Stream: implementers
Topic: Ambulance / Emergency care handover
Jose Costa Teixeira (Apr 16 2020 at 09:25):
Hi. Anyone working with ATMIST?
Jose Costa Teixeira (Apr 16 2020 at 19:59):
Or any project related to handover between ambulances and ER admission?
Jose Costa Teixeira (Apr 19 2020 at 12:16):
Are there any specifications around the data handover between Ambulance / emergency teams and the hospitals?
Derek Ritz (Apr 20 2020 at 18:08):
Jose -- you should reach out to Andrea Fourquet. She did an IHE profile regarding this in FHIR last year (or year before, maybe).
Eric Haas (Apr 20 2020 at 18:13):
in V2 PH did this with Oasis: HL7 Version 2.7.1 Implementation Guide: Message Transformations with OASIS Tracking of Emergency Patients (TEP), Release 1
Jens Villadsen (Apr 20 2020 at 18:21):
@Signe Hejgaard Kristoffersen
Derek Ritz (Apr 20 2020 at 18:22):
The IHE profile for EMS transfer between hospitals is: https://wiki.ihe.net/index.php/Routine_Interfacility_Patient_Transport
Derek Ritz (Apr 20 2020 at 18:22):
hope this helps...
Derek Ritz (Apr 20 2020 at 18:25):
and quality reporting of EMS transfer is here: https://wiki.ihe.net/index.php/Quality_Outcome_Reporting_for_EMS
Martin Grundberg (Apr 20 2020 at 19:39):
@Jose Costa Teixeira , we are currently implementing integrations using FHIR for:
1) Ambulance encounter
2) Triage including priority level
3) Hand over summary from the ambulance to Emergency Department
Use cases are mainly for the ED staff to see what patients are coming in (Ambulance encounter), to see triage data from the ambulance as well as getting a summary of the ambulance encounter.
Would be interested to hear about what you are up to!
Jose Costa Teixeira (Apr 20 2020 at 19:48):
@Martin Grundberg That is exactly what I was discussing with this group in Belgium.
Jose Costa Teixeira (Apr 20 2020 at 19:49):
Can I establish a first contact? Or do you have some materials..?
Jens Villadsen (Apr 20 2020 at 19:50):
I know @Signe Hejgaard Kristoffersen and @Poul Jespersen is at the vendor supplying the national solution in Denmark that handles this
Jose Costa Teixeira (Apr 20 2020 at 19:52):
@Derek Ritz thanks, I just sent them this information
Jose Costa Teixeira (Apr 20 2020 at 19:53):
thanks @Jens Villadsen , would be great to have their input
Jens Villadsen (Apr 20 2020 at 19:54):
and @Finn Terpling / @Finn Terpling as well. It is also based on FHIR
Finn Terpling (Apr 21 2020 at 06:06):
@Martin Grundberg and @Jose Costa Teixeira
Which systems are you integrating and which processes at the hospital do you expect to support?
In Denmark, Region Midtjylland, we are developing a FHIR implementation with DXC to deliver many of the information from the ambulance system called PPJ (Prehospital Patient Journal) including the FHIR resources you mention.
First part of our implementation is to use the logistic information in our Clinical Logistic system, and later we will use the actual journal records in our EHR.
The integration is also going to use resources such as e.g. Task, Observation, Procedure, MedicationAdministration and Media.
Our goal is to use the information from the ambulance as early as possible to do planning before the ambulance gets to the hospital, to secure that the patient is received by the correct staff and the staff is well informed about the situation for the patient.
Martin Grundberg (Apr 21 2020 at 06:57):
@Jose Costa Teixeira , @Finn Terpling , I will speak to my colleague @Anna Riedberg who is managing this project to get back to you. I think it would be very useful to set up a call, maybe we can share some experiences and agree on some basic common patterns for this?
Anna Riedberg (Apr 21 2020 at 07:14):
@Finn Terpling @Jose Costa Teixeira
We're integrating our EHR (used at hospitals, including the emergency ward) with prehospital patient records. We have the same goal as you describe, i.e. to get information from the ambulance as early as possible in order for emergency personnel to work more proactively. We have a long-term roadmap to transfer all kinds of clinical and administrative patient information (in both directions), e.g. administered drugs, results from local analyses, lines/caths, diagnoses.
What we're doing in this project iteration is, in short:
- Create (ongoing) ambulance encounter and present it to end users. We include information such as ETA, destination, ambulance (location ID)
- Send triage (the patient's priority, vital sign measurements, reason for visit) and present it to end users
- Send NEWS2 (vital sign measurements and early warning score) and present in to end users
- When the external prehosptial record is signed a summary including a PDF is sent and stored in the chronological medical record (also published to national services)
I agree with @Martin Grundberg that it would be really interesting and useful to set up a call and share our experiences.
