Featured Project: E-RHIT Network (Louisiana)

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Oct 20, 2014 05:14 PM
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 ERHIT Network

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 ERHIT hardwarePatient 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.


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.


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.


  • 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.

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


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