[CAP] question for the list

[David Aylward]

Larry:

Both Tom's and Rex's comments make sense, and are part of the solution.
Unfortunately, there is no simple answer to your question, with which a number
of organizations, including our own, have been wrestling for some time.  We
believe it is a matter of high priority to develop a set of message and
content standards for tracking patient information (location, diagnosis, care,
etc) across all emergency domains that can contribute information about
patients, or need such information (i.e. private sector, 9-1-1, EMS,
hospitals, medical practitioner offices, public health, emergency management,
military (for mass events)).

After facilitating a national consensus requirements process in the patient
tracking area for 1 1/2 years (www.patienttracking.org), we also strongly
believe that systems and standards need to be for daily use, not just the rare
event where lots of casualties are at a single location and the data needs to
get to another single location (or two).  Instead, some communities appear to
be pursuing "break the glass and everyone use this software tool when the big
one hits" approaches.  These are not standards-based, and will have limited
value and acceptance.

The hardest problem here is that the kind of information flow we need cuts
across professions and federal agencies (e.g. DHS and HHS) that are not used
to working together at all, and there is no state or federal entity, or
standards body, bringing them together.   (EDXL HAVE is a unique effort in
that respect, but it provides a standard message for hospital capacity and
resource data for you to match with the patient data -- for which there are no
standards!)

There is currently no message standard or set of standards for tracking such
patient information within any domain (other than the military and VA), much
less across domains.  The EDXL DE would be a good "header" for routing patient
information payloads, but it hasn't yet been used for that purpose (in the
absence of such payloads).

There are standardized taxonomies within some of the domains, but they are not
yet universally accepted.  9-1-1 doesn't have standards for sharing data.
NEMSIS was developed independently by, and applies only to, EMS (and is not
messaging).  DEEDS is not widely accepted and is being redone.  The hospital
world has its own set of dictionaries: SNOMED, etc.   The HL7 (ANSI) people
and the ASTM people (Continuity of Care Record, or CCR) have done battle over
competing standards for patient information.

There is some good news.  There is a huge federally-sponsored (HHS) effort to
develop standards and interoperability for Electronic Health Records.  It
recommended use of HAVE.   There is currently balloting on an ANSI standard of
patient information that is a compromise between HL7 and ASTM's CCR -- which
will be done early in 2007.  This comes closest to what I think you need,
perhaps with the EDXL DE for routing.  The overall EHR project recently
expanded from day to day care to consider an emergency use case, as the first
step towards standards.

Sukumar Dwarkanath, our Technical Director, or Amy DuBrueler of our staff will
email some citations for this effort.  We and others have pushed hard to get
that use case defined as more than just EMS and traditional hospitals; it
already includes more than just mass casualty incidents.  With the exception
of groups like ours, the community working on these standards is exclusively
the various subdomains of medicine, with a strong emphasis on hospitals and
public health.  It does not include the emergency management, 9-1-1, fire, or
EMS communities.

Hope I didn't make too many mistakes here, and that this is helpful to you in
describing some of the confusion.

David Aylward
COMCARE

________________________________

From: cap-list-bounces at lists.incident.com on behalf of Larry Nathanson
Sent: Sun 12/31/2006 2:43 AM
To: cap-list at lists.incident.com
Subject: [CAP] question for the list



Hi Folks--

I'm currently working on a project that involves electronic
communication of real-time patient data between a mass casualty
incident site and a command center (and other relevant players).

I'm (obviously) familiar with CAP, and will be including support for
it.  I'm also familiar with the NHTSA Prehospital Dataset, as well as
DEEDS.   I was wondering if the list members had any other protocols
they would suggest I review for inclusion.

Thanks for any thoughts or suggestions...

Happy New Year..

--L
_______________________________________________
This list is for public discussion of the Common Alerting Protocol.  This list
is NOT part of the formal record of the OASIS Emergency Management TC.
Comments for the OASIS record should be posted using the form at
http://www.oasis-open.org/committees/comments/form.php?wg_abbrev=emergency
CAP-list mailing list
CAP-list at lists.incident.com
http://eastpac.incident.com/mailman/listinfo/cap-list

This list is not for announcements, advertising or advocacy of any particular
program or product other than the CAP itself.