[CAP] question for the list

[Larry Nathanson]

Thanks David--

My understanding is that in 2007 HITSP will be looking at the 
prehospital EHR use and harmonizing the standards.  Hopefully that 
will go a long way toward what you describe.

I realize that work may well change the landscape, but if you know of 
any other candidate standards, I'd love to take a look -- I'd really 
appreciate those citations you mentioned.

Thanks and Happy New Year to everyone...

--L



At 11:37 AM 12/31/2006, David Aylward wrote:
>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 
>(<http://www.patienttracking.org>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
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