Overcoming a Manual Process with a High-Tech Solution

Interfacility transport medicine is a niche environment, with highly specialized staff, equipment, and IT needs. Our industry, much like the rest of healthcare, has become increasingly reliant on IT infrastructure to support our mission. This IT infrastructure is often customized to the individual program, resulting in minimal or custom interfacing with other hospital-based IT infrastructure. During our recent transition to new dispatch and clinical EMRs for our transport team, we wrestled with some of these barriers. Through a commitment to innovation and improvement in system processes, we were able to identify unique business problems, engage with our vendor and local IT experts, and develop unique solutions. We would like to share our success in the hopes that it would encourage similar innovation and integration in your unique environments.

While hospital EMR systems have become well established, they are built with the primary focus of inpatient and outpatient care in the hospital and clinic settings. Specialized EMRs have been developed to meet the unique needs of transport medicine, although often they are focused either on clinical documentation or on dispatch documentation. Both types of transport EMR have undergone substantial improvement in recent years. In many cases, transport clinical EMRs can link to hospital EMRs, automatically importing the run chart into the patient’s inpatient record. However, dispatch EMR systems have still lagged in their ability to communicate directly with hospital EMR systems.

At our organization, our communications center uses a dispatch EMR not only for the documentation of interfacility transport requests, but also for the documentation of EMS consultations for patients being transported to our emergency department. We have a regulatory commitment to have each EMS consultation signed by the emergency physician who is receiving notification of the inbound unit and who may provide medical recommendations to these units. These charts must then be available for quality assurance purposes and for audit by regulatory bodies.

As there was no established integration between our dispatch and hospital EMRs, this process was strictly on paper. The PDF chart would be emailed to a coordinator who would print it, track down the correct physician to sign it, and then would file the chart for later QA or audit.This was a very time-consuming process. We began to engage our dispatch EMR vendor to look for an automated solution to reduce the man-hours needed for this process.

Our dispatch EMR exchanges data with the NEMSIS specification. Our dispatch EMR vendor was able to supply a sample of a NEMSIS export with an embedded chart PDF. We sought out one of our systems engineers who is highly regarded and known for thinking outside the box. In reviewing the NEMSIS sample, he was confident that the NEMSIS export could be converted to HL7 for import into the hospital’s EMR and that the entire process could be automated.

To build the integration, we had to ensure that the components that we would use for routing the chart into the hospital EMR were available for every chart. This was accomplished by building validation rules into the dispatch EMR that would require documentation of the emergency physician, medical record number and account number for every patient designated as an EMS consult. The dispatch EMR was then set to automatically export a NEMSIS file with embedded PDF for every EMS consult to a folder on our share drive.

Our systems engineer wrote a program that would take the NEMSIS files exported to the folder, extract the embedded patient demographics, provider information & PDF, and then route them into the hospital EMR. The PDF is routed to the correct patient and encounter using the MRN and account number. It is then routed to the emergency physician’s message center inbox for electronic signature, using the physician’s name in the NEMSIS export. Initially, we encountered spelling errors on the physician’s name which would result in mapping errors. We solved this by converting this field in the dispatch EMR to a dropdown field.

As stated earlier, our industry is becoming more and more reliant on IT infrastructure. However, as is often the case with rapid change, integrations between IT infrastructures have not kept pace with our fast growth. By falling back to a systematic approach of identifying the business problem and exploring solutions, we were able to innovate and realize a substantial improvement in efficiency. Of course, this could not have been done without our expert partners. The approach that we found helpful was to be able to clearly articulate the problem, our current capability, and then our desired outcome.