In a cardiac system of care, 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. 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.
Impact of Timely, Pre-hospital Data on Critical Care Response
Rapid access to EMS data is more than important — it’s essential. With the help of HL7 interoperability technology that shares data in near real time, EMS can transmit critical 12-lead data from the field to the receiving hospital while the patient is still in transit. Providers at the ED can see the entire patient care report (PCR), including EKG images, vitals, treatment administered, medical history, demographics, and insurance coverage in the electronic medical record (EMR). Visibility into pre-hospital care prior to patient arrival can reduce door-to-balloon times and improve outcomes.
Value of Accessible, Comprehensive Patient Data for Cardiac Coordinators and Quality Teams
Beyond the ED, cardiac coordinators, quality assurance (QA) staff, and interdisciplinary teams focused on practice and system improvements have ongoing needs to reference, extract, and analyze patient care data that spans the continuum of pre-hospital and hospital interventions. Cardiac specialty hospitals and critical access hospitals rely on comprehensive patient data for many reasons, including:
- Joint Commission compliance
- QA and performance monitoring
- Education and training
- Outcome follow-up for EMS partners
- Identification of evidence-based practice and performance improvement
- Accreditation
- Reporting
Commonly, ST-elevation myocardial infarction (STEMI) reports need to be completed within 24 hours of patient arrival at the hospital. QA staff review the patient’s EMR to identify outlier metrics and anything that requires timely, corrective action. When available, pre-hospital can explain factors such as a longer than normal transport or door-to-balloon time. However, access to pre-hospital data is dependent on the EMS provider finalizing and sharing the PCR, which can be a vexing process involving faxes, document scanning, and manual data input.
Time is of the essence for QA activities, yet there is a significant interoperability gap between pre-hospital and hospital providers. Critical pre-hospital assessment and intervention information typically is not available to the receiving clinicians.
Leveraging Technology To Close the Interoperability Gap and Power Data-driven Improvements
The interoperability gap can be closed by implementing a bi-directional HL7 interface, which solves the problem of lagging and disconnected pre-hospital data. Best-in-class solutions can automatically convert data from the EMS industry's NEMSIS format and import it directly into the EMR using standards, such as HL7v2, FHIR, CCDA, or even proprietary EMR APIs.
This helps meet compliance requirements and provides clinician transparency into the patient's care history. 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 the 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 quality assurance and improvement (QA/QI) initiatives. Hospital outcome data can be easily reported back to partner EMS agencies as part of ongoing collaboration to improve pre-hospital care and coordination.
Return on HL7 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.
Moreover, integration does not have to be complicated or break the budget. While custom API integration is costly and time-consuming to build and maintain, a data exchange that can be integrated with common, HL7-based standards is easy, practical, and cost-effective to implement rapidly.
Hospitals conducting cost-benefit analysis of HL7 data exchange should ask questions, including:
- How difficult or easy is it to obtain PCR? What happens if the PCR isn’t available upon request?
- Does lag time in obtaining the PCR impact ED team readiness, clinician transparency, or QA workflows?
- How much time does QA staff spend requesting and waiting for the PCR for any patient population, including STEMI, stroke, code/resuscitation, infectious disease, trauma, etc.?
- How much time is spent scanning, re-typing, and reformatting PCR data to import into the EMR?
- How could patient outcomes and quality performance be improved by receiving pre-hospital data in near real time?
- Does providing patient outcomes back to EMS partners improve pre-hospital care, and is this required for certification compliance?
- How much time and money could be saved by eliminating manual processes? (Try this Hospital ROI Calculator)
- How much of a learning curve will there be for IT staff?
- What is the cost to implement and maintain?
- How are data privacy, cybersecurity, and compliance ensured?
The Case for EMS-Hospital Interoperability
From faster treatment intervention, to reduced QA/QI workload, to compliance, to more efficient reporting — an HL7 data exchange interface, such as ZOLL Care 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.