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

Emergency Data Exchange Language (EDXL) Tracking of Emergency Patients (TEP). August 25, 2010. Presentation to the: OASIS Emergency Management Technical Committee Dial in: 1-888-325-3989 pass code: 561413 # Attendee URL: https://www323.livemeeting.com/cc/eiip/join?id=DHSOICSWG.

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

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  1. Emergency Data Exchange Language (EDXL) Tracking of Emergency Patients (TEP) August 25, 2010 Presentation to the: OASIS Emergency Management Technical Committee Dial in: 1-888-325-3989 pass code: 561413 # Attendee URL: https://www323.livemeeting.com/cc/eiip/join?id=DHSOICSWG

  2. Current Status • PRESENTATION PURPOSE: OASIS Outreach and Education on the draft Standard – questions at the end • Practitioner Submission to EIC May 14, 2010 • Practitioner Submission to OASIS June 8, 2010 • TEP Voted within OASIS as a Work Product June 22, 2010 • TEP Sub-committee Created Within EM-TC subcommittee & Chairs Voted in (T. Grapes / D. McGarry) August 2010 • Plan to Engage Sub-Committee Work Beginning of Oct. • MOU in-progress between OASIS and HL7 for standard collaboration • Interagency MOU in-progress (privacy, adoption etc.)

  3. Background – TEP & TEC Messaging Standards • The NASEMSO with many other agencies and organizations recognized the need for standards-based interoperability to realize the potential of the numerous patient tracking systems in existence or planned • Introduced TEP to the DHS S&T Office for Interoperability and Compatibility (OIC), sponsor of the EDXL development process – a mature, proven process for developing cross-profession, practitioner-driven messaging standards • Effort was Initiated by the PSG as the next EDXL Priority • Helps close HITSP ER-EHR IS04 Gaps • Supports HHS & DOD AHRQ Objectives

  4. 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 .

  5. 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. • Emergency / Disaster EMS, ED / Hospitals / Care Facilities, Emergency Management, Ops, Dispatch, Command • 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.

  6. TEP Use Case Events / Triggers

  7. EDXL-TEP Structure and Elements

  8. EDXL-TEP Structure and Elements

  9. EDXL-TEP Structure and Elements

  10. 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)

  11. EDXL Process and Pilot

  12. TEP Research •  STANDARDS • OASIS EDXL • ASTM Continuity of Care Record (CCR) • HITSP ER-EHR • HL7 Continuity of Care Document (CCD) • PHIN Standards • Vehicular Emergency Data Set (VEDS) • National EMS Information System (NEMSIS) • Data Elements for Emergency Department Systems (DEEDS) • NON PROFIT • COMCARE/HIMSS Integrated Emergency Medical Response Initiative (IEMRI) • COMCARE Integrated Patient Tracking Initiative (IPTI) • Coordinated Assistance Network (CAN) • VENDOR PRODUCTS • PRE-HOSPITAL • IN HOSPITAL • FEDERAL / DOD • HHS AHRQ Evacuee Movement • HHS AHRQ Patient Tracking Locator (PTL) • DHS - NIMS • Asst. Sec. for Preparedness & Response (ASPR) • DoD & Other Systems. E.g. • TRAC2ES • NDMS • AHLTA Mobile (aka BMIST) • JPTA • TacMedCS • FCC JAC • WebMedis • STATE AND LOCAL • *Triage Tags from across the country • MCI-PT Detailed Requirements TN DOH • Boston PTS for Public Health • Christiana Care Health System • HERDS - NYS • National Capital Region • San Francisco, STARRS 14

  13. 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

  14. Standards Development Process

  15. TEPSteeringCommittee

  16. 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 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 TEP Practitioner Submission

  17. Draft EDXL-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 using volunteer patients, driven by objectives of federal, state and local agencies and NDMS partner hospitals. DHS OIC pilot the draft EDXL-TEP specification in a field exercise before submitting to the standards approval process A hurricane makes landfall resulting in mass casualties requiring evacuation and medical treatment. 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. Patient registration timeframes dramatically reduced – hours to 30 minutes First Electronic Patient Manifest for TN Air National Guard Tennessee NDMS Patient Movement Exercise

