The Louisiana Rural Ambulance Alliance (LRAA), in partnership with the Louisiana Emergency Response Network (LERN) and the Louisiana Health Care Quality Forum (the state designated Health Information Exchange), established the Electronic-Rural Health Information Technology (E-RHIT) Network. Since its inception, the E-RHIT Network has expanded to include twenty three ambulance services and the Louisiana Traffic Records Coordinating Committee. Participation by LaHIE in the E-RHIT Network also expanded the footprint of the network to over 30 hospitals and 70 healthcare delivery facilities (physician offices, FQHCs, etc).

Louisiana is a very rural state, with approximately one-quarter of its residents residing in rural areas. As is true across the United States, rural Louisianans experience health disparities involving trauma. The E-RHIT network’s long-term goal is to integrate the LERN system with the HIE system and to share patient information across the continuum of care. To achieve this long-term goal, an initial and more immediate goal of the proposed project was the implementation of an Emergency Medical Service (EMS) Electronic Patient Care Record that is compliant with National Emergency Medical Service Information System (NEMSIS) requirements. This goal has been accomplished. This Patient Care Record can now be shared with hospitals, specialists, and primary care providers for inclusion in their Electronic Health Records and utilized in meeting Meaningful Use standards. A secondary project goal was the population of a statewide trauma registry. This registry is now in use and continues to be the repository for real time and historical EMS trauma data. Analysis of trauma registry data can identify trends in mortality and morbidity necessitating additional training or a change in protocol.

Description

E-RHIT is a network of ambulance services across Louisiana supporting the implementation and adoption of electronic Patient Care Reporting (ePCR). ePCR is used in these rural ambulances to document care given to patients at the time the care is provided and to record the type of incident. E-RHIT currently supports ePCR for ambulance services many of which are in very rural areas with limited cell phone reception. The software is installed in each ambulance on a ruggedized laptop that can connect to the state database via cellular network. The data collected consists of demographic, scene, and clinical information such as chief complaint and medications. Each service is also able to setup their own template and collect information that is relevant to their service area and local hospitals.
Data is feeding a centralized state reporting system. E-RHIT is participating in the state Health Information Exchange (HIE) and will be able to exchange information in real-time with hospitals and clinics in the future.

Services Offered

E-RHIT supports ambulance services throughout Louisiana with:

• Implementation and training of the ePCR application
• Support for custom template development
• Centralized data storage and first-level support
• Data collection
• Data analysis
• Hardware
• Software

Resources Used

In addition to grant funds awarded by HRSA Federal Office of Rural Health Policy, and generous in-kind donations from EMS services, funds were awarded by the National Traffic and Highway Safety Administration to expand the program to additional EMS providers.

Implementation

Goal 1: Formalize the E-RHIT Network
Objective 1: Establish Workgroups

Goal 2: Implement ImageTrend’s State Bridge software in order to create NEMSIS compliant and HIPAA compliant data sets and Electronic Patient Care Records
Objective 1: Develop agreements with the 40 rural pre-hospital provider organizations in the state to train their 2,500 emergency medical technicians on use of the ImageTrend product.
Objective 2: Increase knowledge about the benefits of and the ability to input data into a statewide EMS data collection system.

Goal 3: Create interoperability between Electronic Health Records (EHRs) used by Critical Access Hospitals and rural Federally Qualified Health Centers and EMS Patient Care Records
Objective 1: Identify certified EHR vendors used within the state which are amenable to development of interoperability with ImageTrend’s EMS Patient Care Record.
Objective 2: Create interoperability

Goal 4: Implement ImageTrend’s Patient Registry on Trauma, Stroke, ST-Segment Elevation Myocardial Infarction (STEMI), and Burn
Objective 1: Develop a process for extracting information from EMS Patient Care Records into the Patient Registry.

Goal 5: Use Continuous Quality Improvement Strategies
Objective 1: Solicit feedback from pre-hospital providers and network members
Objective 2: Analyze Patient Registry data
Objective 3: Hold training events for areas suggested by pre-hospital providers, network members and data

Goal 6: Disseminate Results of Program
Objective 1: Disseminate results to EMS providers
Objective 2: Disseminate results to other professionals, including health care providers and HIT specialists
Objective 3: Disseminate results to general public

Lessons Learned, Concerns, and Barriers

In the field and while in transport in the ambulance, the challenge is simply one of connectivity. As detailed above, much of Louisiana and the majority of the project sites are located in rural areas. Many of these rural areas do not have access to the internet. Paramedics can input data into the system while not connected to the internet, but the data cannot be transferred to a receiving facility until access to the internet can be established. This connectivity often does not happen until the transport is well underway.

