Amy Sebring: Good morning/afternoon everyone. On behalf of Avagene and myself, welcome to the EIIP Virtual Forum! Our topic today is "The Integrated Patient Tracking Initiative: A National Framework for Planning and Implementation " Amy Sebring: Please note that both an overview document and the Phase I high level requirements document that our guest will be describing are linked from the Background Page for today's session at http://www.emforum.org/vforum/060412.htm Amy Sebring: First, before we get into our discussion, for the benefit of any first-timers, we will go over the order of business. We will begin with a presentation and then we will proceed to your questions and comments. Amy Sebring: We will provide further instructions just before we begin the Q&A section, but you may wish to jot down your questions or comments as we go along. Amy Sebring: Please do not send private messages to our speaker or the moderator, as we will be busy with the presentation. If you need assistance, you may send a private message to Avagene. Amy Sebring: We will also be using a few slides during the presentation. When you see a blue URL you can click on it and it should open in another browser window. Amy Sebring: You may need to disable pop-up blocking in order for it to display. We will pause to give you time to view, then you will need to bring this chat window back to the top. Amy Sebring: A formatted transcript of today's session will be available by later this afternoon with links to the slides -- just check back on our home page or the background page (refresh the pages as needed). Now it is my pleasure to introduce today's speaker: Amy Sebring: Judith Woodhall joined COMCARE in January 2004 to serve as Managing Director. She previously served as President of the Advisory Company, a regional management consulting firm. Amy Sebring: She has also served as Chief Information Officer for private sector companies, and previously worked for Mattel, Inc. where she headed mattel!online, responsible for Mattel's e-business initiatives. Amy Sebring: Please see the Background Page for more details on her bio ... Amy Sebring: Welcome Judith and thank you for being with us today. I now turn the floor over to you to start us off please. Judith Woodhall: Welcome everyone to the EIIP Virtual Forum and today's discussion on the Integrated Patient Tracking Initiative. Today's session will provide you with a quick overview of this initiative and tell you how you can become involved. ... Judith Woodhall: The goal of the Integrated Patient Tracking Initiative is to provide communities with the tools they need to make decisions about patient tracking solutions while also ensuring the use of standards and data interoperability. We are hoping to bring together a variety of technologies that ... Judith Woodhall: will enable location tracking of patients and victims as well as the exchange of information needed to care for them as they move through the response and care process. The intent is to design a solution that can be used for everyday events as well as mass casualty events. Judith Woodhall: Traditional patient tracking has been limited to mass casualty incidents in the field, or patient tracking systems within a hospital. As witnessed during Hurricane Katrina, important patient information was lost in the process of evacuating hospitals and transporting patients across the country because there was no standardized way to record and exchange that information in near real-time. Judith Woodhall: A modern patient tracking system could enable important data to be gathered about a patient from the time they enter the emergency response process to the time they leave it, and systems must be in place to gather this information in a standardized format that can be exchanged between different professions, jurisdictions and systems as needed to improve patient care both in daily emergencies and mass disasters. Judith Woodhall: To be truly effective, the solution must accommodate a wide array of disparate practitioners - many of which are not used to working together, let alone exchanging information. This first slide identifies the key stakeholders. Amy, slide 1 please. Amy Sebring: http://www.emforum.org/vforum/IPTI/Slide01.htm Judith Woodhall: To begin the process of cooperation, we formed three working groups with representatives from these organizations and others to discuss the idea of an integrated solution and begin the requirements specification process. Judith Woodhall: A full set of high level requirements were developed in this phase and are currently open for review and comment. This was the practitioner- centric Phase I of this project which we recently completed. Judith Woodhall: We are now starting the technology-centric Phase II. The goal of Phase II is to explore the various technologies that need to be integrated to meet these requirements. A standards group will review current and planned data standards to determine what may be useful and where gaps necessitate new standards to be developed. Judith Woodhall: This phase will also examine the policy and procedural issues for implementing such a system and develop resources to assist in procuring such a system. It will