1. EDXL Tracking of Emergency Patients May 19, 2010 Presented to the: Emergency Interoperability Consortium

2. 2 TEP & TEC Messaging Standards  Requirements definition for Tracking of Emergency Patients and Tracking of Emergency Clients is occurring in two phases. TEP is in-process with the Practitioner Steering and Working Groups (PSG / SWG).  Phase I - Tracking of Emergency Patients (TEP): An XML standard for exchange of emergency patient and EMS tracking information; to increase the effectiveness of emergency medical management, patient tracking and care, and family notification.  Phase II - Tracking of Emergency Clients (TEC): Expands Phase I scope to support clients across the general population. TEC is aimed at more effective evacuation and services management, client tracking, Regulation, Re-unification, and use of assets for all Emergency clients. Client: Generic term for any person displaced, evacuated, sheltering in place, expired, and/or requiring medical attention – i.e. Clients or customers of Emergency Services Patient: A type of client requiring medical attention, being medically evaluated; or a fatality.

3. 3 LNFNOrganization Represented MannClay, Dr. NASEMSD, National EMS Information System (NEMSIS) MearsGreg, Dr.UNC Chapel Hill EMS Medical Director DonohueJohnMaryland Institute for EMS Systems (MIEMSS) SextonJeff Tennessee DOH Office of Information Technology Services, HITSP MorelandJoeKansas Board of EMS WhitneyJoleneBureau of EMS State of Utah McGinnisKevin JNEMSLC, NASEMSO, Vice-Chair-OIC PSG, National Association of State EMS Officials-NASEMSO TEP Steering Committee

4. 4 TEP Stakeholders – Practitioner-Driven Approach  Incumbent Practitioner Steering Group (PSG) & Standards Working Group (SWG)  EMS, Law Enforcement, Fire, Emergency Management, Health, Public Safety, States, Counties, Cities  Over 80 Newly Added Stakeholders plus Vendors – Examples:  Health Information IT Standards Panel (HITSP) Gap-Filler  National Association of State EMS Officials (NASEMSO)  Joint National Emergency Medical Services Leadership Conference (JNEMSLC)  DoD Health & Medical Defense Support of Civil Authorities – OASD(HD&ASA)  HHS-Agency for Healthcare Research and Quality (AHRQ)  HHS-Assistant Secretary for Preparedness and Response (ASPR)  National Disaster Medical System (NDMS)  American Hospital Association (AHA)  American Red Cross  LA R-7 Hospital Disaster Preparedness/Emergency Nurses Association-ENA  Association of Public Safety Communications Officials (APCO)  National Emergency Numbering Association (NENA)  Federal Emergency Management Agency (FEMA)  State of Tennessee

5. 5 Emergency Data Exchange Language Tracking of Emergency Patients (EDXL-TEP) – Status Update Final Stakeholder review period completed March 1 – March 31, 2010; extended to April 14, 2010 Additional comments received from: National Institute of Health (NIH) / US National Library of Medicine “Lost Person Finder (LPF)” effort. Multiple DoD reviewers including the Health & Medical Defense Support of Civil Authorities. Draft TEP Piloted and Improved: National Disaster Medical System (NDMS) live exercise April 29, 2010 at the Tennessee Air National Guard 164th Airlift Wing in Memphis Excellent TEP participation and input Total Issues submitted: 289 Project Initiation Document (PID): 156 Requirements and draft Messaging Specification: 133 EIC Submission May 14, 2010

6. 6 Emergency Data Exchange Language Tracking of Emergency Patients (EDXL-TEP) Documentation may be found at the following website: http://www.evotecinc.com/TEP/ Requirements and Draft Messaging Specification: “EDXL-TEP-Rqmts&draftMessagingSpecFinalV2.2_05-05-2010.pdf” Stakeholder issues list: “TEP-Stakeholder-IssuesRev2.2_05-7-2010.xls”  (Filtered for “open” or “in-process” for review of resolutions) Data Dictionary: TEPdictionaryV2.1.xls  (Excel version provides mappings to NEMSIS and NIEM) Project Initiation Document: EDXL-TEP Project Initiation Document (PID) v4.3.pdf Subject Matter Expert list EDXL-TEP-Participants-FullList5-12-10.pdf (Steering, Stakeholders, Vendors, and PSG / (SWG)

7. 7 TEP Scope  EDXL-TEP is an XML messaging standard for exchange of emergency patient and tracking information across the EMS emergency medical care continuum.  TEP provides real-time information to responders, management and care facilities in the chain of emergency care and transport.  Patient tracking information is exchanged from patient encounter (possibly re-using dispatch information) through admission or release.  TEP also supports hospital evacuations and day to day patient transfers.

