EIIP Virtual Forum Presentation — April 12, 2006

The Integrated Patient Tracking Initiative
A National Framework for Planning and Implementation

Judith Woodhall
Managing Director
COMCARE Emergency Response Alliance

Amy Sebring
EIIP Moderator

The following version of the transcript has been edited for easier reading and comprehension. A raw, unedited transcript is available from our archives. See our home page at http://www.emforum.org

[Welcome / Introduction]

Amy Sebring: Good morning/afternoon everyone. On behalf of Avagene and myself, welcome to the EIIP Virtual Forum! Our topic today is "The Integrated Patient Tracking Initiative: A National Framework for Planning and Implementation".

Please note that both an overview document and the Phase I high level requirements document that our guest will be describing are linked from the Background Page for today's session at http://www.emforum.org/vforum/060412.htm.

Now it is my pleasure to introduce today's speaker: Judith Woodhall joined COMCARE in January 2004 to serve as Managing Director. She previously served as President of the Advisory Company, a regional management consulting firm. She has also served as Chief Information Officer for private sector companies, and previously worked for Mattel, Inc. where she headed mattel!online, responsible for Mattel’s e-business initiatives.

Welcome Judith and thank you for being with us today. I now turn the floor over to you to start us off please.

[Presentation]

Judith Woodhall: Welcome everyone to the EIIP Virtual Forum and today's discussion on the Integrated Patient Tracking Initiative. Today's session will provide you with a quick overview of this initiative and tell you how you can become involved.

The goal of the Integrated Patient Tracking Initiative is to provide communities with the tools they need to make decisions about patient tracking solutions while also ensuring the use of standards and data interoperability. We are hoping to bring together a variety of technologies that will enable location tracking of patients and victims as well as the exchange of information needed to care for them as they move through the response and care process. The intent is to design a solution that can be used for everyday events as well as mass casualty events.

Traditional patient tracking has been limited to mass casualty incidents in the field, or patient tracking systems within a hospital. As witnessed during Hurricane Katrina, important patient information was lost in the process of evacuating hospitals and transporting patients across the country because there was no standardized way to record and exchange that information in near real-time.

A modern patient tracking system could enable important data to be gathered about a patient from the time they enter the emergency response process to the time they leave it, and systems must be in place to gather this information in a standardized format that can be exchanged between different professions, jurisdictions and systems as needed to improve patient care both in daily emergencies and mass disasters.

To be truly effective, the solution must accommodate a wide array of disparate practitioners - many of which are not used to working together, let alone exchanging information. This first slide identifies the key stakeholders. Amy, slide 1 please.

[Slide 1]

To begin the process of cooperation, we formed three working groups with representatives from these organizations and others to discuss the idea of an integrated solution and begin the requirements specification process. A full set of high level requirements were developed in this phase and are currently open for review and comment. This was the practitioner-centric Phase I of this project which we recently completed.

We are now starting the technology-centric Phase II. The goal of Phase II is to explore the various technologies that need to be integrated to meet these requirements. A standards group will review current and planned data standards to determine what may be useful and where gaps necessitate new standards to be developed. This phase will also examine the policy and procedural issues for implementing such a system and develop resources to assist in procuring such a system. It will culminate in a technology showcase demonstrating the concept to a variety of practitioners.

The final phase will take the "blueprint" developed in the first two phases to deploy a solution in several regions of the country. The timeline on this next slide provides a guideline for the length of each Phase. Amy, slide 2 please.

[Slide 2]

To give you a good idea as to what we truly mean by "patient tracking", let me review at a very high level some of the requirements identified by our practitioner working groups. Generally, we are advocating an open, standards-based architecture that will allow multiple views depending on functions and jurisdictions. We also want to make sure that the solutions are compliant with federal guidelines from both a healthcare and patient privacy perspective and from an emergency response, homeland security perspective. Functionally, the solution needs to identify, triage, and track individuals as they are moved through a community's system of care. That means:

• The solution must identify the patients associated with an incident and their current location in order to help confirm identification for data retrieval and reunification with their families.
  
  
• Being able to identify a patient or victim using a variety of variables - maybe a picture or a driver's license number or fingerprints depending on the state of the individual and the severity of the incident.
  
  
• Allowing an individual to enter and leave the process at various points as there is no constant beginning or end.
  
  
• It must allow for data to be accumulated as the individual goes through the process. This data can come from a 9-1-1 operator, a Telematics vendor such as OnStar or a predictive algorithm.
  
  
• The solution must also capture data from paramedics at the scene and must be able to capture vitals from medical instruments.
  