culminate in a technology showcase demonstrating the concept to a variety of practitioners. Judith Woodhall: The final phase will take the "blueprint" developed in the first two phases to deploy a solution in several regions of the country. The timeline on this next slide provides a guideline for the length of each Phase. Amy, slide 2 please. Amy Sebring: http://www.emforum.org/vforum/IPTI/Slide02.htm Judith Woodhall: To give you a good idea as to what we truly mean by "patient tracking", let me review at a very high level some of the requirements identified by our practitioner working groups. Judith Woodhall: Generally, we are advocating an open, standards-based architecture that will allow multiple views depending on functions and jurisdictions. We also want to make sure that the solutions are compliant with federal guidelines from both a healthcare and patient privacy perspective and from an emergency response, homeland security perspective. Judith Woodhall: Functionally, the solution needs to identify, triage, and track individuals as they are moved through a community's system of care. That means: Judith Woodhall: * The solution must identify the patients associated with an incident and their current location in order to help confirm identification for data retrieval and reunification with their families. Judith Woodhall: * Being able to identify a patient or victim using a variety of variables - maybe a picture or a driver's license number or fingerprints depending on the state of the individual and the severity of the incident. Judith Woodhall: * Allowing an individual to enter and leave the process at various points as there is no constant beginning or end. Judith Woodhall: * It must allow for data to be accumulated as the individual goes through the process. This data can come from a 9-1-1 operator, a Telematics vendor such as OnStar or a predictive algorithm. Judith Woodhall: * The solution must also capture data from paramedics at the scene and must be able to capture vitals from medical instruments. Judith Woodhall: * It must also allow for the retrieval of data from sources such as electronic health records, CDC's infectious disease databases or medical alert services. Judith Woodhall: * The individual must be tagged for tracking purposes whether a community has decided to use barcode bracelets or RFID tags or GPS technologies. Judith Woodhall: Finally the solution must be able to accommodate the needs of responders at the scene and those managing it elsewhere like emergency managers or pubic health agencies. Data will need to be available for analysis and decision making throughout the event as well as after the event. Judith Woodhall: The diagram on this next slide shows how all of the pieces fit together during an event. The upper two quadrants focus on patient and victim care while the lower two focus on management of the incident. All four quadrants play a role whether the event is a traffic accident, a fire, a flood or a major hurricane. Amy, slide 3 please. Amy Sebring: http://www.emforum.org/vforum/IPTI/Slide03.htm Judith Woodhall: We are currently in the process of launching a resource portal for communities to use when procuring and deploying patient tracking solutions. This portal will include information about this initiative, news and articles, the functional requirements defined in Phase I, Judith Woodhall: ... a technology directory of vendors that offer components, which could be used for an integrated solution, as well as a variety of reference materials. Please visit http://www.patienttracking.org . Right now this address will take you to the IPTI page of the COMCARE website. When the portal is launched, it will take you directly to that portal. Judith Woodhall: If you would like to participate and have questions as to how you can participate, please contact Amy DuBrueler at adubrueler@comcare.org ... Judith Woodhall: or me at jwoodhall@comcare.org. Our telephone is (202) 429- 0574. Thank you for your interest, and I will turn the floor back over to our moderator to begin our Q&A. Amy Sebring: Thank you very much Judith. Now, to proceed to your questions and comments. Our protocol for audience questions is to enter a question mark ? to indicate you wish to ask a question or make a comment.... Amy Sebring: Then go ahead and compose your question or comment to have it ready, but do NOT hit your Enter key or click on the Send button until you are recognized by name. Please WAIT your turn. We will take questions in the order the question marks are sent to the screen. Amy Sebring: ONE QUESTION AT A TIME please and please keep your questions or comments reasonably concise. If you have a follow up question or comment, please get back in the line with another question mark. Amy Sebring: We are ready to begin now. Amy Sebring: First question usually takes a moment ... RWeinert: ? Amy Sebring: Bob, when you are ready please. RWeinert: How are you going to secure this data? There will be a lot of personal information in this database. Judith Woodhall: There will be a data classification system that will allow only those stakeholders with appropriate authorization see personal information. Amy Sebring: Other questions ? Judith