8. 8 Tennessee National Disaster Management System Patient Reception Exercise DHS Office for Interoperability and Compatibility (OIC) supported the Tennessee Department of Health (TN DOH) and many other organizations in the 2010 National Disaster Medical System (NDMS) Patient Movement Exercise A live exercise driven by objectives of federal, state and local agencies and NDMS partner hospitals. DHS OIC objective to “test-run” the Emergency Data Exchange Language (EDXL) Tracking of Emergency Patient (TEP) specification in a field exercise before submitting to the standards approval process DHS OIC provided program management and technical support to all participants Key Take-Aways: Patient registration timeframes dramatically reduced – hours to 30 minutes First Electronic Patient Manifest for TN Air National Guard

9. 9 The NDMS Patient Movement Exercise Draft TEP interoperability pilot inserted into the 2010 National Disaster Medical System (NDMS) Patient Movement Full-Scale Exercise, with follow-on analysis and presentation A live exercise driven by objectives of federal, state and local agencies and NDMS partner hospitals. The exercise simulates a hurricane making landfall resulting in mass casualties requiring professional treatment. The exercise made use of air and land transports, volunteer patients, and support personnel. Patients were tracked utilizing five independent Patient Tracking systems from Maryland's BWI airport, to a Memphis triage area where an actual C-130 landed and deplaned patients. Patients were then tracked through triage and ambulance boarding, through arrival at one of 5 Memphis area hospitals.

10. 10 Evacuation Patient Receiving Area (PRA) Maryland (MIEMSS) 1- Tag and Transport patient to NDMS DMAT at BWI Thurgood Marshall Airport Begin tracking patients via DE-TEP (100 Patients for on-load to air transport. To be moved by NDMS to another State for Hospitalization and/or Treatment) DE-TEP JPATS COG 6978 (Apprio) JPATS COG 6978 (Apprio) DM OPEN First Track COG 6975 (DM Solutions) First Track COG 6975 (DM Solutions) Patient Tracking COG 6974 (UPP Technology) Patient Tracking COG 6974 (UPP Technology) HAVE COG 6976 (EM Systems) HAVE COG 6976 (EM Systems) HC Standard COG 6977 (GER911) HC Standard COG 6977 (GER911) DE-TEP 2 – Load patients to aircraft and provide TEP updates (JPATS update all) Tennessee – Memphis Shelby: 3 -Offload patients from aircraft (First Track update all) 4 - Patient ambulance transport (First Track update all) DE-TEP Local Hospital NDMS Hospital NDMS Hospital Local Hospital EMSystems EDXL-HAVE TNCRN/WebEOC (No Message Exchange via DM OPEN) 5 – Patients received at hospitals (First Track update all) First Track COG 6975 (DM Solutions) First Track COG 6975 (DM Solutions) DM OPEN DE-TEP DM OPEN DE-TEP Updates Landing Take-off WebEOC DE-HAVE …Hospitals provide HAVE updates HC Standard COG 6977 (GER911) HC Standard COG 6977 (GER911)

11. 11 NDMS Patient Movement Exercise Organizations DHS Office for Interoperability and Compatibility DHS Tech Support - Evolution Technologies HHS / ASPR / NDMS Maryland Institute for Emergency Medical Services Systems (MIEMSS) Memphis / Shelby County Health Department Memphis / Shelby EMA Memphis Fire Memphis Shelby Regional Hospital Coordinator Methodist Hospital Corp Vendor - Disaster Management Solutions (DMS) Vendor - EMSystems Vendor - Global Emergency Resources (GER) Vendor - HHS Joint Patient Assessment & Tracking System (JPATS) Vendor - UPP Technologies TN DOH Exercise Coordinator & State Response Coordinator TN Air National Guard Veterans Administration

12. 12 Post Exercise Analysis, Improvement and Outreach EDXL-TEP draft Requirements and Messaging Specification improved from planning and conduct of the exercise Improved federal, state and local patient tracking requirements Changed and validated Required and Optional Elements Validated applicability and value of EDXL standards approach for patient tracking across locations, organizations, jurisdictions, and across independent systems already in place. Messaging data analysis Validate messaging and data passed and develop statistics Outreach Poster session presentations at the 2010 Integrated Medical, Public Health, Preparedness and Response Training Summit June 3 & 4. “After-Action” Report A description of what happened, what worked, what didn’t, recommendations for improvement to the standard(s), and a recommended action plan

13. 13 Identification of Future Implementation Opportunities Pre-Implementation- Greater Coordination with Publisher/Subscribers and Supporting Organizations  Sequencing of Messages  Security/Protection of Information  Event Type Drives Optionality Agreements with other Standard Development Organizaitons like HL7 How do we address system errors i.e. A patient gets designated “Black (Morgue)” what if they are not moved or re-triaged because someone made a mistake early in process?