  
• It must also allow for the retrieval of data from sources such as electronic health records, CDC's infectious disease databases or medical alert services.
  
  
• The individual must be tagged for tracking purposes whether a community has decided to use barcode bracelets or RFID tags or GPS technologies.

Finally the solution must be able to accommodate the needs of responders at the scene and those managing it elsewhere like emergency managers or pubic health agencies. Data will need to be available for analysis and decision making throughout the event as well as after the event.

The diagram on this next slide shows how all of the pieces fit together during an event. The upper two quadrants focus on patient and victim care while the lower two focus on management of the incident. All four quadrants play a role whether the event is a traffic accident, a fire, a flood or a major hurricane. Amy, slide 3 please.

[Slide 3]

We are currently in the process of launching a resource portal for communities to use when procuring and deploying patient tracking solutions. This portal will include information about this initiative, news and articles, the functional requirements defined in Phase I, a technology directory of vendors that offer components, which could be used for an integrated solution, as well as a variety of reference materials. Please visit http://www.patienttracking.org. Right now this address will take you to the IPTI page of the COMCARE website. When the portal is launched, it will take you directly to that portal.

If you would like to participate and have questions as to how you can participate, please contact Amy DuBrueler at adubrueler@comcare.org or me at jwoodhall@comcare.org. Our telephone is (202) 429-0574. Thank you for your interest, and I will turn the floor back over to our moderator to begin our Q&A.

Amy Sebring: Thank you very much Judith. Now, to proceed to your questions and comments.

[Audience Questions & Answers]

Question:
Robert Weinert: How are you going to secure this data? There will be a lot of personal information in this database.

Judith Woodhall: There will be a data classification system that will allow only those stakeholders with appropriate authorization see personal information. The system should use some form of role-based access whereby only these roles have access.

Question:
Amy Sebring: Judith, does the anticipated system presume one central repository, or will it be distributed in some manner?

Judith Woodhall: It does not assume one central repository. Although there are some offerings built around a central repository, that is not a requirement.

Question:
Dennis Atwood: First, I commend COMCARE for this vital initiative. Does the project team include representatives from the NDMS program office and US HHS e-health office?

Judith Woodhall: Yes, the project team does include representatives from NDMS and HHS. They were present at our summit in December, and David Aylward from COMCARE will be presenting at the NDMS conference in Reno later this month.

Question:
Avagene Moore: Judith, I also commend the COMCARE effort. You have an industrious schedule set out. Who will be involved and how will the testing be done?

Judith Woodhall: Of course, the practitioners that participated in Phase I will be involved, as well as a number of technology vendors wishing to integrate their products into a comprehensive solution. In Phase II, the vendors will use standards to test integration in a demo setting. In Phase II, testing will take place within a community wishing to deploy a solution as part of their implementation plan.

Question:
Dennis Atwood: What were the key findings of your reviews in St. Louis (EPTS) and Kansas City (MEIS)? And, let me load this up with a recommendation: I suggest it would be very valuable to use whatever solutions are agreed for non-medical patient evacuee tracking.

Judith Woodhall: While we had participants from Kansas City and St. Louis on our working groups, we did not perform an evaluation of their implementations. We did, however, incorporate their lessons learned, such as ensuring that the solution works for both daily and mass casualty events.

Question:
Frank Califano: Are you looking for any new partners in the development this system? I represent a health system with 15 hospitals as well as a large EMS system here in the New York Metro area. We are currently looking at a solutions for many of the things you are discussing.

Judith Woodhall: First, let me be clear. We are not developing a solution but we are facilitating practitioner requirements and vendor interoperability efforts. We will gladly use what we discovered and work with any community wishing to deploy this type of solution.

Amy Sebring: If NYC would like to participate, they should use the contact info you provided above Judith?

Judith Woodhall: Yes, they should.

Question:
Robert Weinert: Do you have a list of vendors that are involved with this that you could send us? We are currently working on a statewide data sharing project and are thinking of including patient tracking.

Judith Woodhall: Bob, we are now compiling a technology directory of vendors categorized by the solution they provide. It will be available on the patient tracking portal. However, if you need it sooner, I will send you a preliminary link to it.

Question:
Joseph Zalkin: My experience with NDMS reception and charter flights during Katrina and Rita is that there is a need for both the patients as well as "stuff" (wheel chairs, respirators, scooters etc.) to be tagged and tracked.

Judith Woodhall: Joseph, you are exactly right. ALL assets should be tracked whether they are patients, victims, or equipment. A successful solution should be able to be used for tracking all of these assets.