The E-RHIT Network member discussions around data collection and analysis have focused primarily on two components; the challenges with timeliness and accuracy. While efforts to train end users on process to submit data timely and accurately continue, the members of the E-RHIT Network members recognize that there is some percentage of inaccurate data being submitted. To date, the Network members have not identified a way to determine what percent might be inaccurate and how to incorporate this potential inaccuracy into the analyzed data.

Results

• Successfully developing, adopting, and incorporating a National EMS Information System (NEMSIS) compliant data dictionary into the state EMS / Trauma system;
• Creating an EMS specific electronic health record template and making this template available to all EMS providers in the state while working with EMS providers to customize and incorporate a NEMSIS compliant template into their EMS Service;
• Awarding 120 rugged laptop computers to twenty three Louisiana licensed EMS Services and ensuring that this hardware was incorporated into their standard operating protocols and procedures. Specifically, these computers are used in the ambulances, on scene and in route, to capture patient data. The data is then transmitted to and incorporated into LERN, which is the statewide trauma registry, as well as to the EMS providers system to be used for patient care reports, billing, and quality improvement activities;
• Successfully facilitating the submission of data by EMS providers into LERN by training EMS professionals on this process. Prior to the formalization of the E-RHIT Network, only hospitals were submitting data into this registry; no EMS providers were submitting data. The submitted data is de-identified then analyzed to determine variations across communities in mortality and morbidity and used to inform training efforts; and
• Identifying gaps in the system as it relates to communicating and sharing patient data, patient outcomes, and morbidity.

As a result of the collection of data in real-time, more complete patient data is available to a broader spectrum of providers. The system has improved charge capture and inventory management for the rural ambulance services.

For the first time many of the ambulance services are collecting good data that can be used for process improvement. In addition, the collection of accident type data will be used to focus community education efforts. For example, if a large portion of ambulance calls are for ATV accidents, then community education on ATV safety can be provided.

Replication
By using a network to centralize the implementation and training of the ePCR system, E-RHIT was able to provide this valuable technology to man rural, volunteer ambulance services in Louisiana. This model could be replicated in many areas of the country.

Additional Information

While all of the accomplishments of the E-RHIT Network are significant, one certainly bears repeating. It is the accomplishment of identifying gaps in the system as they relate to communicating and sharing patient data, patient outcomes, and morbidity.

This accomplishment is the basis for the next stage of the E-RHIT Network. The next phase of the project will be to create a system to share patient information across the continuum of care. Specifically, access to LaHIE will allow EMS Practitioners, Paramedics and Basics, to access electronic patient data prior to or while conducting a transport on-scene at a: residence; motor vehicle accident (MVA); mass casualty event (MCE) hurricane / school shooting; physician office / FQHC/ RCH / nursing home; public facility (grocery store / football game / church); and in the Ambulance while in route to the most appropriate receiving facility. Additionally, creating access to the Hospital Dashboard will make electronic patient data available to the receiving health care facility.

For more information, contact:
Donna Newchurch
Executive Director
Louisiana Rural Ambulance Alliance
Ph: 985-513-3593
Email 

Expanded Learning Management System Now Part of VCW Platform

CENTENNIAL, CO - 12/16/13 - Providing access through technology is at the heart of the Virtual Care Works mission, and was the key driver for expanding the continuing education capabilities of its platform. 

“We work with a number of groups who are using our platform to facilitate medical education across geographically divided locations, quite often very remote locations.  Feedback from these members made us realize that there was interest in expanding our platform’s educational capabilities,” said Jim Ward, Telehealth and Marketing Specialist at Virtual Care Works.

Previously, Virtual Care Works offered its members access to CORRE, a searchable database of timely and clinically relevant continuing education for healthcare professionals.  In response to member interest, Virtual Care Works turned to partner Educational Measures to build a learning management system that would be embedded in the platform and available as part of the VCW membership.

“We selected Educational Measures as our partner in expanding of offering based on their experience, their ability to meet our specific technology and security parameters and their commitment to innovation,” said Ward.  “We were excited to work with a partner who has a team of developers that can ensure our offering has the ability to grow and scale with us as we respond to our members needs and usage patterns.”

The integrated learning management system gives VCW members a framework to administer, document, track, report and deliver e-learning education courses or training programs.  (Members also have the ability to link their own proprietary learning management systems to the VCW platform if they choose.)

