HEALTH INFORMATION TECHNOLOGY FOR EMS PROJECT (HITEMS)

Daniel Smiley Chief Deputy Director Leslie Witten-Rood Project Manager, HIE for EMS Projects California Emergency Medical Services Authority State of California

Build Health Information Exchange Infrastructure for Bi-Directional Communication between Ambulance Providers (Ground and Air) and Hospitals

Create a lasting statewide infrastructure to improve patient care for EMS Will lead to better outcome data, information, and quality patient care

HITEMS Goals

1. +EMS SAFR Model -Design, development, and implement an interoperable system that EMS providers can on-board with hospitals, Medi-Cal providers, public health entities 2. On-Board Community Paramedic Use query-based HIE to exchange care plans and enhanced the information available from the public health, social services, or behavioral health

3. ePOLST -Connect EMS Provider and hospitals to specialized end-of life registries, such as POLST to allow patients wishes to be carried out for end-of-life decisions 4. PULSE - Build Full Statewide connectivity and access to PULSE to be used in a disaster 5. Data - Promote the use of data analytics and HIT to improve health care quality for Medicaid patients

Overall HITEMS Project Goals

Status of Health Information Technology for EMS Project (HITEMS)

Matching Funds : CARESTAR Foundation has provided $1 million initial match. Overall Funding Distribution if full match: • $31 M in contracts for EMS

Integration for +EMS, Community Paramedics, and POLST

• $1.2 M for Disaster Operations Integration

• $7.8 Million for State HITEMS Coordination, Technical Assistance and HIE Training

Project Status: EMSA’s funding request was approved by Centers for Medical and Medicare Services (CMS) on July 1, 2018 for $36 M with a 10 % matching fund requirement Project Funding Period: July 1, 2018 to September 30, 2021 Match Requirement: The 10% match must be secured for the HITEMS Project to start and for Federal $ to be expended. The project end date remains September 30, 2021

Grant Funding Opportunity Timeline

Match Requirement: No match requirement for GFO. However, if LEMSAs or foundations wish to increase their funding, non-Federal match may augment the project. The project end date remains September 30, 2021 Initial Funding Distribution • $8 M in local assistance

contracts for EMS Integration for +EMS

Matching Funds : To date, CARESTAR Foundation has provided $1 million initial match. GFO Release: EMSA plans to release the GFO for local assistance funding by mid-October GFO Submission deadline: TBD -- but likely on December 7, 2018

EMS Deliverables Project Scope and Use Case

Emergency Medical Services Up to 33 Local LEMSAs to onboard to 345 ground and air ambulance providers and 283 EMS Receiving Hospitals throughout the State of California

Emergency Medical Services Use Case Daily operations for SAFR activities POLST eRegistry and access Community paramedicine and mobile integrated healthcare EMS analytics

Who Can Be the Lead Agency?

HITEMS Project Participants: • Ambulance Providers • Receiving Hospitals • Regional Health Information

Organization

• OR Equivalent Functional Entity

Local EMS Agencies Private, Non-Profit Regional Health Information Organizations

Participation Thresholds

HITEMS Project Participants: • Ambulance Providers may

have the same ePCR system • Receiving Hospitals may be

connected through a Regional Health Information Organization

EMSA Seeks to have a balance of Northern and Southern California HITEMS participation

Goal is to have a high level of participation Propose the Thresholds that you feel are achievable Need to know the % of the both Emergency Ambulance Providers and Receiving Hospitals that are proposed

Technical Requirements

Pay for Onboarding and Interfaces HITEMS Project Participants : • Goals are functional SAFR

components • Proposers may use the

technical requirements necessary to meet their local system design

• NEMSIS 3 standards are required (HS 1797.227)

Adoption Contracts Testing Exchange Search Alert Interoperability File Reconcile

Data Interoperability: PULSE +EMS Project California Emergency Medical Services Authority

S SEARCH:

PARAMEDICS and EMTs may look up and display patient problem list, medications, allergies, POLST and DNR in field on ePCR screen

Improve clinical decision making Improve patient care

A ALERT:

Display patient Information on hospital dashboard at ED to alert and share incoming patient information to assist in time-sensitive therapies

Improve decision support Better transitions of care Improve patient care

F FILE: Incorporate ePCR data into hospital EHR in HL7 format (using NEMSIS 3.4 CDA standards)

Build better longitudinal patient record

R RECONCILE: Receive patient disposition information from hospital EHR to add to EMS provider patient record

Improve population health

SAFR Model

Data Interoperability: PULSE +EMS Project California Emergency Medical Services Authority

+EMS Success in San Diego and Orange County

• Example in Orange County Featured in JEMS

• Newport Beach Fire Department

• Hoag Hospital • Orange County

Partnership Regional Health Information Organization (OCPRHIO)