John Moehrke (Apr 21 2020 at 12:49):
This use-case has been profiled in FHIR by IHE. They would be a good place to further refine. I will try to get Andrea Forquet over here.
ANDREA FOURQUET (Apr 21 2020 at 19:14):
I am working on updating an IHE profile that does this, PCS a project happening in PCC. It has both FHIR and CDA solutions. If there is a call i'd love to join.
Lloyd McKenzie (Apr 21 2020 at 19:32):
That's a lot of TLAs :) PCS=? PCC=?
David Pyke (Apr 21 2020 at 20:38):
PCS = Paramedicine Care Summary , PCC=Patient Care Coordiation (an IHE Domain)
David Pyke (Apr 21 2020 at 20:38):
https://wiki.ihe.net/index.php/Paramedicine_Care_Summary
Michaela Ziegler (Apr 22 2020 at 14:55):
@Jose Costa Teixeira , @Martin Grundberg , @Finn Terpling , @Anna Riedberg , @ANDREA FOURQUET
In Switzerland we are also working on this topic (@Oliver Egger ). We are currently working on a FHIR Implementation Guide (http://build.fhir.org/ig/hl7ch/ch-ems/branches/master/index.html) under the leadership of the "Interverband für Rettungswesen". A standardised information flow is to be defined, which is applicable for Swiss emergency medical services and also enables the link to the EPR. The information content is based on FHIR and the processes are described technically according to IHE integration profiles. The Use Case describes the information flow among the participants during a emergency medical service (ambulance emergency call centre, rescue vehicles, target hospital, back office of the rescue service, etc.). It also maps the required medical, demographic, and other information between the participants (patient, practitioner, etc.). We are interested in the current projects and try to achieve a harmonisation of our project.
Martin Grundberg (Apr 22 2020 at 15:14):
I took the liberty to create a Doodle for an online call: https://doodle.com/poll/kx9zfafysmxfcp94 (assumed US and EU, so went for afternoon EU time).
cc @Jose Costa Teixeira , @Finn Terpling , @ANDREA FOURQUET , @Michaela Ziegler , @Anna Riedberg . Feel free to pass this onwards.
Jose Costa Teixeira (Apr 22 2020 at 15:15):
Thank you!
Kevin Mayfield (Apr 23 2020 at 05:21):
Scheduled for England NHS, not got ATMIST on the radar but ATMIST is in use in English NHS organisations.
Martin Grundberg (Apr 24 2020 at 06:37):
@Jose Costa Teixeira , as far as I can see, you havent responded to the doodle. Do you want to have a look before I suggest a time?
Jose Costa Teixeira (Apr 24 2020 at 06:42):
Hi. I was waiting for the project team to do it first - but I just saw that Astrid already did.
Jose Costa Teixeira (Apr 24 2020 at 06:42):
Just filled in my availability - thanks!
Martin Grundberg (Apr 27 2020 at 14:10):
I just sent out an invite for:
Monday May 4th 16.00-17.00 CEST (GMT +2)
I sent it to the emails which I found here, hope that was right.
I could not find emails for Felix Fischer and Astrid Philippron, does anyone have their contact details or can forward the invite to them if you know their email?
Jose Costa Teixeira (Apr 27 2020 at 14:12):
just sent it to Astrid (internal mail)
daniel bernås (May 05 2020 at 10:01):
Hi, I think it was a good call yesterday.
1) General
2) Follow up from yesterday
3) General contribution from Ortivus
General:
From Ortivus side, I think our take is a bit wider than just profiling since we decided to build our own FHIR implementation as a server inside our Backend of MobiMed.
The way we see it is that MobiMed(The system used in Ambulances and PrimaryCare) is the server of the data as long as the patient is within the Ambulance Organization. There is number of reasons for that and that is a complete chapter so I skip that for now.
It means that the ePR system at the hospital is either a client or another server. I think we need to come back to what architecture you have chosen.
Follow up from yesterday:
Yesterday we decided to share a spreadsheet to describe the profiles that are around the world divided into the three main categories.
about the three different steps in a CareEpisode.
1[BASE (a reference to the incident init, the Patient, The Call sign of the ambulance, Destination and ETA, Location... etc) ]
2[Diagnostics and Medications( Vital signs, Triage, Info about the accident e.g. Falls, Stroke etc, and Medics given to the patient)]
3)[handover(The Summary section when the Ambulance crew hand over the patient to the next care provider, This may also include km driven, waiting time at the emergency, etc ...so it can be more than one report.)
Cambio will send out the spreadsheet.
General Contribution from Ortivus:
We think FHIR is a very good initiative and since the ambulance is one of the first steps in a patient journey it is essential that the data is in a good structure.
