OverviewOverview

Enabling electronic health record (EHR) Enabling electronic health record (EHR) exchange when patients are transferred exchange when patients are transferred between participating hospitals during a between participating hospitals during a disaster involving mass casualties, for disaster involving mass casualties, for improved patient careimproved patient care

BHEPP – PatientBHEPP – Patient Data ExchangeData Exchange

Acute care community hospital Level II Trauma Center Community preparedness experience Decontamination capacity

Clinical research facility Surge capacity Sophisticated diagnostic laboratory facilities Skilled campus HAZMAT & decontamination team Substantial basic science and specialty/subspecialty expertise

Military hospital Extensive decontamination capacity Skilled deployable workforce Availability of “in-residence” staff Preparedness training

BHEPP PartnershipBHEPP PartnershipSuburban Hospital NIH Clinical Center NNMC

Disaster ScenarioDisaster Scenario

Disaster causes mass casualties

Non-critical patients are transferred to other hospitals to make space for emergency patients

Patient data is transferred electronically to the receiving hospital to aid in patient care

1 2

3

ChallengesChallenges

1.1. What to share ?What to share ?

2.2. Which format / standard ?Which format / standard ?

3.3. How to share ?How to share ?

Patient Summary Record Patient Summary Record

66

• Required “Minimum Data Set”Required “Minimum Data Set”• Based on “Based on “NHIN Core ContentNHIN Core Content SpecificationSpecification” for exchange ” for exchange of Patient Summary Recordof Patient Summary Record• Content ModulesContent Modules

Person Information Support (Emergency Contact Information) Allergies and Drug Sensitivities Conditions (Problem list) Medications Information Source

Patient Summary Record Patient Summary Record

77

““Data Format - HL7 CDA Standard (XML)”Data Format - HL7 CDA Standard (XML)”

Machine readable entry Human readable entry

Document Level

Constraints

Patient Summary Record Patient Summary Record

88

Data Transformation – Suburban EHRData Transformation – Suburban EHR

XML to CDAUsing Adapters

Patient Summary Record Patient Summary Record

99

Data Transformation – NIH Clinical CenterData Transformation – NIH Clinical Center

XML to CDAUsing Adapters

Patient Data Exchange - ApplicationPatient Data Exchange - Application

1010

Mapping &

Translation

• Web Upload• Mapping and Translation• Patient Search• Patient View• PDF/XML Download• Admin Module• Integration with Triage Data (Digital Pen)• Integration with RFID Data (Future)

Web Upload

Search&

View

Hospital 1 Hospital 2NNMC Adapter

NLM CC Adapter

Suburban Adapter

CDA

HTML Adapter

PDF Adapter

FeaturesFeatures

ReceivingHospital

Patient Data Exchange - ApplicationPatient Data Exchange - Application

1111

• ColdFusion 8.0 Application Server• Apache Web Server 2.2• HTTPS based for security and encryption• ColdBox (MVC) based framework for easier extensibility• Internationalization and localization

Technical SpecificationsTechnical Specifications

CMAX 2009CMAX 2009

1212

Future DirectionsFuture Directions

1313

• Integration with RFID for location tracking during disaster

• Integration with “NHIN – National Health Information Network” for

nationwide real time Patient Data Exchange• DICOM support for including medical images with Patient Summary Record