The long-term goal of electronically tracking patients from the field to the hospitals to which they are taken is becoming a reality in several major jurisdictions in the United States. This achievement comes through the marriage of existing patient-tracking systems and new technologies designed to effectively capture, share, and manage health data on patients from the time an ambulance arrives on-scene to the day and time those patients are discharged from the hospital. Although certain technological and policy challenges remain significant hurdles that are still in the way of creating a true “end-to-end” solution, the future now looks much brighter for connecting healthcare providers at all levels and locations.
In such major cities as Los Angeles and St. Louis, for example – as well as in the National Capital Region (NCR – i.e., Washington, D.C., and its closer Maryland and Virginia suburbs) – EMS (emergency medical services) field personnel are using personal digital assistants (PDAs), cell phones, barcodes, and RFID (radio-frequency identification) tags to identify, track, and store essential health data for patients during major mass-casualty incidents (MCIs). These systems wirelessly link physical tags to the patient data collected in the field and transmit the information to a central server, which provides secure web access to individual hospitals, local and/or regional hospital command centers, emergency-management agencies, and other authorized healthcare agencies, organizations, and decision-making officials.
During and in the aftermath of an MCI, the aggregated data will provide healthcare leaders and operational personnel at all levels with a comprehensive report on the type, scale, and severity of a given incident. That information is of crucial importance to ensure that the appropriate level and type of response is provided both at the scene of the incident and later. The same data also greatly assists emergency managers, hospital resource officials, and other decision-making leaders with the information – based on hospital capacity (and, if needed, the specialized medical capabilities available) – needed to route patients expeditiously and efficiently.
The Real-Life Importance of Real-Time Admittance
Another of the several important technological achievements referred to above involves the connection between the field data-gathering system (master patient database) and the patient-tracking systems of individual hospitals. For many years, hospitals have installed, and used, a relatively broad spectrum of internally focused patient tracking systems. Recently, however, many, if not quite all, of these systems have added a one-way data feed to newer types of field-tracking databases conformed to use existing medical data-exchange standards such as what is referred to as Health Level Seven (HL7). By simply referencing patient field “tags,” hospitals can now transmit near real-time admittance data from their individual databases to the central master patient database, thereby providing emergency managers with updated status reports on the location of patients.
A major “added benefit” of connecting these systems is that it simplifies the important task of facilitating family reunifications in the aftermath of an MCI or other major incident or event. Emergency managers with access to the master database can now quickly direct family members to a given patient’s hospital almost immediately after that patient has been admitted.
Future goals for these connected systems include the establishment of “bi-directional” data exchanges between field and hospital systems. In the NCR, for example, the data, including vital statistics collected in the field during an MCI, are not at present automatically entered into the receiving hospital’s internal patient tracking system. Adding this capability will require additional technical development as well as the establishment of new data standards governing the format for such types of exchanges. The Department of Homeland Security’s Science and Technology Directorate has already taken the first steps needed, though, to sponsor the development of the new TEP (Tracking of Emergency Patients) XML messaging standard being designed to support the exchange of emergency tracking information on patients from the time of the individual’s hospital admission to and through the time of his or her release. These standards will be critical as additional “homegrown” commercial and government systems are developed and deployed. This new technological aspect of “mutual aid” must be clearly and carefully defined, though, to facilitate an efficient multi-jurisdictional response to an MCI.
The Privacy Act, FDA Concerns & Other Significant Issues
It is particularly important that policy issues, including privacy concerns, be considered fully during the development and use of the new systems and devices now in the pipeline – primarily to ensure compliance with existing laws such as the Health Information Privacy Act. In Virginia, a robust legal review was conducted as part of the process that created the statewide web portal to enable access to patient tracking data. Thanks to that review, such data is available only through the system’s secure portal and not through newer GIS-based “situational awareness” and/or “decision-support” tools.
Another factor to be considered is that the U.S. Food and Drug Administration (FDA) has expressed potential interest in regulating cell phones and PDAs as “medical devices.” The rationale here is that the use of field patient-tracking software could be seen as “transforming” a PDA or cell phone into a medical device, therefore requiring the FDA’s approval for use.
Despite these and other challenges, the future for “connected” patient-tracking systems now appears brighter than ever before and should facilitate a better-managed and more comprehensive response to large-scale incidents and events at all levels of government.
Rodrigo (Roddy) Moscoso
Rodrigo (Roddy) Moscoso is the executive director of the Capital Wireless Information Net (CapWIN) Program at the University of Maryland, which provides software and mission-critical data access services to first responders in and across dozens of jurisdictions, disciplines, and levels of government. Formerly with IBM Business Consulting Services, he has more than 20 years of experience supporting large-scale implementation projects for information technology, and extensive experience in several related fields such as change management, business process reengineering, human resources, and communications.