Woodhall: The system should use some form of role-based access whereby only these roles have access. Amy Sebring: Judith, does the anticipated system presume one central repository, or will it be distributed in some manner? Dennis Atwood: ? Judith Woodhall: It does not assume one central repository. Although there are some offerings built around a central repository, that is not a requirement. Amy Sebring: Thanks, Dennis next please. Dennis Atwood: First, I commend COMCARE for this vital initiative. Does the project team include reps from the NDMS program office and US HHS e-health office? Judith Woodhall: Yes, the project team does include reps from NDMS and HHS..... Dennis Atwood: Great...thanks. Avagene Moore: ? Judith Woodhall: They were present at our summit in December and David Aylward from COMCARE will be presenting at the NDMS conference Reno later this month. Amy Sebring: Ava next please. Dennis Atwood: ? Avagene Moore: Judith, I also commend the COMCARE effort. You have an industrious schedule set out. Who will be involved and how will the testing be done? Frank Califano: ? Judith Woodhall: Of course, the practitioner that participated in Phase I will be involved..... Judith Woodhall: As well as a number of technology vendors wishing to integrate their products into a comprehensive solution. Amy Sebring: Can you address the testing part of that question Judith? Judith Woodhall: Sorry. In Phase II, the vendors will use standards to test integration in a demo setting..... Judith Woodhall: In Phase II, testing will take place within a community wishing to deploy a solution ....as part of their implementation plan. RWeinert: ? Amy Sebring: Dennis next please. Dennis Atwood: Not shy....What were the key findings of your reviews in St. Louis (EPTS) and Kansas City ((MEIS)? And, let me load this up with an recommendation: I suggest it would be very valuable to use whatever solutions are agreed for non-medical patient evacuee tracking. Judith Woodhall: While we had participants from Kansas City and St. Louis on our working groups. we did not perform an evaluation of their implementations.... Joseph Zalkin Wake EMS NC: ? Dennis Atwood: OK..thanks....good to have them aboard. Judith Woodhall: We did however incorporate their lessons learned, such as ensuring that the solution works for both daily and mass casualty events. Amy Sebring: Frank next please. Frank Califano: Are you looking for any new partners in the development this system. I represent a health system with 15 Hospitals as well as a large EMS system here in the New York Metro area. We are currently look at a solutions for many of the things you are discussing DuaneWhittingham: ? Judith Woodhall: First, let me be clear. We are not developing a solution..... Judith Woodhall: but we are facilitating practitioner requirements and vendor interoperabiltiy efforts. We will gladly use what we discovered and work with any community wishing to deploy this type of solution. Amy Sebring: If NYC would like to participate, they should use the contact info you provided above Judith? Judith Woodhall: Yes, they should. Amy Sebring: Thanks. Bob next please. RWeinert: Do you have a list of vendors that are involved with this that you could send us? We are currently working on a statewide data sharing project and are thinking of including patient tracking. Matt Bruns CT: ? Judith Woodhall: Bob, we are now compiling a technology directory of vendors categorized by the solution they provide.... Judith Woodhall: It will be available on the patient tracking portal. However, if you need it sooner, I will send you a preliminary link to it. Amy Sebring: Joseph next please. Amy Sebring: ? Joseph Zalkin Wake EMS NC: My experience with NDMS reception and Charter flights during Katrina and Rita is both the need for Patients as well as "stuff" needed to be tagged and tracked - Wheel Chairs, Respirators, scooters etc. Amy Sebring: Comment Judith? Is this beyond the scope of what is currently included? Judith Woodhall: Joseph, you are exactly right. ALL assets should be tracked whether they patients, victims, or equipment. .... Judith Woodhall: A successful solution should be able to be used for tracking all of these assets. Amy Sebring: Duane next please. Dennis Atwood: ? DuaneWhittingham: For larger incidents, where there are multiple locations and patients, will tracking of the patients be incorporated into all the new NIMS type software coming out and can be overlayed with current and future mapping software, that way can track patterns whether its flu or bio/chem, etc? Judith Woodhall: Most definitely - these requirements are stated in our document.... DuaneWhittingham: great, tnx Judith Woodhall: Please review them and add or embellish them as you see fit. The document is available in background materials. Amy, please provide the link again. Amy Sebring: or http://www.emforum.org/vforum/060412.htm Amy Sebring: Matt next please. Matt Bruns CT: Hi Judith- Great project, although it seems extremely ambitious with ramifications far beyond emergency response. There is already a relevant patient data format standard (HL7) in place, and I wonder how this initiative relates to national murmurings over electronic patient data