A new initiative from the Sequoia Project, working with multiple healthcare industry stakeholders, aims to get electronic health records to emergency medical professionals and healthcare providers, regardless of where patients and evacuees are being treated when a disaster strikes.

The initiative aims to build the Patient Unified Lookup System for Emergencies, or PULSE, modeled after a demonstration program in California.

The effort, led by Sequoia, which operates the eHealth Exchange nationwide network to securely share clinical information using a standardized process, is getting financial and technical support from the Centers for Medicare and Medicaid Services, the Office of the National Coordinator for Health Information Technology, the HHS Assistant Secretary for Preparedness and Response, the California Association of Health Information Exchanges, research firm Mitre Corp. and an advisory council for PULSE.

“PULSE is a public-private collaborative to ensure our cities, counties and states are ready for when the next disaster strikes,” says Mariann Yeager, CEO at Sequoia. “There are always going to be disasters, and we are always seeking new ways to help people affected.”

As help starts arriving following a disaster, PULSE will authenticate EMS personnel, physicians, physician assistants, nurses, nurse practitioners, pharmacists and other emergency workers, such as registration clerks and those who set up field hospitals and evacuation centers, so patient continuity of care documents can be shared to inform the best treatment options for patients during the emergency.

The goal is to retrieve patient data from health information exchanges, hospitals and delivery systems, pharmacies and other sources using Sequoia’s national exchange standards, and to match patients to their data.

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Sequoia’s role in the program is to support a broader deployment of PULSE, Yeager explains. The organization has a presence across all 50 states serving the Departments of Defense and Veterans Affairs, Centers for Medicare and Medicaid Services and Social Security Administration, as well as 70,000 medical groups, 3,400 dialysis centers, 8,300 pharmacies and 75 percent of hospitals.

“We will start to see more benefits,” Yeager adds. “This is an opportunity to put investments into practice. It’s a lesson for all of us to make an impact. Declared disasters are a scary and stressful time. Folks need seamless healthcare, whether for emergency care or just uninterrupted prescription access when they are displaced by a disaster.”

As work begins to take PULSE nationwide, the initiative has models to follow, says Jeremy Wong, director of master data management services at Audacious Inquiry, a vendor that facilities the exchange of health information.

Audacious Inquiry built a first version of PULSE for the California Emergency Medical Services Authority and also built a version for the California Association of Health Information Exchanges. The EMS authority wanted PULSE because it wish to conduct health information exchange, as emergency professionals were left out of the electronic health records meaningful use program, and PULSE offered a viable HIE option, Wong explains.

While final decisions on the building of a national PULSE system are not yet finalized, Rim Cothren, executive director at the California Association of HIEs and a member of the advisory board to Sequoia on planning expansion, expects that Audacious Inquiry will build and operate PULSE.

PULSE actually has been used during a disaster, but only for a short time. It was activated during the southern California wildfires in late 2017 for volunteers to register to work in medical facilities and field hospitals, but few residents lived in the region, and individuals needing care were sent to the hospital, a physician office or urgent care center.

However, some lessons emerged, Cothren says. PULSE was simple to use, although connectivity was dependent on access to the Internet, electronic health record systems or health information exchanges, which was limited in a very remote region. In future similar situations, connectivity likely will come from satellites and mobile microwave systems, among other technologies, he believes.

Now, the challenge for PULSE is to start the nationwide push for its use. Sequoia Project is engaging states and educating them on PULSE with the hope that some will join the project this year. For now, California is the only live state.

Cothren envisions that every participating state will have its own policies on which subsets of clinical and non-clinical professionals are credentialed to receive patient data from PULSE. Some states also may create laws to enable patients to retrieve their records from PULSE electronically. But overall, “the expectation is the model will be substantially unchanged,” he adds.

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