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Subject: Fwd: FW: Emergency data standards

Title: Fwd: FW: Emergency data standards
Hi Folks,

Apparently this area is heating up. The recent release of EDXL-HAVE for its second 60-Day Public Review plays into this area, as does the very, very quiet development of the provisions of last year's S. 3678 for Pandemic and All-Hazards Preparedness Act, which moved responsibility for the National Disaster Medical System (NDMS) from the Department of Homeland Security (DHS) to the HHS.

I would like to suggest that we discuss this in the OASIS International Health Continuum Technical Committee and possibly contact COMCARE about participating in this effort. As informal liaison to the OASIS Emergency Management TC, I could share responsiblity for keeping abreast of this with another IHC-TC member. Unfortunately, my existing commitments prevent me trom shouldering the entire effort.

However, we should discuss this further since our work does include the Emergency Response (ER) even if it is not our main focus.


Subject: FW: Emergency data standards
Date: Wed, 28 Nov 2007 15:43:42 -0500
Thread-Topic: Emergency data standards
Thread-Index: AcgwUQsmeHP5zEDbTt+SYfCxdcCWTQAAB1knAACzsyAAAuOSIABn6elA
From: "Charlee Hess" <chess@comcare.org>
To: <rexb@starbourne.com>
X-SpamScore: 0
X-Rcpt-To: <rexb@starbourne.com>
X-DPOP: Version number supressed
David and Elysa asked me to forward the e-mail below to you.

From: David Aylward
Sent: Monday, November 26, 2007 2:31 PM
To: 'N Clay Mann'; 'Bob Cobb'
Cc: 'dleonar@lumc.edu'; 'Seb Haileleul'; 'Parker, David D (IHS/HQE)'; 'Laurie Flaherty'; 'Earl Hardy'; Judith Woodhall; Amy DuBrueler; 'Michael L. Glickman'; 'SHufnagel@Tiag.net'; 'Roger Hixson'; 'bthornburg@nena.org'; 'rjones@nena.org'; 'Patrick Halley'; 'jeff.sexton@state.tn.us'; 'Robert Bass'; Eileen Groell; 'jpotter@valleyhealthlink.com'; 'richard.taylor@ncmail.net'; 'mcginnis@nasemsd.org'; 'Timothy Grapes'; 'ltincher@evotecinc.com'; 'dennis.gusty@dhs.gov'; 'David Lamensdorf'; 'Donald Ponikkvar'; 'Paul Mangione'; 'Drew.Dawson@dot.gov'; 'Tracy Ryan'; 'Elysa Jones'; 'Letartefamily@comcast.net'; Lauren Barna; Charlee Hess; 'Collins, David'
Subject: Emergency data standards