Example: San Diego Best Practices

SEARCH : • List of Encounters • Retrieval of Problem

List, Medications, Allergies

• POLST Form • NOTE: Proposers should have

Search in ePCR “POLST Ready”

SEARCH Functionality “Automatic” Searching after entry of demographic information

Data Interoperability: PULSE +EMS Project California Emergency Medical Services Authority

Electronic Health Record Required for EMS Providers (ePCR): Device at Point-of-Service -- “Gurneyside”

Required by California Health and Safety Code 1797.227 (Effective January 1, 2016)

Data Interoperability: PULSE +EMS Project California Emergency Medical Services Authority

Community HIO

Multiple Receiving Hospitals

Multiple Ambulance Providers

Model for Use of Community HIO to Achieve “Real-Time”, bidirectional, Interoperable connectivity for EMS

Target Population

33 Local EMS Agencies 8 Infrastructure Regions Ambulances Hospitals

Data Interoperability: PULSE +EMS Project California Emergency Medical Services Authority

Data Interoperability: PULSE +EMS Project California Emergency Medical Services Authority

Reconcile Phase: Return of ADT Messages and eOutcomes

UCSD captures & HIE converts PV1-36 PV1-36

ADT-DG1 segments (where PV2-12="E") ADT - PV1-44

ADT - DG1 segments

PV1-36 - use for 4317013.

ADT - PV1-45 ADT - PV2-3

ADT-PID-18 MSH

to NEMSIS equivalent eOutcome.01 Emergency Department Disposition eOutcome.02 Hospital Disposition eOutcome.09 Emergency Department Procedures eOutcome.10 Emergency Department Diagnosis eOutcome.11 Date/Time of Hospital Admission eOutcome.12 Hospital Procedures eOutcome.13 Hospital Diagnosis eOutcome.14 Total ICU Length of Stay eOutcome.15 Total Ventilator Days eOutcome.17 Outcome at Hospital Discharge eOutcome.16 Date/Time of Hospital Discharge eOutcome.06 Emergency Department Chief Complaint eOutcome.07 First ED Systolic Blood Pressure eOutcome.08 Emergency Department Recorded Cause of Injury

eOutcome.05 Other Report Registry Type eOutcome.04 External Report ID/Number eOutcome.03 External Report ID/Number Type

Data Interoperability: PULSE +EMS Project California Emergency Medical Services Authority

Anecdotal Benefits

• Ambulance (Ground and Air)

• Better Patient Information (SEARCH)

• Save Time in completing EHR (ePCR)

• Improved billing data • Improved patient

outcome data

• Hospital • Receive accurate

patient information earlier

• Trauma, Stroke, STEMI time sensitive therapy

• Estimated cost savings to UCSD of $230,000/yr.

Grant Accountability

HITEMS Project Oversight : • Federal Government Office of

Management and Budget (OMB)

• Centers for Medicaid and Medicare Services (CMS)

• Department of Health Care Services State of California (DHCS)

• Department of Finance • Funders of 10% Matching

California Department of Finance provides EMSA the authority to increase its expenditures specifically for the 90/10 project. EMSA will set up a special account for the federally funded project funds which may only be spent on the HITEMS Project. EMSA will be subject to Federal and State Regulation, Rules and Guidelines, Policies and Laws for use of HITEMS funds received for the 90/10 project.

Fiscal Requirements: Expenses are incurred first then it is reimbursable Maintain Accounting records that adequately identify and segregate 90/10 resources and isolates them from all other transactions. Records will contain 90/10 awards and authorizations, obligations, unobligated balances, assets, labilities, outlays or expenditures Subcontractors are subject to the same Federal and State policies, procedures, conditions and certifications as EMSA

Project Monitoring and Oversight

Project Requirements: Administer the project in accordance with the terms of the agreement Maintain timelines specific in the agreement Maintain cost with the approved amounts for budget line items and cost category Keep adequate records of project process and accountability of funds expended Ensure required grant reports are submitted in a timely manner

Project Funders: All Funders will be included in any project materials and will have the opportunity to have their branding included as a contributor. Currently the PULSE Project is being nationally adopted off of the previous work California did with PULSE and PULSE Phase II with 90/10 funding will be a big part of the National Effort.

EMSA Continues to Seek Additional Non-Federal Match

Sustainability: Project Benefits will encourage continued support to sustain the HIE Project by County Board of Supervisors, LEMSA, EMS Providers, and Hospitals. The project decrease costly ED visits by allowing paramedics to facilitate a collaborative discussion between the patient, medical provider, and paramedic on non-emergency conditions. Future federal opportunities with MITA funding which allows for ongoing maintenance cost.

Contact Information Dan.Smiley@emsa.ca.gov Leslie.Witten@emsa.ca.gov (916) 431-3723 Website: www.emsa.ca.gov/HIE