Utilizing a Patient Tracking System for Public Health Emergencies

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Utilizing a Patient Tracking System for Public
Health Emergencies
Laura Williams, MPH Boston EMS Justin Pendarvis,
MPH Boston Public Health, CDC
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Boston EMS
Your Emergency 9-1-1 Responders

• Largest municipal provider of EMS in New England
• Employs 350 uniformed field and administrative
  staff
• Responds to approximately 100,000 calls per year
• 69,000 patient transports per year

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More than An Ambulance Service

• Additional Areas of Responsibility
• Boston MMRS
• Special Events and Special Operations
• Surge Planning
• Disaster Planning
• DelValle Institute for Emergency Preparedness

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Boston Public Health Commission

• Communicable Disease Control Division
• Manage disease outbreaks for the city
• Syndromic Surveillance
• Advise response agencies and the public on
  measures to control the spread of the disease and
  reduce morbidity and mortality.
• Work with Office of Public Health
  Preparedness, Healthcare, and first
  response agencies

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Communicable Disease Control Division

• Since 2004 BPHC CDC has effectively managed
  several mass prophylaxis clinics in response to
  infectious disease outbreaks. However patient
  information data was largely collected on paper
  based forms, limiting the availability of
  real-time clinic data to incident command.

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The History

• 2003 Identified gap in emergency response
  capabilities for tracking patients who are unable
  to identify themselves.
• 2004 Focus groups identified required patient
  data elements for system Childrens Hospital
  helped tailor the system for lost children.
• 2004 Access database prototype developed for
  the 2004 DNC.
• 2005 Awarded Boston UASI funds, for building
  out a regional patient tracking system.
• 2005 to 2006 Core group from EMS CDC office
  clarified system requirements, issued an RFP, and
  selected a vendor.
• 2006 to 2007 Work with vendor and stakeholders
  to build out the system to meet Boston
  requirements.

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The System

• Key components
• The ability to identify lost individuals
  reunite family members
• Data views and reports that allow for incident
  management (showing locations, numbers triage)
• Flexibility to handle short term/high impact
  incidents, which would require rapid data entry,
  and long term events, such as a pandemic flu that
  would require collection of more extensive data.

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The TeamThroughout every stage of this project
Coordination with Stakeholders has been Constant

• 13 EMS Providers (municipal, fire based,
  private)
• Boston Public Health (PHP CDC)
• Massachusetts Public Health Department
• 17 Hospitals
• The Mayors Office of Emergency Preparedness
• Boston Emergency Management
• Community Health Centers
• Chief Medical Examiners

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Patient Tracking Users

• EMS
• Enter information in the field during patient
  loading.
• Hospitals
• Notified when patients are transferred to their
  facility
• System will be integrated with their registration
  system
• Emergency Managers
• Log on to web interface for immediate view of
  scale and scope of the incident
• Public Health
• View records on web interface or via local
  application to determine appropriate response.
• Volunteers
• Family Reunification patients will be
  searchable via name or identifiable
  characteristics.

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Defining the Data Elements

• Weekly meetings took place for six months to
  discuss the data requirements for the system.
• A representative from the Boston Public Health
  Commission CDC department was present at each of
  these meetings to ensure that PHIN standards
  were met and that the system could be utilized
  during a pandemic flu.

Countermeasure/response administration
functional requirements, version 1.0 4/26/05
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Data Standards

• Health Insurance Portability and Accountability
  Act (HIPAA) compliance
• Standardized vocabulary protocols as defined by
  the National Incident Management System (NIMS)
  and the CDC Public Health Information Network
  (PHIN)
• Each individual and agency have a predetermined
  level of access to the data.

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Data Elements - Demographics

• Patient Tracking ID
• First Name
• Middle Name/Initial
• Last Name
• Street Address
• City
• State
• Zip Code
• Phone
• Phone Type
• Email Address
• Housing Type
• Temporary Address
• Permanent Home Destroyed
• Age
• Date of Birth

Height Feet/Inches Weight Gender Eye Color Hair
Length Hair Color Facial Hair Skin
Color Shirt Pant/Skirt Shoes Uniform Found with
Objects Identifying Marks Alternate ID Driver's
License Driver's License State
DL/ID Raw Data (from Scan/swipe) Ethnic
Background Language(s) Spoken Translation
Required Insurance Image Image Description
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Complaint/History Vital Signs

• Triage Category
• Complaint Category
• Complaint Description
• Incident Involvement
• Allergies
• Medications
• Medical History
• Glasses
• Dentures
• Hearing Aid
• Contaminated
• Contamination Description
• Decontaminated
• Decon Date Time

Blood Pressure Pulse Respiration Temperature
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Complaint/History
Triage status values are based on START triage
definitions, although we added WHITE (uninjured)
and GREY (almost dead)
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Medications Procedures

• Med Time
• Medication Name
• Dose
• Amount
• Lot
• Manufacturer
• Route
• Site
• Administered By
• Ordered by
• Reaction
• State Administered
• Comment

Procedure Time Procedure Name Procedure
Results Administered by Ordered by Reaction State
Administered Treatment Level Treatment Comment
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Relatives Property

• Relative Type
• Relative Note
• Relative Link to Exist Patient
• Relative First Name
• Relative Middle Initial
• Relative Last Name
• Relative Street Address
• Relative City
• Relative State
• Relative Zip
• Relative Phone
• Relative Email

Prop. ID Prop. Description Prop Current
Location Prop. Current Loc Comment Prop.
Destination Prop. Destination Comment Prop.
Destination Contact Prop. Returned to Owner
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Provider

• Provider Name
• Provider Unit ID (if applicable)
• Actual Start Time
• End Time (either estimated or actual)
• Latitude
• Longitude
• Disposition
• Actual Patient Arrival Time
• Actual Patient Arrival Update User
• Actual Patient Discharge by
• Actual Patient Discharge Time

FOR GIS MAPPING
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Labels
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Incident Management

• The system is set to provide real time summary
  information on the location and triage status of
  all individuals involved in an incident.
• This data is extractable in various formats
  including user defined fields to Excel, a graph
  summary, and a text only summary (which can be
  pasted into an email and read on a blackberry).
• WebEOC board providing a summary of the
  incident(s)

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WebEOC Interface/Summary View
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Hospital Integrations

• We have successfully developed an
  interface between our tracking system and the
  Massachusetts General Hospital registration
  system. This will allow selected information
  (name, age, gender, ID, location, etc) to be
  pulled from the records of disaster patients
  during registration, directly into our patient
  tracking system.
• Over the coming year we will work with other
  Metro-Boston hospitals to develop the same type
  of interface.

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Types of Interfaces
HRS
WebEOC
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Using Industry Standards
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Security

• Data Provider includes Authentication
• All transactions are 128 bit HTTPS
• SSL encryption
• a third party certificate authority

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Sample Data
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Symbol MC-9094

• Field Data Collection Device
• Photograph Capability

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Patient Tracking System Hardware Communication

• Command Kits field kits with Panasonic
  Toughbooks with 802.11 receiver, and both
  cellular and satellite communication devices
  serves as a local data collection

point, mechanism for transferring data to
regional server, and local command station.
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Thank You! Williams_la_at_bostonems.org 617-343-1109