The Educational Measures team is enthusiastic about the partnership as well.  “We feel that telehealth is an emerging market for us and we are thrilled to be partners with an organization like Virtual Care Works who is already established in this space,” said Marc Crawford, President at Educational Measures.

About Virtual Care Works  

Virtual Care Works (VCW) provides secure, “medical-grade” communications solutions for health care providers.  The VCW platform includes tools to converse with colleagues and patients via videoconference, exchange medical data and images via secure email or text and collaborate across a secure, HIPAA-compliant network.  Healthcare organizations of all types and size benefit from the safety and security VCW offers, and use the VCW platform to avoid the significant fines ($10k per violation, up to $1.5m annually) and penalties that come with mishandling health information.  VCW partners with other industry leaders such as Dell, Juniper Networks, Level 3 Communications and Vidyo to provide their medical-grade communications platform.  VCW has members nationwide and is headquartered outside of Denver, CO.         

About Educational Measures

Founded over a decade ago as a technology company focused on data collection and management in the healthcare industry, Educational Measures was created to meet a need in the marketplace; the need to effectively collect and analyze data to its fullest extent to improve physician performance and ultimately patient care. Using their background in technology and education, the founders built a company based on cutting edge technology, innovative thinking and superior customer service.

Today, the company has expanded its services across all industries and added a suite of innovative, customizable products and services designed to help companies properly utilize content and data. With offices in Colorado, Pennsylvania, and New York, Educational Measures’ staff works to ensure their clients deliver content effectively and collect the data they need, because more facts, more figures and better stratification lead to more powerful results.

Comments and questions are greatly appreciated!  Feel free to contact Jim Ward directly: jim.ward@virtualcareworks.com

About the Author
Jim Ward serves as Telhealth Specialist with Virtual Care Works. VCW is a secure, private broadband network enabling the practice of telemedicine, telebehavioral health and medical education as well as the exchange of protected patient data and medical images. VCW is a NCHN Business Partner.

New platform introduced this academic year

CENTENNIAL, CO (October 23, 2013) - Remote students at the Pacific Northwest University of Health Sciences will be the first users of a new telemedicine platform that will allow them to meet “face to face” with their main campus despite being spread out across the northwest.

 “This is what it means to be a health care professional in 2013!” exclaimed Brandon Isaacs, DO.   “We are proud to offer our students this kind of ‘real world’ technology and give them this kind of practical experience as part of their training.  We believe whole-heartedly in embracing telemedicine because it helps us carry out our mission of bring care to those where access is often a challenge.”

Pacific Northwest University of Health Sciences educates and trains health care professionals with osteopathic values and conducts research to provide quality care to communities of the Pacific Northwest, particularly rural and underserved populations.

The Virtual Care Works platform enables the students to meet with their deans in private, HIPAA-compliant videoconference settings so that they discuss patient data and conduct training in a secure environment.  The platform supports videoconferencing that includes multiple students, professors and administrators at once.

“This is an amazing technology and working virtually is a critical skill for our students to be exposed to,” said Dr. Isaacs. “We look forward to expanding the program and finding additional ways to add this platform into our curriculum and workflows, allowing all students and professors better means of remote communication.”

“Our goal as a University is to take the training of future physicians out into the communities where they will eventually serve after graduation,” Isaacs continued.   “This platform helps us to maintain great communication and education as well as administrative actions to those training in these remote sites.  Community based medical training is geared to assisting communities in rural area to recruit physicians back to their area and with this technology we can maintain necessary communication and high level of education in spite of the distances.”

About Virtual Care Works        

Virtual Care Works (VCW) provides secure, “medical-grade” communications solutions for health care providers.  The VCW platform includes tools to converse with colleagues and patients via videoconference, exchange medical data and images via secure email or text and collaborate across a secure, HIPAA-compliant network.  Healthcare organizations of all types and sizes are required to maintain the level 0f privacy and security this technology offers.  VCW has members nationwide and is headquartered outside of Denver, CO.

Comments and questions are greatly appreciated!  Feel free to contact Jim Ward directly: jim.ward@virtualcareworks.com

About the Author
Jim Ward serves as Telhealth Specialist with Virtual Care Works. VCW is a secure, private broadband network enabling the practice of telemedicine, telebehavioral health and medical education as well as the exchange of protected patient data and medical images. VCW is a NCHN Business Partner.

CENTENNIAL, CO (September 9, 2013) - Doctorate of Nursing Practice students are experiencing 21^st Century health care right from the start at the University of Colorado Colorado Springs.  This year’s orientation featured the use of secure, “medical grade” teleconferencing which allowed students and faculty to participate in the session from remote locations.

