Devices & Technology

Integrated Patient Tracking Initiative Aims to Assist in Emergency Situations


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By Suzi Birz, principal, HiQ Analytics, LLC.

How do we create national guidelines that are useful at a local level and during a regional or national response to emergency situations?

COMCARE, a national advocacy organization with more than 100 members dedicated to advancing emergency communications, has embarked on the development of a national framework for the planning and implementation of Integrated Patient Tracking Systems. While mass casualty incidents are placing the spotlight on patient tracking, patient tracking can be improved each day during every emergency response.

Integrated Patient Tracking Initiative (IPTI)

The Integrated Patient Tracking Initiative (IPTI) is bringing together a representative group of experts to develop a national framework that communities and regions can use when beginning their own patient tracking programs—programs that will be useful day to day and in the event of a mass casualty emergency response.

Michael Pariser, a project associate at COMCARE explained that the intent of the initiative “does not stop at the scene, does not stop at the hospital, but continues through family reunification.” The goal, continued Pariser, “is better patient outcomes.”

With respect to patient confidentiality, Pariser stated that one of the first steps in the project was to address HIPAA and its associated regulations.

“Systems meeting the minimum requirements reflected in the project are required to be HIPAA compliant and may have safeguards that exceed legal requirements,” he said.

As a member of the task force, Kathy Robinson, RN, 2003 president of the Emergency Nurses Association, draws on 22 years of emergency room nursing to provide information on how emergency rooms work, the role of nurses and the barriers to information exchange.

The initiative has three phases. The first phase is the detailing of the functional requirements. It is designed to rapidly develop national consensus requirements from all emergency professions that can be used when selecting a patient tracking system. Phase I is expected to be completed by January 31, 2006.

The second phase is the research piece, studying the implementation of patient tracking systems across the country. This information gathering completes the other components of the national patient tracking framework, including the development of a model RFP. Phase II is expected to take six months.

The third phase will be a model implementation. It “test drives” the framework with field trials and by following a few communities through their procurement and implementation processes. Phase III is estimated to take a year or more.

Phase I: Functional Requirements

Amy DuBrueler, a manager at COMCARE, detailed Phase I. The functional requirements resulted from collective discussion across the wide range of emergency domains that need to share information, which include Emergency Medical Services (EMS), emergency medicine, hospitals, emergency management, 911, public health, disaster services, state, local and federal agencies and the private sector.

The functional requirements outlined follow the systems of care and are segmented into the following areas:

  • Triage: Information related to the initial assessment of the patient’s condition.
  • Patient Identification: Data points collected to positively identify an individual.
  • Treatment: Description of the treatment administered, medications administered and related notes; use of predictive algorithms and protocols.
  • Location of Patient within the System: Identification of an individual’s movement within the system, and the present location of the individual.
  • Incident Management: Data points and functions related to emergency management.
  • Family Reunification: Functionality related to identification of the location of individuals entered in the system.
  • Post Event Analysis and Reporting: Functionality related to producing reports and aggregating data for analysis.

The technical requirements pertain to the technical aspects that the system must fulfill, such as performance, reliability, and availability issues.

Pariser confirmed that the solution will be compliance with requirements and regulations from the Department of Health and Human Services and the Department of Homeland Security as well as other federal and state legislation.

Impact on Nursing

Robinson noted there is great opportunity for improvement in the day-to-day operations related to patient tracking.

“Much information is passed via radio from caregivers on a scene to caregivers in the hospital,” she explained.

The emergency room nurse spends time charting that information, which may be a redundant effort to the emergency response personnel who may also be charting it in a scene record. This takes nurse time away from direct patient care.

Robinson followed-up: “Notes must be lost to illegibility and misplacement every day.”

From the pre-hospital setting through family reunification, successful patient tracking can have a powerful impact on patient care and patient safety. Properly implemented, duplicate data entry and its inherent errors, information loss, emergency room procedure preparation for patient arrival and caregiver communication can all be improved.

Robinson outlined opportunities for improvement, including disease surveillance, quality improvement, hospital hand-off during transfers, data access across the continuum of care, medication reconciliation and increasing time for direct patient care.

“Hospitals might be able to anticipate needed resources, such as gear up an OR, start to call in additional staffing or implement internal disaster plans,” she added.

Pariser explained that the system is designed so that data will be accessible by practitioners for individual patient care and by emergency managers and other officials to aid disease surveillance and statistic reporting.

Take-Away Messages

“One thing that is important about this project is that it is interdisciplinary,” Robinson concluded. “Through collaboration dreams become a reality.”

Pariser extolled the goals of the requirements process: “To make an impact, the system has to be used every day,” he said. “Therefore, the system has to be useful every day to all those involved.”

For more information visit the COMCARE Emergency Response Alliance Web site.

© 2006. AMN Healthcare, Inc. All Rights Reserved.

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