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EDXL-TEP-OASISEM-TCmembershipAug2010

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					Emergency Data Exchange Language (EDXL)
     Tracking of Emergency Patients (TEP)

                                         August 25, 2010


   Presentation to the:
   OASIS Emergency Management Technical Committee

   Dial in: 1-888-325-3989 pass code: 561413 #
   Attendee URL:
   https://www323.livemeeting.com/cc/eiip/join?id=D
   HSOICSWG
                   Current Status


 PRESENTATION PURPOSE: OASIS Outreach and
  Education on the draft Standard – questions at the end
 Practitioner Submission to EIC May 14, 2010
 Practitioner Submission to OASIS June 8, 2010
 TEP Voted within OASIS as a Work Product June 22, 2010
 TEP Sub-committee Created Within EM-TC subcommittee
  & Chairs Voted in (T. Grapes / D. McGarry) August 2010
 Plan to Engage Sub-Committee Work Beginning of Oct.
 MOU in-progress between OASIS and HL7 for standard
  collaboration
 Interagency MOU in-progress (privacy, adoption etc.)
                                                           2
   Background – TEP & TEC Messaging Standards

 The NASEMSO with many other agencies and
  organizations recognized the need for standards-based
  interoperability to realize the potential of the numerous
  patient tracking systems in existence or planned
 Introduced TEP to the DHS S&T Office for Interoperability
  and Compatibility (OIC), sponsor of the EDXL
  development process – a mature, proven process for
  developing cross-profession, practitioner-driven
  messaging standards
 Effort was Initiated by the PSG as the next EDXL Priority
 Helps close HITSP ER-EHR IS04 Gaps
 Supports HHS & DOD AHRQ Objectives
                                                              3
                    TEP & TEC Messaging Standards

 Requirements definition for Tracking of Emergency Patients and Tracking of
  Emergency Clients is occurring in two phases. TEP is in-process with the
  Practitioner Steering and Working Groups (PSG / SWG).

    Phase I - Tracking of Emergency Patients (TEP): An XML standard for
     exchange of emergency patient and EMS tracking information; to increase
     the effectiveness of emergency medical management, patient tracking
     and care, and family notification.

    Phase II - Tracking of Emergency Clients (TEC): Expands Phase I scope to
     support clients across the general population. TEC is aimed at more
     effective evacuation and services management, client tracking,
     Regulation, Re-unification, and use of assets for all Emergency clients.

                               Client: Generic term for any person displaced, evacuated,
                               sheltering in place, expired, and/or requiring medical attention –
                               i.e. Clients or customers of Emergency Services
                               Patient: A type of client requiring medical attention, being
                               medically evaluated; or a fatality .
                                                                                                    4
5
   TEP Scope
 EDXL-TEP is an XML
  messaging standard for
  exchange of emergency patient
  and tracking information across
  the EMS emergency medical
  care continuum.
 TEP provides real-time
  information to responders,
  management and care facilities
  in the chain of emergency care
  and transport.
 Emergency / Disaster EMS, ED
  / Hospitals / Care Facilities,
  Emergency Management, Ops,
  Dispatch, Command
 Patient tracking information is
  exchanged from patient
  encounter (possibly re-using
  dispatch information) through
  admission or release.
 TEP also supports hospital
  evacuations and day to day
  patient transfers.


                                    6
                    Key Events That Trigger                                                 Description
                          Messages
              Responders dispatched                                    PSAP / dispatch center dispatches responders to an
                                                                       incident. Possible starting point for sharing of incident and
                                                                       patient data
              Patient Encountered                                      The first or initial meeting or contact between a given care
                                                                       provider and a given patient.
              Patient Evaluated or Triaged                             Medical observation, measurement, and assessment of a
                                                                       patient or possible patient
              Patient Treated                                          Medical performance or administering of procedures,
                                                                       medications, or other treatments.
              Patient moved/ transported (physical location            Patient is physically moved from one location, site, or