Question:
Duane Whittingham: For larger incidents, where there are multiple locations and patients, will tracking of the patients be incorporated into all the new NIMS type software coming out, to be overlaid with current and future mapping software, to track patterns whether it’s flu or bio/chem, etc?

Judith Woodhall: Most definitely - these requirements are stated in our document. Please review them and add or embellish them as you see fit. [The requirements document is available at http://www.emforum.org/vforum/IPTI/IPTI%20Draft%20Requirements%20Report%2012142005%20MASTER.pdf ]

Question:
Matt Bruns: Hi Judith. Great project, although it seems extremely ambitious with ramifications far beyond emergency response. There is already a relevant patient data format standard (HL7) in place, and I wonder how this initiative relates to national murmurings over electronic patient data reforms?

However I am primarily concerned, as in an earlier question, regarding the issue of protected health information under the federal HIPPA regulations. These regulations require quite extensive information security measures, and significant penalties for breaches. (Current/future access rights, access logging, encryption aspects, etc.) Are you coordinating this effort with HHS with an eye on HIPPA? ( http://www.hhs.gov/ocr/hipaa/ )

Judith Woodhall: Actually, Dr. Braithwaite, the father of HIPAA, was an advisor to us. We are also coordinating our efforts of other standards groups such as HITSP, CDC, etc.

Question:
Amy Sebring: Judith, during the Phase II technology piece, is an OASIS XML standard of some sort anticipated? Or is that what you will be investigating?

Judith Woodhall: There is a definite need for additional standards, which could be submitted to OASIS or other Standards Development Organizations. In addition, we will need to harmonize with a number of data dictionaries that are currently being used - SNOMED, NEMSIS, LOINC - so that content of the standards will be understood.

Comment:
Dennis Atwood: Joseph and Duane said it - regarding those material resources, as well as the deployable responder personnel, they will need to be NIMS resource management compliant. Good to note the "layering" Duane and Judith mentioned. Now, it is also important to remember how to keep records with pen and paper, or felt markers, in case the electronic system(s) malfunction.

Judith Woodhall: Or another way would be to have the ability to work offline as well as online.

Question:
Mike Morellato: Do you foresee / has discussion taken place of the system being explored to be interoperable with mainstream GIS software? Data privacy issues to get in the way? We apply GIS to emergency planning and are always exploring new systems.

Judith Woodhall: GIS is an integral part of the solution. I have given a number of presentations to OGC and at the Location Intelligence conference trying to get geospatial vendors interested in providing integrated solutions for such as things as hospital surge capacity, situational awareness, biosurveillance, etc.

Question:
Amy Sebring: On the tagging piece, do I understand correctly that the tagging system used (barcode bracelets, triage tags, etc.) will be independent, and if so, will you specify the way that the tagging system will interface with the tracking system?

Judith Woodhall: Yes, the "tagging system" can be independent and integrated using standards. Some vendors have already incorporated such things as active RFID tags, GPS, etc. into their tracking applications.

Question:
Zachary Goldfarb: Will there be a way to migrate data readily between systems such as EMS tracking systems and hospital medical information systems so information only needs to be entered once?

Judith Woodhall: Most definitely - that is one of our core requirements.

Question:
Amy Sebring: I am glad you mentioned hospital surge. Will you be looking at interoperability with the HAVE standard or other approaches being developed?

Judith Woodhall: Yes, as you know we are currently working on HAVE for approval by OASIS. Surge and IPTI go hand in hand when managing an event.

Question:
Dennis Atwood: Sensitive, perhaps, but do you have any significant groups/associations who are competing with COMCARE on the IPTI project, who need to be "brought into the fold?"

Judith Woodhall: Actually, no. There is an effort being conducted by AHRQ, [HHS’s Agency for Healthcare Research and Quality] but we are active in that, as they with us. We have also been involved with DoD efforts as well.

Question:

Amy Sebring: Judith, can you give us an idea when you anticipate the new portal will be available?

Judith Woodhall: Within the next 2-3 weeks.

[Closing]

Amy Sebring: Let's wrap it up for today. Thank you very much Judith for an excellent job. We appreciate your time and effort to share this information with us Please stand by a moment while we make a couple of quick announcements Again, the formatted transcript will be available later today. If you are not on our mailing list and would like to get notices of future sessions and availability of transcripts, just go to our home page to subscribe.

Thanks to everyone for participating today. We stand adjourned but before you go, please help me show our appreciation to Judith for a fine job.