Orthner CS Seminar 070404

IT Challenges in the Pre-Hospital Emergency EnvironmentApril 4, 2007: 

IT Challenges in the Pre-Hospital Emergency Environment April 4, 2007 Helmuth F. Orthner, Ph.D., FACMI Professor, Health Informatics University of Alabama at Birmingham Birmingham, AL CS Seminar

Acknowledgement: NLM Support: 

Acknowledgement: NLM Support N01-LM-3-3513 – Applications of Advanced Network Infrastructure in Health and Disaster Management; PI: HF Orthner, GG Grimes; TE Terndrup; Sep 30, 03 – Sep 30, 07 ($3,2235,234 total cost including subcontract with Intergraph) N01-LM-0-3524 – Informatics for the National Heart Attack Alert Program: Integrated Information Technologies for Emergency Medical Care; PI: HF Orthner, GG Grimes, TE Terndrup; Sep 30, 00 – Sep 29, 03 ($968,837 total cost) NLM 99-NHAAP/VMS -- Informatics for the National Heart Attack Alert Program: Integrated Information Technologies for Emergency Medical Care ; PI: HF Orthner, UAB; BE Bray, Univ. of Utah; Sep 30, 99 – Sep 29, 2000 ($291,334 total cost)

Acknowledgement: Project Team: 

Acknowledgement: Project Team Co-Principal Investigators (UAB) Helmuth F. Orthner, PhD, PI, Professor, Health Informatics, Department of Health Services Administration Gary J. Grimes, PhD, Professor of Engineering and Executive Director, Center for Telecommunications Thomas E. Terndrup, MD Professor and Chair, Department of Emergency Medical Services (left UAB Nov 2006) Investigators Joseph E. Acker, MPH, EMT-P, Director, Birmingham Regional Emergency Medical Services System (BREMSS) Jeffry G. Gray, PhD, (CS), Advisor of Rohit Shenvi Jill B. Gemmill, MS (CE & EE), Assistant Director for Academic Computing, Office of the VP for IT, UAB Presidents Office (2006) David C. Pigott, MD., Assist Prof of Emergency Medicine (2005) James Leaming, MD, Emergency Medicine (left UAB in 2004)

Acknowledgement: Project Team: 

Acknowledgement: Project Team Management and Technical Support Marcie H. Battles, MSEE, Project Manager, AdvNet Project, Health Informatics, Department of Health Services Administration Giovanni G. Mazza, MS, MSHI, AdvNet System Manager and Lead Developer Michael Minor, EMT-P, Assistant Director, BREMSS Shannon W. Stephens, EMT-P, Clinical Research Coordinator, Emergency Medicine Joel Rodgers, BS, Project Management Support, Emergency Medicine

Acknowledgement: Project Team: 

Acknowledgement: Project Team Student & Trainees Kawaljeet Kaur, MD, MSHI, (graduated) Nathan Almeida, MD, MSHI (graduated) Ashok Muthukrishnan, MD, MSHI (graduated) Amarinder Sandhu, MD, MSHI (graduated) Ninad K. Mishra, MD, MSHI (graduated) Manish S. Mittal, MSEE, MSHI (graduated) Mandor M. Gori, BE-IT, MSHI (graduated) Najaf Shah, (CS student) Giovanni G. Mazza, MS, MSHI (graduated) Devashish Saini, MD, (HI Student) Muzna Mirza, MD, (HI Student) Krishna Nandigam, MD, (HI Student) Rohit V Shenvi, (CS Student)

Overview: 

Overview Motivation and Significance Current EMS Infrastructure IT Challenges 9-1-1 Call Centers and Dispatching Data Acquisition in the field Mobile Communication Optimal Ambulance Selection Optimal Patient Transport Data Integration Process Improvement

Emergency Medical Services (EMS): 

Emergency Medical Services (EMS) Acute Killers Heart Attacks (#1) Stroke (#3) Trauma (#5) Opportunity “Time is (heart) Muscle” & “Time is Brain” “Golden Hour” – 60 min to treatment Bring patient to Emergency Department where resources to treat are available Challenges Systems & Process Integration Security and Confidentiality Organizational Collaboration

Slide8: 

911 calls the EMS provider Ambulance dispatched to the site of emergency Patient is stabilized by EMS Provider Surgery Traditional EMS Patient Flow Pt. Transport Hospital ED

Problems with Current System: 

Problems with Current System Patients delay calling 9-1-1 9-1-1 is busy (in mass casualty situations) Call Center & Dispatching Problems Wrong ambulance sent; right ambulance is far away EMS Providers Cannot find location of patient Patient location is “unfriendly” (vicious dog; steep steps) Patient condition is “complicated” (250 lb. patient) Patient data is not collected, unreadable, or not “trusted” ED Resources are not available No beds; no Cath Lab; no X-Ray; no qualified provider Unnecessary additional tests are ordered Previous Patient Care Reports are not available

Objectives: 

Objectives Integrate the Information Infrastructures of EMS with Hospitals & Clinics Medical Emergency Infrastructure 9-1-1 Call Centers and Medical Dispatching Ambulance and Rescue Services Healthcare Information Infrastructure Hospital-based Ambulatory-based Others (e.g., Nursing Homes, Home Health Care)