Dear Friends:
I am writing informally on behalf of COMCARE, the HIMSS/COMCARE Emergency Responder Task Force, and the Health Information Technology Standards Panel (HITSP) Working Group on the Emergency Responder Electronic Health Record (ER-EHR).  As you may know, this is a major effort funded by HHS to be able to develop and exchange electronic health records.  For more information, please see
Last year this was expanded to include an emergency use case and an associated working group was set up,  http://www.hhs.gov/healthit/erehr.html
COMCARE has become an increasingly active member of this group.  We have been very pleased at the ER-EHR Working Group's willingness to reach out beyond the traditional hospital and hospital technology-based communities, and to include the fine work coming out of the practitioner/DHS/OASIS emergency standards development process.  We are working through with them the details of implementing the vision of informed emergency medical response that most of us have been working on for years, but now within the HITSP context.  This coming together of different "movements" is very exciting.  At the recent HITSP face to face meeting in Chicago we had an excellent session of the ER-EHR Working Group.  This included a special session with a number of experts from the emergency medical world, led by Clay Mann for NEMSIS and neurosurgeon Peter Letarte for COMCARE.  Clay is now participating in the Group on a regular basis.
During this session, we identified three key, major standards gaps/problems that our EMS and 9-1-1 organizational members are well situated (in some cases with others) to solve.   Each is critical to interoperability among the private sector and various professions during emergency medical response.
The purpose of this email is to ask you to participate in two or three conference calls to scope these issues.  The draft HITSP ER-EHR Interoperability Specification (IS) calls for this activity.
In summary, the three suggested projects are:
1. The need to have a consistent definition of incident types (This goes well beyond just EMS and 9-1-1 as well as beyond HITSP and ER-EHR.)
2.  Determine the best way to link data produced by various agencies. This is so the data entries about the incident and patients during a response by the different agencies and organizations can be tied together. One suggestion is the use of unique identifiers for both incidents and patients/victims.
3.  Inconsistent terminology describing all things about patients/victims, from their identity to their care.
1 and 2.  The ER-EHR Interoperability Specification supports use of the OASIS EDXL Distribution Element to route various kinds of emergency data.  The DE routes messages based on incident type, among other factors.  The DE calls for the use of a common "managed" list of incident types - but such a list doesn't exist.  Several years ago, we put a draft together from the lists of each profession when the detailed specification for the DE was put together and submitted to OASIS, but nothing has been done with that since.  So, as remarkable as it sounds, there is no agreed upon nomenclature for incident types across professions.
In addition, we cannot tie messages and data about an incident or patient/victim together (e.g. 9-1-1 to EMS to hospital) unless the various organizations that contribute information or care agree on a method for doing so.  Today, each agency (system) assigns its own identifier.  As the IS suggests, probably the best solution is that the number assigned by the first agency to encounter the incident or patient/victim should be followed by each succeeding organization as soon as they become aware of it.   There is a lot of devil in that sentence!
These first two issues are closely tied to work we have done with you and others on the EDXL messaging standards.  Proper resolution will clearly need parties outside the emergency medical community, but we need to solve this problem to share information about patients. This is a good time and reason to get going on two key interoperability problems.
3.  Regarding patient terminology, the issue is a variant of the one that caused NENA and COMCARE a couple of months ago to request a coordinated review led by DHS (which they do not now have the resources to do).  It appears that there are four primary overall collections of possible taxonomies for patient/victim care purposes:
    a.  9-1-1 (i.e. any NENA standards for data)
    b.  EMS (clearly NEMSIS)
    c.  Hospitals (DEEDS, HL7 and perhaps SNOMED)
    d.  Global Justice Data Dictionary has significant entries on indentification, although not on treatment.
Clay Manning agreed to work with the hospital folks to see how NEMSIS and DEEDS can be harmonized.  We have put him in touch with our colleague Dr. Kevin Coonan who has been working on updating DEEDS.  The purpose of this email is to extend the same question in other directions: other pre-hospital emergency professions.
We would like to ask NENA and the NEMSIS experts to participate in a conference call in the near future to scope how we could get agreement between 9-1-1 and EMS on taxonomy, and to see if others (e.g. Global Justice Data Dictionary) need to be involved.  I am acutely aware that I made a similar invitation a couple of years ago on behalf of the Department of Homeland Security, and included with it the offer of $50,000 to fund NENA, NAEMSO and others' participation in an effort to develop "common terms" between all emergency professions.  When the standards program was moved to another part of the department, the new management reneged.  Ok, ok.  I am still sorry!
So no, I am not offering to pay your expenses of participating.  :-)  Let's just have a first call to scope the problem and see where we go from there.
It would be great if Bob Cobb for NENA, Clay Mann for EMS and Tim Grapes from the DHS EDXL project could figure out who will participate from their ends for this preliminary discussion of each of the three issue sets, and then give Eileen Groell (egroell@comcare.org) 3 times in December when those folks could be on the phone for an hour.  We will then let all of you know and hopefully most can join in.
David Aylward

Rex Brooks
President, CEO
Starbourne Communications Design
GeoAddress: 1361-A Addison
Berkeley, CA 94702
Tel: 510-898-0670

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