When paramedics are called, they typically know little about the person they're about to treat"and sometimes not much more even after they arrive. Patients might be unable to communicate, and even family and friends are often hazy about the details of the person's medical history and current prescriptions.
"Someone might say, "˜Well, he's taking medication for this condition' or "˜I think he suffered from that disease a few years back,'" said Thomas Arkins, a paramedic and special operations manager for the Wishard EMS in Indianapolis, which responds to about 65,000 emergency calls a year. "It generally doesn't help us much, so we just go ahead and treat based on what we see."
Until recently, that is. Wishard EMS now has real-time, secure access to patient health records thanks to the establishment last fall of a link between a wireless EMS electronic patient reporting system and the Indiana Network for Patient Care (INPC). The INPC is a health information exchange that allows emergency department providers in hospitals across the state to securely obtain patient health records.
The effort represents the first time ever that medical emergency personnel in the field have had electronic access to a patient's medical data via an HIE.
Information pushed out to medics includes a patient's prior diagnoses, medication history and allergies. Authorized paramedics and technicians are only required to input a patient's first and last name, gender and date of birth to access a health record.
The medical information helps medics route patients to the most appropriate hospital, for example. It can be used to advance diagnostics or rule them out. Medics can also display the record on their tablets to an attending physician once they arrive at the emergency room.
When technicians have access to a patient's data, "it just puts certain things a little bit higher up on the radar screen," said John T. Finnell, an emergency room physician and Regenstrief Institute investigator who developed the INPC extension to EMS. To ensure security, the system requires emergency personnel to authenticate into both the EMS system and the INPC, and if more than one match of a patient name comes up, the INPC won't provide any records. "We're not going to give the medics a look-up table to determine which John Smith they want," said Finnell. "They have to be very clear that it's John Smith at this address with this zip code and this date of birth, and if that matches uniquely to one person, then we push out the abstract with the EMS data elements on it." Another potential pitfall, says Arkins, is making sure that medics don't start relying too heavily on health records to treat patients. Calls often take EMS calls into tunnels or other areas without wireless coverage or a patient record may not be available, for example.
"Focusing on the patient is our absolute top priority," says Arkins. "There may be instances where having a patient record would have been helpful, but the patient was just too sick for a medic to worry about that."