IT Challenges & Solutions: 

IT Challenges & Solutions Current EMS Infrastructure Emergency Communication Infrastructure 9-1-1, E9-1-1, I9-1-1 (VoIP) Call Centers Scalable Medical Dispatching Fail-Safe, Scalable, GIS/GPS Support Regional Emergency Patient Database Coordinated EMS Communication EMS Data Terminal Regional “High Risk” Patient Database

Communication Infrastructure: 

Communication Infrastructure The 9-1-1 Infrastructure Works well for the wired telephone system Analog Plain Old Telephone System (POTS) Integrated Services Digital Network (ISDN) Universally implemented; public has been “educated” PSAP 911 Center POTS ISDN POTS ISDN

Communication Infrastructure: 

Communication Infrastructure The E9-1-1 Infrastructure (Cell Phones) Not universally implemented (e.g., non-national cell phone companies) Automatic Location accuracy is uneven Network-based (e.g., triangulation) Device-based (e.g., GPS-based) PSAP 911 Center ISDN POTS Cell Cell Cell Cell Cell Cell ISP VoIP Internet

Communication Infrastructure: 

Communication Infrastructure Current Problems Calling 911 from telephones within a Private Branch Exchange (PBX) will not provide location information to the 9-1-1 call center Calling from an Internet phone, i.e., using Voice over IP (VoIP) does not provide location information (the IETF is working on a standard) Cell phone channels are quickly overloaded

Communication Infrastructure: 

Communication Infrastructure 9-1-1 Call Centers or Public Safety Answering Points (PSAPs) Technology is well understood Works well if Automatic Number Identification (ANI) and Automatic Location Information (ALI) is provided by phone company 9-1-1 Call Takers Answer 911 calls Passes calls to Dispatchers Police, Medical, Fire

Emergency Medical Dispatching: 

Emergency Medical Dispatching Emergency Medical Dispatching (EMD) Started in the 1970s by Dr. Jeff Clawson in SLC, UT Professionals with minimal training (6 months) Determines level of EMS (basic or advanced) Basic – Fire truck; EMTs with basic training Advanced – Rescue truck, EMT-Ps with advanced training Dispatches appropriate EMS Team Basic, Advanced, Hazmat; Bio-terrorism Provides pre-arrival support Computer Aided Dispatching (CAD) We use Intergraph’s CAD System Triple screens workstations & non-fail-safe configuration Street Maps showing static and dynamic assets Event-driven design with extensive event tracking

Dispatching Workstation: 

Dispatching Workstation

Street Maps with GPS/GIS: 

Street Maps with GPS/GIS

Intergraph’s CAD Map: 

Intergraph’s CAD Map

AdvNet Test Bed: 

AdvNet Test Bed

Emergency Medical Dispatching: 

Emergency Medical Dispatching Enhancements to the Intergraph CAD Linkage to a Regional Emergency Medical Patient (EMP) database Very useful if patient can be identified Improved EMD algorithms HI Graduate Student’s Thesis Projects) Utilizes EMP data Fewer questions to reach a dispatch decision Evaluated with Test Patient Clinical Evaluation planned for this year Map Improvements Static Assets with Floor Plans Dynamic Assets with GPS tracking

Slide22: 

Ambulance Dispatched INTERNET Physician accesses Patient data “Data Pull” Patient Examined Queries local cardiology database WORKFLOW MODEL FOR EMS DATA TRANSMISSION Wireless transmission over WAN by EMT [Data “PUSH”] 911 calls EMS Provider Cardiology Database Server Cardiologist Alerted ED Physician Workstation

EMS Communication: 

EMS Communication WiFI Hotspot around ambulances Tested range with 802.11 a, b, g, pre-n Used “Smart Packets” and “Turbo Codes” to extend communication at the ”fringe” (Manish Mittal’s Thesis) Experiment with Wi-Max Static Communication – excellent Mobile communication – poor

New Ambulance: 

New Ambulance

EMS Data Collection: 

EMS Data Collection Rejected Pocket PC format Adopted small Tablet PC format Usability Study using Tablet PCs Amarinder Sandhu’s Thesis Evaluation of study with simulated patients Clinical evaluation planned for this year Touch Interface Stylus is not usable in ambulance Finger Touch works well Voice Interface Prototype Giovanni Mazza’s Thesis

EMS Data Collection: Vitals: 

EMS Data Collection: Vitals

EMS Data Collection: Trauma: 

EMS Data Collection: Trauma

EMS Data Collection: Burns: 

EMS Data Collection: Burns

Conclusions: 

Conclusions EMS Environment is organizationally complex and very competitive Accurate data capture is poor EMTs are willing to try but environment is difficult and challenging Have not found the “solution” yet Sharing data is not a reality yet Most EMS data is ignored by ED physicians Robust portable devices are appearing but they need to be adapted for EMS use Integrated communication infrastructure between LAN & WAN is emerging

IT Challenges in the Pre-Hospital Emergency EnvironmentThe End: 

IT Challenges in the Pre-Hospital Emergency Environment The End Helmuth F. Orthner, Ph.D., FACMI Professor, Health Informatics University of Alabama at Birmingham Birmingham, AL CS Seminar