  TEP Use     tracking)
              Patient being transferred to new care provider
                                                                       facility to another
                                                                       Patient care responsibility is transferred from one care

Case Events   Patient condition changes
                                                                       provider to another
                                                                       Patient health / medical condition changes in some way
 / Triggers
              Patient vitals and monitoring taken                      Care Provider takes vital signs or other measurements,
                                                                       typically using various monitoring equipment, some of
                                                                       which may be electronic
              Patient Released                                         Patient is released from care, and is no longer considered
                                                                       to be part of the EMS incident continuum of care, and is no
                                                                       longer tracked using TEP
              Patient Admitted                                         Patient is formally admitted into a fixed medical facility or a
                                                                       temporary deployable facility capable of providing definitive
                                                                       care, which typically involves transfer of Care Provider and
                                                                       physical location.
              Patient ID information updated                           Further identifying information is collected / shared about
                                                                       the patient
              Time-driven information i.e. transfer to AHRQ            Patient Tracking information is automatically or manually
              National Database                                        shared with a National Database used for consolidated
                                                                       tracking of patients and clients
              Change in conditions requiring patient reroute           Change in circumstances requiring patient transport to re- 7
              (change in patient condition, receiving facility full)   route from current destination to a new destination
8
EDXL-TEP Structure and Elements




                                  9
EDXL-TEP Structure and Elements




                                  10
EDXL-TEP Structure and Elements




                                  11
Emergency Data Exchange Language Tracking of Emergency
Patients (EDXL-TEP)
    Documentation may be found at the following website:
              http://www.evotecinc.com/TEP/

• Requirements and Draft Messaging Specification:
 “EDXL-TEP-Rqmts&draftMessagingSpecFinalV2.2_05-05-2010.pdf”
 Stakeholder issues list:
 “TEP-Stakeholder-IssuesRev2.2_05-7-2010.xls”
    (Filtered for “open” or “in-process” for review of resolutions)
• Data Dictionary:
 TEPdictionaryV2.1.xls
    (Excel version provides mappings to NEMSIS and NIEM)
• Project Initiation Document:
 EDXL-TEP Project Initiation Document (PID) v4.3.pdf
• Subject Matter Expert list
 EDXL-TEP-Participants-FullList5-12-10.pdf
   (Steering, Stakeholders, Vendors, and PSG / (SWG)
                                                                       12
EDXL Process and Pilot




                         13
TEP Research
  • OASIS EDXL                                 HHS AHRQ Evacuee Movement
  • ASTM Continuity of Care Record (CCR)       HHS AHRQ Patient Tracking Locator (PTL)
  • HITSP ER-EHR                               DHS - NIMS
  • HL7 Continuity of Care Document (CCD)      Asst. Sec. for Preparedness & Response (ASPR)
  • PHIN Standards                             DoD & Other Systems. E.g.
  • Vehicular Emergency Data Set (VEDS)              TRAC2ES
  • National EMS Information System (NEMSIS)         NDMS
  • Data Elements for Emergency Department           AHLTA Mobile (aka BMIST)
    Systems (DEEDS)                                  JPTA
                                                     TacMedCS
  • COMCARE/HIMSS Integrated Emergency               FCC JAC
    Medical Response Initiative (IEMRI)              WebMedis
  • COMCARE Integrated Patient Tracking
    Initiative (IPTI)                          *Triage Tags from across the country
  • Coordinated Assistance Network (CAN)       MCI-PT Detailed Requirements TN DOH
                                               Boston PTS for Public Health
  • PRE-HOSPITAL                               Christiana Care Health System
  • IN HOSPITAL                                HERDS - NYS
                                               National Capital Region
                                               San Francisco, STARRS

