In a cardiac system of care, STEMI-referring hospitals and STEMI-receiving centers rely on accurate, timely communication and coordination between their facilities and their EMS partners. Availability of comprehensive patient data that spans the pre-hospital to hospital continuum of care plays an essential role in a range of use cases. For example, emergency department (ED) providers can optimize treatment for cardiac arrest patients arriving via ambulance. Cardiac coordinators and quality teams can perform analysis and conduct activities aligned with The Joint Commission’s Resuscitation Standards for Hospitals. Combined pre-hospital and hospital data also supports reporting required for compliance and hospital certification.
With the abundance of practical uses for this data, it’s easy to make the case for EMS-hospital interoperability. Even so, it’s not the norm for most cardiac systems of care. Why? Rapid access to EMS data is more than important — it’s essential. The cumulative impact of interoperability on critical care, compliance, quality, education, and accreditation makes a compelling value proposition.Commonly, STEMI reports need to be completed within 24 hours of patient arrival at the hospital. QA staff review the patient’s EMR to identify live time trends, door-to-balloon times, room turnovers, restenosis, or other complications. They look for outlier metrics and anything that requires timely, corrective action. When available, pre-hospital data patient documentation will include first medical contact, time of first EKG transmission, 12-lead information, vital signs, and more. It can explain factors such as a longer than normal transport or door-to-balloon time. For example, the PCR will capture any unusual circumstances in the patient’s location, health particulars, or even communication limitations in areas with sub-optimal cellular coverage. However, access to pre-hospital data is dependent on the EMS provider finalizing and sharing the PCR, which can be a surprisingly time-consuming process involving faxes, document scanning, and manual data input.
Time is of the essence for QA activities; yet in an age when near-real time digital transfer of information is taken for granted (think everything from online banking to your favorite streaming service), there is a significant interoperability gap between pre-hospital and hospital providers due to the necessity for EMS to leave or fax paper "drop sheets" to receiving facilities. Critical pre-hospital assessment and intervention information typically is not available to the receiving clinicians who are responsible for safely continuing care.
The interoperability gap can be closed by implementing an HL7 interface like ZOLL Care Exchange, which solves the problem of lagging pre-hospital data. Best-in-class solutions can automatically NEMSIS-standardize ePCR datasets and import them into the EMR, meeting compliance requirements and providing clinician transparency. Clinical feedback and visibility into the patient care history can be accessed via a single, platform- and device-agnostic tool. From the get-go, hospital staff responsible for reporting, quality, education, and compliance have access to comprehensive patient data that spans the continuum from the 911 call to eventual post-resuscitation care (essential information for quality assessment).
Pre-hospital and hospital patient data collected and compiled by the hospital, including the number and location of cardiac arrests, resuscitation outcomes, and transfers to facilities with a higher level of care, is readily available in a format that supports a range of analysis and reporting activities. Teams responsible for improving resuscitation performance have visibility into complete cardiac arrest data to help identify opportunities and drive QI initiatives. Outcome data can be easily reported out to partner EMS agencies as part of ongoing collaborations to improve pre-hospital care and coordination.
For hospitals that are evaluating the costs and benefits of HL7 data exchange, there will inevitably be many questions coming from a range of stakeholders. As is the case with any information technology initiative, questions like, “How much does it cost?” and “Can we afford it?” are likely to be top of mind. While the investment cost cannot be dismissed, there are other, more targeted questions that can help decision makers ascertain the true value of the investment. The opportunity cost of not implementing HL7 may be significantly greater than meets the eye. In addition to staff workflow inefficiencies, lack of timely, comprehensive patient data inhibits performance, which can have a downstream dampening effect on revenue. Maintaining quality and continuously improving systems and patient outcomes is an important success driver for business development, as well as for accreditation and community reputation.
Some questions hospitals in the cardiac system of care should consider, in addition to calculating the financial return on investment (ROI), are:
The Case for EMS-Hospital Interoperability
From faster treatment intervention, to reduced QA workload, to compliance, to more efficient reporting, HL7 data exchange improves patient safety, outcomes, and continuity of care. EMS providers can share PCRs and EKGs with hospitals electronically, in near real time. At the ED, patient hand-off is streamlined with no wait time or need for barcode readers. Cardiac coordinators and QA staff can access complete patient information from incident onset through discharge, in near real time and later, for a variety of analysis and reporting needs.