California funds building of HIE capable of exchanging data during a disaster

Network will let providers share patient information through earthquakes, fires and other times when normal links are knocked out.

The California Emergency Medical Services Authority has funded development of a solution to provide real-time health information exchange during disasters, when electronic health records are frequently unavailable to first responders and providers.

The agency awarded Baltimore-based health IT company Audacious Inquiry (Ai) a $518,000 contract that runs through July 2017 to develop the standards-based Patient Unified Lookup System for Emergencies (PULSE) platform to enable the secure exchange of healthcare data across HIE and provider organizations during both natural and manmade disasters.

The platform is being developed for California, but the standards-based approach being used to develop it could be replicated in other areas of the country.

Supported by a grant from the Office of the National Coordinator for Health IT, PULSE will connect health information organizations (HIOs) and health systems to an HIE interoperability broker that has connectivity to all the existing HIEs and healthcare organizations.

During a disaster, the web portal will be activated, enabling healthcare professionals employed by health systems or participating with HIOs to access patient records through their existing systems. Other authorized healthcare professionals will be able to access the portal via a user interface using single sign-on.

PULSE leverages exchange specifications, Integrating the Healthcare Enterprise (IHE) standards, and federated directory services enabled by the California Trusted Exchange Network, as well as built-in security protocols. Specifically, IHE promotes the coordinated use of established standards such as Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven International (HL7).

“We came up with a way for HIE technology to support not only the day-to-day operations of emergency medical services but also in a disaster scenario,” says Scott Afzal, partner at Ai. “Our aim is not to create some new proprietary platform. There are a lot of existing data exchange standards, IHE profiles that are out there that are increasingly adopted by health information exchanges, vendors and health systems. The basic IHE profiles are transactions that allow for different organizations to communicate with one another.”

According to Afzal, Ai will develop PULSE functionality that is critical to EMS personnel and other providers, including the ability of users to search for patient information and to request/view clinical documents from connected HIEs and health systems within the portal.

“Health data are often missing for patients in the most difficult circumstances, across a range of natural or manmade disaster scenarios,” said Dan Smiley, chief deputy director of EMSA, which has responsibility for promoting disaster medical preparedness throughout the state. “We welcome this opportunity to combine our teams’ collective strengths in HIE and medical services, emergency preparedness and response, systems modernization, and health information policy.”

Afzal points out that California is home to a “number of pretty strong health information exchange organizations serving their communities” and that Ai has defined the PULSE California use case in collaboration with the California Association of Health Information Exchanges (CaHIE) for specific disaster scenarios.

“God forbid there’s a terrible earthquake in San Francisco and there’s a mass population migration to other areas of the state, providers treating patients will have the ability to query information for as long as PULSE is activated,” he says. “This kind of population displacement did happen during Hurricane Katrina in 2005, and hundreds of thousands of people could have benefitted from having their information available to first responders and providers. The objective is to demonstrate that this is a viable methodology to support disaster response.”

While PULSE is being developed for California, Afzal contends that the standards-based work to create EMS-to-HIE interoperability could be leveraged at a national level, bringing the capability to other states nationwide.

“The thing that makes it hard on a day-to-day basis is just getting over the unwillingness to share data among competitive enterprises,” he concludes. “Even if it’s challenging to get organizations to work together on a day-to-day basis to exchange data, for all the reasons that it’s hard to get HIE set up around the country, in a large-scale disaster maybe they’d be willing to participate.”

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