By Suzi Birz, principal, HiQ Analytics, LLC.
How do we create national guidelines that are useful at a
local level and during a regional or national response to emergency situations?
COMCARE, a national advocacy organization with more than 100
members dedicated to advancing emergency communications, has embarked on the
development of a national framework for the planning and implementation of
Integrated Patient Tracking Systems. While mass casualty incidents are placing
the spotlight on patient tracking, patient tracking can be improved each day
during every emergency response.
Integrated Patient Tracking Initiative (IPTI)
The Integrated Patient Tracking Initiative (IPTI) is bringing
together a representative group of experts to develop a national framework that
communities and regions can use when beginning their own patient tracking
programs—programs that will be useful day to day and in the event of a mass
casualty emergency response.
Michael Pariser, a project associate at COMCARE explained that
the intent of the initiative “does not stop at the scene, does not stop at the
hospital, but continues through family reunification.” The goal, continued
Pariser, “is better patient outcomes.”
With respect to patient confidentiality, Pariser stated that
one of the first steps in the project was to address HIPAA and its associated
“Systems meeting the minimum requirements reflected in the
project are required to be HIPAA compliant and may have safeguards that exceed
legal requirements,” he said.
As a member of the task force, Kathy Robinson, RN, 2003
president of the Emergency Nurses Association, draws on 22 years of emergency
room nursing to provide information on how emergency rooms work, the role of
nurses and the barriers to information exchange.
The initiative has three phases. The first phase is the
detailing of the functional requirements. It is designed to rapidly develop
national consensus requirements from all emergency professions that can be used
when selecting a patient tracking system. Phase I is expected to be completed by
January 31, 2006.
The second phase is the research piece, studying the
implementation of patient tracking systems across the country. This information
gathering completes the other components of the national patient tracking
framework, including the development of a model RFP. Phase II is expected to
take six months.
The third phase will be a model implementation. It “test
drives” the framework with field trials and by following a few communities
through their procurement and implementation processes. Phase III is estimated
to take a year or more.
Phase I: Functional Requirements
Amy DuBrueler, a manager at COMCARE, detailed Phase I. The
functional requirements resulted from collective discussion across the wide
range of emergency domains that need to share information, which include
Emergency Medical Services (EMS), emergency medicine, hospitals, emergency
management, 911, public health, disaster services, state, local and federal
agencies and the private sector.
The functional requirements outlined follow the systems of
care and are segmented into the following areas:
- Triage: Information related to the initial assessment of
the patient’s condition.
- Patient Identification: Data points collected to positively
identify an individual.
- Treatment: Description of the treatment administered,
medications administered and related notes; use of predictive algorithms and
- Location of Patient within the System: Identification of an
individual’s movement within the system, and the present location of the
- Incident Management: Data points and functions related to
- Family Reunification: Functionality related to
identification of the location of individuals entered in the system.
- Post Event Analysis and Reporting: Functionality related to
producing reports and aggregating data for analysis.
The technical requirements pertain to the technical aspects
that the system must fulfill, such as performance, reliability, and availability
Pariser confirmed that the solution will be compliance with
requirements and regulations from the Department of Health and Human Services
and the Department of Homeland Security as well as other federal and state
Impact on Nursing
Robinson noted there is great opportunity for improvement in
the day-to-day operations related to patient tracking.
“Much information is passed via radio from caregivers on a
scene to caregivers in the hospital,” she explained.
The emergency room nurse spends time charting that
information, which may be a redundant effort to the emergency response personnel
who may also be charting it in a scene record. This takes nurse time away from
direct patient care.
Robinson followed-up: “Notes must be lost to illegibility and
misplacement every day.”
From the pre-hospital setting through family reunification,
successful patient tracking can have a powerful impact on patient care and
patient safety. Properly implemented, duplicate data entry and its inherent
errors, information loss, emergency room procedure preparation for patient
arrival and caregiver communication can all be improved.
Robinson outlined opportunities for improvement, including
disease surveillance, quality improvement, hospital hand-off during transfers,
data access across the continuum of care, medication reconciliation and
increasing time for direct patient care.
“Hospitals might be able to anticipate needed resources, such
as gear up an OR, start to call in additional staffing or implement internal
disaster plans,” she added.
Pariser explained that the system is designed so that data
will be accessible by practitioners for individual patient care and by emergency
managers and other officials to aid disease surveillance and statistic
“One thing that is important about this project is that it is
interdisciplinary,” Robinson concluded. “Through collaboration dreams become a
Pariser extolled the goals of the requirements process: “To
make an impact, the system has to be used every day,” he said. “Therefore, the
system has to be useful every day to all those involved.”
For more information visit the COMCARE Emergency Response
Alliance Web site.
© 2006. AMN Healthcare, Inc. All Rights Reserved.