How EMS agencies can participate in Health Information Exchanges

The Center for Medicare and Medicaid Services released a letter in early 2016 to expand the eligibility of funds to encourage the adoption and use of Health Integration Exchanges through 2021 [1]. These funds are directed through the Health Information Technology for Economic and Clinical Health Act of 2009. The HITECH act can directly address many of the challenges that EMS faces daily and reduces the obstacles in creating successful community medicine programs.

What is a Health Integration Exchange?
An electronic Health Information Exchange allows all providers of care to appropriately access and share patient information timely and securely. For example, instead of faxing or dropping off EMS patient care records at the hospital an HIE allows the patient care record to immediately be placed inside the hospital's records of care. An HIE greatly improves the completeness of a patient’s record as treatments and evaluations are jointly reviewed to reduce readmissions, avoid medication errors, improve diagnoses and decrease duplication testing.

What are the advantages of an HIE for EMS?
Here are five advantages of an HIE for EMS agencies to be aware of.

1. Improved health care quality and safety
EMS providers have always had the challenge of providing care for patients based on only the knowledge provided by the patient or bystanders at a scene. Every provider has a story about poor historians or being told they have all my records at the hospital.

By looking at a correct list of past medical history, medications and allergies an HIE will allow the EMS provider to make better treatment and clinical decisions in the field; greatly enhancing the care provided. One of the most promising advantages for HIE is improved patient safety, up to 18 percent of the patient safety errors and as many as 70 percent of adverse drug events could be eliminated if the right information is available at the right time [2].

2. Enhanced clinical decisions
Imagine EMS providers being able to look up old 12-lead EKGs and comparing them to the 12-lead EKG they just acquired as they make critical clinical decisions for STEMI activations. This would reduce time to activation and allow the correct resources to be allocated more appropriately.

3. Increased billing revenues
Being able to reconcile the electronic health record information including diagnoses, dispositions, insurance information, demographics and payment information back into the EMS patient care report for will improve revenue collection. Increasing CMS and private insurance revenue will serve as a critical return on investment for EMS agencies.

4. Increased quality improvement and assurance
Imagine knowing the outcome for every patient you transported. An HIE allows for individual and system quality improvements. Increased clinical quality measures and basing them on outcomes makes EMS a full participant in the patient care model. Incorporating this data increases the ability to analyze and examine trends of EMS impact on quality outcomes.

5. Expanded community medicine
One of the biggest challenges to a successful community medicine or community paramedicine program is communication with other participants in the health care system. The integration of information systems allows for more efficient transitions of care between traditionally partitioned sections of the health care system, including prehospital, emergency department, inpatient and outpatient care. The HIE can alert the community medicine team help track frequent users in addition to allowing up to date information exchange between primary care physicians, emergency physicians and community medicine providers.

Where to find HEI funding?
Meet with your state Medicaid officials to understand where and how EMS can fit into the state HEI plan. The HITECH Act funds are to be allocated by the state Medicaid offices so collaborate early and often with CMS officials.

In "Emergency Medical Services at the Crossroads" the Institute of Medicine stated, "EMS operates at the intersection of health care, public health and public safety and therefore has overlapping roles and responsibilities. Often local EMS systems are not well integrated with any of these groups and therefore receive inadequate support from each of them."

Taking the steps to integrate with your local HIE will improve patient care, safety and the EMS system.  

Find more information about the HITECH Act check on EMS.gov or contact the experts at EMSGrantsHelp.com. 

References
1. State Medicaid Director Letter 16-003 for EMS

2. Kaelber, D. C., & Bates, D. W. (2007). Health information exchange and patient safety. Journal of Biomedical Informatics, 40(6). doi:10.1016/j.jbi.2007.08.011