerns, but there is also a lack of understanding as to 1) why EMS needs to have access to patient records at all, 2) why putting ePCR information into the EHR as structured data is better than attaching a pdf, and 3) why hospitals should devote their limited resources to bringing in EMS when they are still struggling to meet CMS’ meaningful use requirements. The most important strategy for developing cooperation among potential participants is to focus on developing and maintaining a strong relationship, and while doing so, you may want to mention the points below.
- EMS needs access to patient information in the moment in order to provide better patient care, which is one of the three pillars of health care reform. Paramedics don’t need access to the entire record, but they need the pertinent information to provide better care immediately. Access to allergies, medications, health conditions, and advance directives will help prevent medical errors in cases of diabetes, latex allergy, adverse drug interactions, stroke or under a do not resuscitate order, among many other use cases.
- The Joint Commission accreditation requires hospitals to have an EMS record for each patient received from an ambulance. Currently, most hospitals comply with this requirement by attaching a pdf of the EMS ePCR to the EHR. Automatically incorporating some amount of EMS ePCR data into the EHR through HIE will reduce or eliminate workload related to receiving (by email, fax or hard copy), scanning and filing PCRs into the patient’s EHR. The benefit to the patient is that it creates a better longitudinal patient record. The benefit to the healthcare system is that the prehospital information becomes searchable and researchable for analysis and system improvement.
- Actions taken by prehospital care providers on scene affect the patient experience, quality of care and outcomes, all of which are becoming ever more important factors in reimbursement. Helping EMS to participate in information exchange will have benefits for the hospital as well as for EMS. For instance, as written by Dr. Greg Mears in JEMS, “As CMS increases the use of pay-for-measurement and pay-for-performance strategies, more and more process metrics will become standardized and required nationwide. CMS has stated that core measures will be coming to all aspects of healthcare it pays for – including EMS. The only question is when. Accountable Care Organizations will also be looking for such metrics and the accountability they bring from their EMS partners.”
On the PULSE side, which is interconnectivity of HIOs and HIEs for access to EHRs by healthcare professionals during a disaster, there are benefits for the hospital as well. CMS meaningful use stage two core measures require hospitals to provide a summary care record for each transition of care or referral via EHR or CCDA. During a disaster, relocation of a patient outside their usual healthcare system may constitute a transition of care, triggering the need for access to the patient’s electronic health record. With PULSE in place, the mechanism to meet that standard effectively during a disaster will be available.