                                                                                               14
  TEP Stakeholders – Practitioner-Driven Approach

 Incumbent Practitioner Steering Group (PSG) & Standards Working Group (SWG)
     EMS, Law Enforcement, Fire, Emergency Management, Health, Public Safety, States, Counties, Cities
 Over 80 Newly Added Stakeholders plus Vendors – Examples:
     Health Information IT Standards Panel (HITSP) Gap-Filler
     National Association of State EMS Officials (NASEMSO)
     Joint National Emergency Medical Services Leadership Conference (JNEMSLC)
     DoD Health & Medical Defense Support of Civil Authorities – OASD(HD&ASA)
     HHS-Agency for Healthcare Research and Quality (AHRQ)
     HHS-Assistant Secretary for Preparedness and Response (ASPR)
           National Disaster Medical System (NDMS)
     American Hospital Association (AHA)
     American Red Cross
     LA R-7 Hospital Disaster Preparedness/Emergency Nurses Association-ENA
     Association of Public Safety Communications Officials (APCO)
     National Emergency Numbering Association (NENA)
     Federal Emergency Management Agency (FEMA)
                                                                                                          15
     State of Tennessee
Standards Development Process




                                16
                   TEP Steering Committee

    LN            FN                 Organization Represented
                       NASEMSD, National EMS Information System
Mann       Clay, Dr.   (NEMSIS)

Mears      Greg, Dr.   UNC Chapel Hill EMS Medical Director
Donohue    John        Maryland Institute for EMS Systems (MIEMSS)
                       Tennessee DOH Office of Information
Sexton     Jeff        Technology Services, HITSP
Moreland   Joe         Kansas Board of EMS
Whitney    Jolene      Bureau of EMS State of Utah
                       JNEMSLC, NASEMSO, Vice-Chair-OIC PSG, National
McGinnis   Kevin       Association of State EMS Officials-NASEMSO



                                                                        17
TEP Practitioner Submission

• Final Stakeholder review period completed March
  1 – March 31, 2010; extended to April 14, 2010
• Additional comments received from:
    • National Institute of Health (NIH) / US National Library
      of Medicine “Lost Person Finder (LPF)” effort.
    • Multiple DoD reviewers including the Health & Medical
      Defense Support of Civil Authorities.
• Draft TEP Piloted and Improved: National
  Disaster Medical System (NDMS) live exercise at
  the Tennessee Air National Guard 164th Airlift
  Wing in Memphis
• Excellent TEP participation and input
  Total Issues submitted: 289
    • Project Initiation Document (PID): 156
    • Requirements and draft Messaging Specification: 133        18
Tennessee NDMS Patient Movement Exercise
• Draft EDXL-TEP interoperability pilot inserted into the 2010
  National Disaster Medical System (NDMS) Patient Movement
  Full-Scale Exercise, with follow-on analysis and presentation
    • A live exercise using volunteer patients, driven by objectives of
      federal, state and local agencies and NDMS partner hospitals.
    • DHS OIC pilot the draft EDXL-TEP specification in a field exercise
      before submitting to the standards approval process
    • A hurricane makes landfall resulting in mass casualties requiring
      evacuation and medical treatment.
    • Patients were tracked utilizing five independent Patient Tracking
      systems from Maryland's BWI airport, to a Memphis triage area
      where an actual C-130 landed and deplaned patients. Patients
      were then tracked through triage and ambulance boarding,
      through arrival at one of 5 Memphis area hospitals.
• Patient registration timeframes dramatically reduced – hours
  to 30 minutes
• First Electronic Patient Manifest for TN Air National Guard
                                                                       19
     NDMS Patient Movement Exercise Organizations
DHS Office for Interoperability and Compatibility
DHS Tech Support - Evolution Technologies
HHS / ASPR / NDMS
Maryland Institute for Emergency Medical Services Systems
(MIEMSS)
Memphis / Shelby County Health Department
Memphis / Shelby EMA
Memphis Fire
Memphis Shelby Regional Hospital Coordinator
Methodist Hospital Corp
Vendor - Disaster Management Solutions (DMS)
Vendor - EMSystems
Vendor - Global Emergency Resources (GER)
Vendor - HHS Joint Patient Assessment & Tracking System (JPATS)
Vendor - UPP Technologies
TN DOH Exercise Coordinator & State Response Coordinator
TN Air National Guard
                                                                  20
Veterans Administration
      Evacuation
Patient Receiving Area           Maryland (MIEMSS)
         (PRA)      1- Tag and Transport patient to NDMS DMAT at
                            BWI Thurgood Marshall Airport                                                                             EMSystems
     HC Standard          Begin tracking patients via DE-TEP
       COG 6977
                       (100 Patients for on-load to air transport.                                                                    EDXL-HAVE
       (GER911)                                                                                   TNCRN/WebEOC
                      To be moved by NDMS to another State for
                           Hospitalization and/or Treatment)                                        (No Message
                                                                                                  Exchange via DM
                                                                                                       OPEN)                                 NDMS
                                                             HC Standard                                                                     Hospital
                                                               COG 6977
                                                               (GER911)
            DE-TEP
                                                                                                                …Hospitals
                           2 – Load                                                                            provide HAVE                   NDMS
                          patients to                     Patient Tracking                                        updates                     Hospital
                         aircraft and                        COG 6974
         DM                                                                                                        DE-HAVE
                         provide TEP                      (UPP Technology)
        OPEN                                                                                                                       WebEOC
                       updates (JPATS
                          update all)