reforms. Matt Bruns CT: However I am primarily concerned, as in an earlier question, regarding the issue of Protected Health Information under the federal HIPPA regulations. These regulations require quite extensive information security measures, and significant penalties for breaches. (Current/future access rights, access logging, encryption aspects, etc.) Are you coordinating this effort with HHS wih an eye on HIPPA? ( http://www.hhs.gov/ocr/hipaa/ ) Judith Woodhall: Actually, Dr. Braithwaite, the father of HIPAA, was an advisor to us..... Judith Woodhall: We are also coordinating our efforts of other standards groups such as HITSP, CDC, etc. Amy Sebring: Judith, during the Phase II technology piece, is an OASIS XML standard of some sort anticipated? Or is that what you will be investigating? Judith Woodhall: There is a definite need for additional standards which could be submitted to OASIS or other Standards Development Organizations... Mike Morellato: ? Judith Woodhall: In addition, we will need to harmonize with a number of data dictionaries that are currently being used - SNOMED, NEMSIS, LOINC - so that content of the standards will be understood. Amy Sebring: Dennis next please. (We are glad you are not shy!) Dennis Atwood: Joseph and Duane said it - ((((echo))))) regarding those material resources, as well as the deployable responder personnel, they will need to be NIMS resource management compliant... Good to note the "layering" Duane and Judith mentioned. Now, important to remember how to keep records with pen and paper, or felt markers, in case the electronic system(s) malfunction.... Judith Woodhall: Or another way would be to have the ability to work offline as well as online. Dennis Atwood: Judith - right-o. Amy Sebring: Mike next please. Mike Morellato: Do you foresee / has discussion taken place of the system being explored to be interoperable with mainstream GIS software? Data privacy issues to get in the way? We apply GIS to emergency planning and always exploring new systems... sorry if I haven't read the documentation yet Amy Sebring: ? Judith Woodhall: GIS is an integral part of the solution..... Judith Woodhall: I have given a number of presentations to OGC and at the Location Intelligence conference trying to get geospatial vendors interested in providing integrated solutions for such as things as..... Judith Woodhall: hospital surge capacity, situational awareness, biosurveillance, etc. Amy Sebring: On the tagging piece, do I understand correctly that the tagging system (barcode bracelets, triage tags, etc.) used will be independent, and if so, will you specify the way that the tagging system will interface with the tracking system? Amy Sebring: (We have time for a few more questions, so please enter your question mark now if you have further.) Mike Morellato: Great work, will stay tuned Judith Woodhall: Yes, the "tagging system" can be independent and integrated using standards.... Zachary Goldfarb: ? Judith Woodhall: Some vendors have already incorporated such things as active RFID tags, GPS, etc. into their tracking applications. Amy Sebring: Zachary next please. Zachary Goldfarb: Will there be a way to migrate data readily between systems such as EMS tracking systems and hospital medical information systems so information only needs to be entered once? Judith Woodhall: Most definitely - that is one of our core requirements Amy Sebring: Other questions? I have one more ... Amy Sebring: I am glad you mentioned hospital surge. Will you be looking at interoperability with the HAVE standard or other approaches being developed? Dennis Atwood: ? Judith Woodhall: Yes, as you know we are currently working on HAVE for approval by OASIS..... Judith Woodhall: Surge and IPTI go hand in hand when managing an event. Amy Sebring: Dennis, last question for today please. Dennis Atwood: Sensitive, perhaps, but do you have any significant groups/associations who are competing with COMCARE on the IPTI project, who need to be "brought into the fold?" Judith Woodhall: Actually, no. There is an effort being conducted by AHRQ, but we are active in that as they with us. .... Dennis Atwood: RAH! Judith Woodhall: We have also been involved with DoD efforts as well. Is there one we should know about? Dennis Atwood: Not that I am aware of....they would be "at risk" if there were....(:_}.... Amy Sebring: Judith, can you give us an idea when you anticipate the new portal will be available? Judith Woodhall: Within the next 2-3 weeks. Amy Sebring: Great ... Amy Sebring: Let's wrap it up for today. Thank you very much Judith for an excellent job. We appreciate your time and effort to share this information with us and the good work that COMCARE and the initiative participants are doing ... Amy Sebring: Please stand by a moment while we make a couple of quick announcements .... Amy Sebring: Again, the formatted transcript will be available later today. If you are not on our mailing list and would like to get notices of future sessions and availability of transcripts, just go to our home page to subscribe. Amy Sebring: Thanks to everyone for participating today. We stand adjourned but before you go, please help me show our appreciation to Judith for a fine job.