  18. 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

  19. Missouri / Louisiana Hospitals & Mississippi, Wisconsin & Tennessee Tracking TEP Patient Tracking Proof of Concept MESSAGE FLOW-ONLY VIEW • EMTrack Missouri Hospital evacuation to the airport • NO TEP to ARR • EMTrack Missouri Receipt of Patient arrival at airport • NO TEP to ARR • EMTrack Missouri updated to assign 35 patients to Shreveport, LA Region 7 NDMS hospitals (JPATS assigns to appropriate flight) • EMTrack Shreveport patients land / received at Shreveport PRA • EMTrack Shreveport assign patients to ambulances at the PRA, destined to specified local hospitals • EMTrack patient arrival at each Shreveport hospital • May 16–19 SEPARATE from and parallel with the end-to-end tracking of the 35 patients above, HC Standard sends TEP updates to the Tennessee National Family Reunification Center (UPP) for up to 1000 patients during the course of their movement and tracking. • May 19 2011 HC Standard now begins to send TEP updates to EMTrack today in addition to UPP 3 4 EMTrack Missouri COG 6951 EMTrack Shreveport COG 6951 A R R Shreveport COG 6971 5 8 6 1 6 2 3 4 5 UPP Technology Tennessee COG 6972 National Family Reunification Center (notional) ALL Messages 1 - 8 7 (as provided – up to 1000 patients) HC Standard Mississippi / Wisconsin COG 6983 “Monitor” COG COG 6993

  20. Missouri Hospital Evacuation 1- May 19, 2011 Missouri hospital enters 35 patients into EMTrack for evacuation (paper patients) to be moved to another State for Hospitalization and/or Treatment NDMS Hospitals Local Hospitals Missouri / Louisiana Hospitals & NDMS TEP Patient Tracking Proof of Concept EMTrack Missouri COG 6951 NOTE: EMTrack is configured as a single “instance”, self-updating between Missouri and Louisiana Missouri Airport 1send Paper HAVE Report to VA Area Emergency Manager TRAC2ES Manual EMResource Missouri Airport Manual A R R Shreveport COG 6971 2,3 send EMTrack Missouri COG 6951 3 send Hospitals provide HAVBed updates 3 EMSTAT La IPAWSOPEN IPAWSOPEN IPAWSOPEN IPAWSOPEN 2 - Missouri EMTrack Receipt of Patient arrival at airport 3 - Missouri EMTrack assign 35 patients to Shreveport, LA Region 7 NDMS hospitals Shreveport PRA 4,5,6 “Monitor” COG COG 6993 6- EMTrack patient arrival at each Shreveport hospital National Family Reunification Center Tennessee ALL Messages 1-8 UPP Technology Tennessee COG 6972 EMTrack Shreveport Hospital(s) COG 6951 1,2,3 4,5,6 6 send Shreveport PRA 4,5 send 7 Landing HC Standard Minnesota / Georgia National Guard COG 6983 7send May 16-19 EMTrack Shreveport COG 6951 8 send May 19 8 4 – Shreveport EMTrack patients land / received at Shreveport PRA 5 – Shreveport EMTrack assign patients to ambulances destined to specified local hospitals Mississippi & Wisconsin 7 & 8– May 16–19, 2011 SEPARATE from and parallel with the end-to-end tracking of the 35 patients, HC Standard sends TEP updates to Tennessee (UPP) and later to EMTrack for up to 1000 total patients

  21. EDXL-TEC update

  22. TEP-TEC Jurisdictions and Systems Federal HHS (JPATS) FEMA (NEFRLS, NMETS, NSS), NLM (LPF) DoD JPTA TRAC2ES ETAS TEP-TEC Incident TEP-TEC Local All incidents start locally TEP-TEC TEP-TEC TEP-TEC TEP-TEC Local / States TX (SNETS, TWIRP) LA TN MD …etc. NGO’s ARC (Family Links) Hospitals Shelters Ushahidi, Sahana iREPORT Facebook Twitter TEP-TEC TEP-TEC

  23. TEC “Generic Process”

  24. TEC “Generic Process”

  25. TEC “Generic Process”

  26. TEC “Generic Process”

  27. BACKUP SLIDES

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