                                                                                                                                               Local
                         DE-TEP                  DE-TEP
      JPATS                            DM                      First Track                                                                     Hospital
      COG 6978                        OPEN                      COG 6975
       (Apprio)                                               (DM Solutions)
                                                           Tennessee – Memphis Shelby:
                                               3 -Offload patients from aircraft (First Track update all)                                      Local
                                               4 - Patient ambulance transport (First Track update all)                                        Hospital
                          Take-off


                                             Landing
                                                                                                                                      First Track
                                                                 HAVE                                        DM                        COG 6975
                                                               COG 6976                                     OPEN                     (DM Solutions)
                                                             (EM Systems)                                           DE-TEP

                                                                                                                 5 – Patients                  DE-TEP Updates

                                                                                                                  received at
                                                                                                                                             DM         21
                                                                                                                hospitals (First
                                                                                                                                            OPEN
                                                                                                               Track update all)
                                                                                                   Missouri / Louisiana Hospitals &
                                                                                             Mississippi, Wisconsin & Tennessee Tracking
1. EMTrack Missouri Hospital
   evacuation to the airport                                                                    TEP Patient Tracking Proof of Concept
      • NO TEP to ARR                                                                                MESSAGE FLOW-ONLY VIEW

2. EMTrack Missouri Receipt of Patient
   arrival at airport
       • NO TEP to ARR

3. EMTrack Missouri updated to assign                                                                                              3
   35 patients to Shreveport, LA Region                                                                               4
   7 NDMS hospitals (JPATS assigns                          EMTrack                    EMTrack                        5
                                                                                                                                  ARR
   to appropriate flight)                                      Missouri                Shreveport                                Shreveport
                                                             COG 6951                  COG 6951                                  COG 6971
4. EMTrack Shreveport patients land /      8
                                                                                                                                   6
   received at Shreveport PRA

5. EMTrack Shreveport assign patients                              1                             6
   to ambulances at the PRA, destined
   to specified local hospitals                                          2   3     4   5

6. EMTrack patient arrival at each
   Shreveport hospital
                                                                             UPP
7. May 16–19 SEPARATE from and
   parallel with the end-to-end tracking
                                                                          Technology
                                               National Family               Tennessee
   of the 35 patients above, HC                                                                                           ALL Messages 1 - 8
                                               Reunification                 COG 6972
   Standard sends TEP updates to the
                                               Center (notional)
   Tennessee National Family
   Reunification Center (UPP) for up to
                                                                                    7 (as provided – up to
   1000 patients during the course of
                                                                                        1000 patients)
   their movement and tracking.

