2. Overview Enabling electronic health record (EHR) exchange when patients are transferred between participating hospitals during a disaster involving mass casualties, for improved patient care BHEPP – PatientData Exchange BHEPP – Patient Data Exchange

3.  Acute care community hospital  Level II Trauma Center  Community preparedness experience  Decontamination capacity  Clinical research facility  Surge capacity  Sophisticated diagnostic laboratory facilities  Skilled campus HAZMAT & decontamination team  Substantial basic science and specialty/subspecialty expertise  Military hospital  Extensive decontamination capacity  Skilled deployable workforce  Availability of “in-residence” staff  Preparedness training BHEPP Partnership Suburban HospitalNIH Clinical CenterNNMC

4. Disaster Scenario Disaster causes mass casualties Non-critical patients are transferred to other hospitals to make space for emergency patients Patient data is transferred electronically to the receiving hospital to aid in patient care 1 2 3

5. Challenges 1. What to share ? 2. Which format / standard ? 3. How to share ?

6. Patient Summary Record 6 Required “Minimum Data Set” Required “Minimum Data Set” Based on “NHIN Core Content Based on “NHIN Core Content Specification” for exchange Specification” for exchange of Patient Summary Record of Patient Summary Record Content Modules Content Modules Person Information Support (Emergency Contact Information) Allergies and Drug Sensitivities Conditions (Problem list) Medications Information Source

7. Patient Summary Record 7 “Data Format - HL7 CDA Standard (XML)” Machine readable entryHuman readable entry Document Level Constraints

8. Patient Summary Record 8 Data Transformation – Suburban EHR XML to CDA Using Adapters

9. Patient Summary Record 9 Data Transformation – NIH Clinical Center XML to CDA Using Adapters

10. Patient Data Exchange - Application 10 Mapping & Translation Web Upload Mapping and Translation Patient Search Patient View PDF/XML Download Admin Module Integration with Triage Data (Digital Pen) Integration with RFID Data (Future) Web Upload Search & View Hospital 1 Hospital 2 NNMC Adapter NLM CC Adapter Suburban Adapter CDA HTML Adapter PDF Adapter Features Receiving Hospital

11. Patient Data Exchange - Application 11 ColdFusion 8.0 Application Server Apache Web Server 2.2 HTTPS based for security and encryption ColdBox (MVC) based framework for easier extensibility Internationalization and localization Technical Specifications

12. CMAX 2009 12

13. Future Directions 13 Integration with RFID for location tracking during disaster Integration with “NHIN – National Health Information Network” for nationwide real time Patient Data Exchange DICOM support for including medical images with Patient Summary Record