Gail Katz, an assistant professor at UCCS’ Beth-El College of Nursing and Health Sciences, was one of the faculty members who participated in the session via the secure teleconference provided by Virtual Care Works, a leading telemedicine provider based outside of Denver. 

“It was amazing! Not only was the picture and sound quality far better than other videoconferences I’ve been on, but we were able to share examples of real patient data like x-rays on the screen as well because the technology meets or exceeds HIPAA security rules,” said Katz.

Dean Nancy Smith was equally enthusiastic about the successful orientation and the integration of the Virtual Care Works platform. 

“I am proud that we are bringing the latest and greatest from private sector technology into our approach, and exposing our students to the ways that health care professionals really interact with each other.  I look forward to more opportunities to use telemedicine solutions in our curriculum,” Smith said.

About Virtual Care Works
Virtual Care Works platform offers secure, “medical-grade” communications tools that allow health care professionals to communicate securely and without fear of violating HIPAA regulations.

Comments and questions are greatly appreciated!  Feel free to contact Jim Ward directly: jim.ward@virtualcareworks.com

About the Author
Jim Ward serves as Telhealth Specialist with Virtual Care Works. VCW is a secure, private broadband network enabling the practice of telemedicine, telebehavioral health and medical education as well as the exchange of protected patient data and medical images. VCW is a NCHN Business Partner.

CENTENNIAL, CO—(July 30, 2013):  Renowned speaker Margaret Fitzgerald was able to present at the 2013 National Nurse Practitioner Symposium in Copper Mountain, CO despite being two time zones and thousands of miles away.  Attendees were able to listen to and interact with Fitzgerald through a secure videoconference platform provided by Virtual Care Works.

Fitzgerald is known for creating the most up-to-date, evidence-based NP certification exam preparation available and is a popular speaker for continuing education among nurse practitioners.  Her talk, “Hot Topics in Drug Therapy: New Products, New Uses, New Warnings” was extremely popular with symposium attendees.

“I’m so happy that we’re using the technology to make something like this possible,” said Vicki Brownrigg, an attendee of the Symposium and an Assistant Professor, Clinical Teaching Track at University of Colorado-Colorado Springs Beth-El Nursing School.  “It was like having her in the room with us, the picture and sound quality were fantastic and we were able to interact and ask questions easily.”

Virtual Care Works platform offers secure, “medical-grade” communications tools that allow health care professionals to communicate securely and without fear of violating HIPAA regulations.

Comments and questions are greatly appreciated!  Feel free to contact Jim Ward directly: jim.ward@virtualcareworks.com

About the Author
Jim Ward serves as Telhealth Specialist with Virtual Care Works. VCW is a secure, private broadband network enabling the practice of telemedicine, telebehavioral health and medical education as well as the exchange of protected patient data and medical images. VCW is a NCHN Business Partner.

As reported in the National Law Review, “Representative Doris Matsui (D-CA), a member of the Energy and Commerce Committee, indicated that she intends to introduce legislation that would create a workable federal definition for telehealth services.”¹   Representative Matsui’s effort to establish this definition of telehealth will become a step forward in the unfolding implementation of the Affordable Care Act (ACA). 

Telehealth is commonly understood to include both the methods and medium of transmitting health information between providers and patients.  However, contradictory state definitions often become a barrier to establishing telehealth services.  For instance, does telehealth have to be via a phone line?  Internet?  Does it include SMS (text messaging)?  Video chats? Integrated database portals? Phone apps? What type of security is needed to meet HIPAA regulation?

Reimbursements from both Medicare, Medicaid or insurance companies often hinge on the definitions in their regulations. Providers and patients are anxious to use technology to ensure better, lower cost, more convenient treatment, and creating a “common understanding” on the federal level will smooth out many of these difficulties. 

It is estimated that more than 10 million patients in the United States have employed telehealth services in 2012, and this number is expected to increase exponentially in the next several years.  In the near future "Telemedicine" will simply be considered "Medicine". 

Comments and questions are greatly appreciated!  Feel free to contact Jim Ward directly: (mailto:jim.ward@virtualcareworks.com)

About the Author
Jim Ward serves as Telhealth Specialist with Virtual Care Works. VCW is a secure, private broadband network enabling the practice of telemedicine, telebehavioral health and medical education as well as the exchange of protected patient data and medical images. VCW is a NCHN Business Partner.

¹http://www.natlawreview.com/article/congressional-representative-signals-willingness-to-facilitate-telehealth-services