8. May 19 2011 HC Standard now                                           HC Standard                                          “Monitor”
   begins to send TEP updates to                                       Mississippi / Wisconsin                                  COG
                                                                             COG 6983                                         COG 6993
   EMTrack today in addition to UPP
Missouri Hospital     1- May 19, 2011 Missouri hospital enters 35                                                Missouri / Louisiana Hospitals & NDMS
   Evacuation          patients into EMTrack for evacuation (paper                                               TEP Patient Tracking Proof of Concept
    EMTrack             patients) to be moved to another State for
                                                                                   NOTE: EMTrack is configured as a single “instance”, self-updating between Missouri and Louisiana
      Missouri               Hospitalization and/or Treatment
    COG 6951
                                                                                              Missouri Airport
                                                                                                                           Paper HAVE
 1send                                                                                                            Manual   Report to VA Area
                                                                                                  TRAC2ES                  Emergency
                                                                                                                           Manager

                                                                                                                                      Manual
                                                                                                                                                   EMResource
                                           Missouri Airport
                                                                                                                                                   Hospitals
                             2,3 send          EMTrack             3 send                     3          ARR                     EMSTAT             provide
         IPAWS                                                                   IPAWS
          OPEN                                   Missouri                         OPEN                 Shreveport                  La
                                                                                                                                                   HAVBed
                                               COG 6951                                                COG 6971                                    updates

                                         2 - Missouri EMTrack Receipt                                             Shreveport PRA
                                         of Patient arrival at airport                                4,5,6                                                        Local
                                         3 - Missouri EMTrack assign                                                                                               Hospitals
                                         35 patients to Shreveport, LA              “Monitor”
                                         Region 7 NDMS hospitals                      COG
                                                                                    COG 6993
                                                                                                                                                        6- EMTrack patient
                                  National Family Reunification Center
                                                                                                                                                          arrival at each
                                              Tennessee                           ALL Messages
                                                                                       1-8                                                              Shreveport hospital


                              1,2,3
                                              UPP                        4,5,6                                                                              EMTrack
                                                                                                            IPAWS
                                           Technology                                                        OPEN                              6 send    Shreveport Hospital(s)
                                               Tennessee                                                                                                     COG 6951
                                               COG 6972

                                                                                  Shreveport
                                                      7                              PRA Landing                  4,5 send
      HC Standard            7send May 16-19
     Minnesota / Georgia                         IPAWS                                                EMTrack
                                                  OPEN                                                  Shreveport                                                   NDMS
       National Guard                                                                     8
         COG 6983
                              8 send May 19                                                             COG 6951                                                     Hospitals
                                                                                         4 – Shreveport EMTrack
  Mississippi & Wisconsin                                                                patients land / received at
 7 & 8– May 16–19, 2011 SEPARATE from and parallel         with                          Shreveport PRA
 the end-to-end tracking of the 35 patients, HC Standard sends                           5 – Shreveport EMTrack assign
TEP updates to Tennessee (UPP) and later to EMTrack for up to
                                                                                         patients to ambulances destined
                       1000 total patients
                                                                                         to specified local hospitals
EDXL-TEC update




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                    TEP-TEC Jurisdictions and Systems
  Federal
 HHS (JPATS)
FEMA (NEFRLS,                  TEP-TEC
                                                            DoD
   NMETS,                                                   JPTA
    NSS),                                                 TRAC2ES
  NLM (LPF)                                                 ETAS
                           Incident

                              Local




                                                             TEP-TEC
                      All incidents start locally
       TEP-TEC




Local / States                                          NGO’s
TX (SNETS, TWIRP)
                                                    ARC (Family Links)
       LA
       TN
                                                         Hospitals
                            TEP-TEC                      Shelters
       MD
      …etc.                                          Ushahidi, Sahana
                                                        iREPORT
                                                        Facebook         26
                                                          Twitter
TEC “Generic Process”




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TEC “Generic Process”




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TEC “Generic Process”




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TEC “Generic Process”




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BACKUP SLIDES




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