Ortivus started with telemedicine and send ECG in realtime from ambulance to hospitals about 34 years ago and we have quite many examples of good and bad integrations long before FHIR.
If anyone wants a quick brief on the use cases on how ambulance monitoring and ePRs solve a few specific needs we are happy to set that up.
As I said yesterday, the ambulances are moving away from taxi service to becoming a care-provider and the need for understanding the works that are done in helicopters, IntesiveCare Ambulances, First Responders and normal 1-2 patient ambulances.
Ping me in a PM if you are interested in this as this is a separate topic from profiling but rather repeating the use cases.
Have a Nice Day everybody.
Daniel Bernås, Team Leader R&D at Ortivus AB, +46 730 355 741
daniel.bernas@ortivus.com
Jose Costa Teixeira (May 05 2020 at 11:09):
I thhink it will save us a lot of work if we identify our data needs on a logical level, not directly in the FHIR resources
Martin Grundberg (May 06 2020 at 10:08):
I agree with Daniel, I think it was a very useful call to start listening to our different perspectives.
Here is a googe docs for everyone to update if they want (please do!). https://docs.google.com/spreadsheets/d/1O8OPdb_ZT6zsYVCIE-PG0MU0MY0SxjSjfJa37lY8-ro/edit?usp=sharing
I have added a fourth use case area which I think is relevant, "Reporting to national or regional databases". That gives these four.
1 Notification of ambulance encounter to Emergency department (BASE)
2 Continuous transfer of data during the ambulance encounter between ambulance and emergency department (Diagnostics & Medications)
3 Ambulance to emergency department handover
4 Reporting to national or regional databases
How do these use cases map to what you are working on? Something missing? Something unclear?
@Jose Costa Teixeira , @Finn Terpling , @Felix Fischer , @Signe Hejgaard Kristoffersen , @Poul Jespersen , @ANDREA FOURQUET , @Michaela Ziegler
Martin Grundberg (May 06 2020 at 10:10):
@Jose Costa Teixeira , I also think it is a good idea to separate the logical model from the implementation model (FHIR). What type of material do you have around your logical models? Can you add them to the google doc?
Jose Costa Teixeira (May 06 2020 at 10:38):
I don't think we have a logical model (i will ask Astrid to join the fhir chat, she's new to FHIR and she's focused on the overall product, not only interoperability, i'm trying to bridge)
Jose Costa Teixeira (May 06 2020 at 10:39):
but what I mean is things like this:
image.png
Jose Costa Teixeira (May 06 2020 at 10:39):
or this
Jose Costa Teixeira (May 06 2020 at 10:39):
Jose Costa Teixeira (May 06 2020 at 10:40):
it's a clinical / non-fhir description of what data we think we need.
daniel bernås (May 12 2020 at 09:40):
@Jose Costa Teixeira , @Finn Terpling , @Felix Fischer , @Signe Hejgaard Kristoffersen , @Poul Jespersen , @ANDREA FOURQUET , @Michaela Ziegler,
@Martin Grundberg,
I was looking at the document Martin sent out and did not see any input from the rest of the world. It would be nice to see what you use and for what
https://docs.google.com/spreadsheets/d/1O8OPdb_ZT6zsYVCIE-PG0MU0MY0SxjSjfJa37lY8-ro/edit?usp=sharing
daniel bernås (May 12 2020 at 09:42):
Not sure if you guys get tagged or not :slight_smile:
/Daniel
Martin Grundberg said:
I agree with Daniel, I think it was a very useful call to start listening to our different perspectives.
Here is a googe docs for everyone to update if they want (please do!). https://docs.google.com/spreadsheets/d/1O8OPdb_ZT6zsYVCIE-PG0MU0MY0SxjSjfJa37lY8-ro/edit?usp=sharing
I have added a fourth use case area which I think is relevant, "Reporting to national or regional databases". That gives these four.
1 Notification of ambulance encounter to Emergency department (BASE)
2 Continuous transfer of data during the ambulance encounter between ambulance and emergency department (Diagnostics & Medications)
3 Ambulance to emergency department handover
4 Reporting to national or regional databasesHow do these use cases map to what you are working on? Something missing? Something unclear?
Jose Costa Teixeira , Finn Terpling , Felix Fischer , Signe Hejgaard Kristoffersen , Poul Jespersen , ANDREA FOURQUET , Michaela Ziegler
Jose Costa Teixeira (May 12 2020 at 10:52):
Belgian input should be appearing some time soon
ANDREA FOURQUET (May 15 2020 at 20:17):
should we have another call to discuss the data that was out into the spreadsheet?
Last updated: Apr 12 2022 at 19:14 UTC
