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Data Content Standards
The following data content standards and profiles may be used for each step of the EMS interoperability workflow.
EMS may query for and receive patient medical history information in the following types of documents.
HL7 Consolidated Clinical Document Architecture (C-CDA) is an agreed-upon set of twelve CDA document types that are widely supported. Continuity of Care Document (CCD) is the type most commonly used to summarize a patient's medical history. It is the standard most commonly supported via national networks. Other C-CDA document types that may also be relevant to EMS to understand a patient's medical history include Discharge Summary and Progress Note.
When querying a national network, many CCDs will usually be available for a patient: one from each provider organization that has seen the patient (and even multiple documents from a provider that uses multiple EMR systems, such as separate emergency department and inpatient systems). Some state or local health information exchanges may offer a single document that represents a combination of information from multiple providers. Some qualified health information networks (QHINs) under the Trusted Exchange Framework and Common Agreement (TEFCA) may also provide a combined CCD in the future.
All C-CDA documents from ONC-certified health IT systems should be at CDA Level 3; that is, they should contain structured data that can be parsed to present only the relevant information to an EMS provider. Ambulatory care providers are less likely to use ONC-certified systems and may produce C-CDA documents at Level 1 (structured header, unstructured content) or Level 2 (structured header, unstructured content within structured sections). Some CCDs may be very large for patients with extensive medical history.
- Status: Active
- Latest Release: 3.0, May 2024
- HL7 versions supported: v3, FHIR (see CDA on FHIR)
- Hospital support: Widespread via national networks and state/regional health information exchanges
Documents exchanged using the IHE Exchange of Personal Health Record Content Integration Profile (XPHR) have content that adheres to the IHE Personal Health Record (PHR) Extract specification (see §6.3.1.5), which is an IHE Medical Summary document, which is an HL7 Clinical Document Architecture (CDA) document (though not necessarily one of the document types in Consolidated CDA, or C-CDA). Documents may comply with the older Health Information Technology Standards Panel (HITSP) C32: HITSP Summary Documents Using HL7 CCD standard, the precursor to HL7 Consolidated Clinical Document Architecture (C-CDA) Continuity of Care Document (CCD).
- Status: Active
- Latest Release: 11, November 2016
- HL7 versions supported: v3
- Hospital support: Widespread via national networks and state/regional health information exchanges
"An International Patient Summary (IPS) document is an electronic health record extract containing essential healthcare information about a subject of care." It contains a patient's medications, allergies, and problems, as well as additional optional medical history information. The standard is under development and is seeing adoption internationally. It may be adopted in the future in the US.
- Status: Draft/trial use
- Latest Release: 1.1.0, November 2022
- HL7 versions supported: FHIR R4
- Hospital support: Not yet in widespread use in the US
EMS information can be shared with a hospital as structured or unstructured data. Many hospitals currently prefer to receive unstructured data from EMS, for several possible reasons:
- The hospital's EMR system may not have a place for structured EMS information in the medical record.
- The provenance of the data is not well understood by the hospital.
- Unstructured data is usually a PDF document generated by the EMS provider, so the hospital's view of the document matches the EMS provider's view exactly.
- The parsing of structured data is not necessary a native capability of the hospital's EMR system but may need to be performed by a separate service.
- Parsing of structured data may lead the hospital to be subject to additional regulatory requirements regarding its obligations to use the data.
- Some hospitals do not use the standardized code sets that are necessary to interpret structured data.
The good news is that documents that implement the HL7 Clinical Document Architecture (CDA, described below) can contain both structured and unstructured data. For the time being, hospitals may choose only to process the unstructured data, but over time they can begin processing the structured data, since both can be available in the same document.
The HL7 CDA R2 Emergency Medical Services Patient Care Report is a level 3 (structured data) clinical document in the HL7 Clinical Document Architecture (CDA). "This implementation guide supports the provision of emergency medical service data from provider agencies to hospital emergency departments using the CDA standard. The clinical specifications were developed by the National EMS Information System Technical Assistance Center in collaboration with thirteen professional societies and eight federal partners."
- Status: Active
- Latest Update: Release 3, April 2023
- NEMSIS versions supported: 3.4 and 3.5
- HL versions supported: v3, FHIR (see CDA on FHIR)
- Hospital support: Unknown. Hospitals can process a Clinical Document but may not parse the specific contents of an HL7 EMS PCR document.
The IHE Paramedicine Care Summary (PCS) is a profile of the IHE Medical Summary "for providing the patient's paramedicine encounter information to the receiving facility."
- Status: Trial Implementation
- Latest Update: 1.1, September 2018
- NEMSIS versions supported: 3.4
- HL versions supported: v3, FHIR
- Hospital support: Hospital support for processing IHE Medical Summary documents is widespread. Hospitals may be able to process IHE PCS documents with minimal additional effort.
HL7 Consolidated Clinical Document Architecture (C-CDA) is an agreed-upon set of twelve CDA document types that are widely supported. The documents are not EMS-specific but may be capable of supporting the transfer of EMS information to a hospital. C-CDA document types that could be utilized by EMS include Continuity of Care Document (CCD), Transfer Summary, and Unstructured Document.
- Status: Active
- Latest Release: 3.0, May 2024
- NEMSIS versions support: N/A
- HL7 versions supported: v3, FHIR (see CDA on FHIR)
- Hospital support: Widespread
HL7 version 2 message types are not EMS-specific but are capable of supporting the transfer of some EMS information to a hospital. Commonly used message types for EMS information include Admit, Discharge, and Transfer (ADT, for pre-arrival alerts); Observation Result (ORU, for vital signs); and Medical Document Management (MDM, for cardiac rhythm images, narratives, and complete patient care reports).
- Status: Active
- Latest Release: 2.9, December 2019
- NEMSIS versions support: N/A
- HL7 versions supported: v2
- Hospital support: Widespread
Most medical devices used by EMS have built-in capabilities to transmit the data they collect to a receiving hospital.
Unlike EMS encounters, hospital encounters can vary in length from an hour to several weeks or more. As a result, a hospital's record of a patient encounter changes and gradually becomes more complete over time. During that time, the hospital may generate a variety of messages and documents pertaining to different aspects of the patient's care.
HL7 Consolidated Clinical Document Architecture (C-CDA) is an agreed-upon set of twelve CDA document types that are widely supported. Continuity of Care Document (CCD) is the type most commonly used to summarize a patient's hospital encounter. It is the standard most commonly supported via national networks. C-CDA document types that are relevant to EMS to understand a patient's hospital outcome include Discharge Summary, Continuity of Care Document, Referral Note, and Progress Note. Implementers should focus on the use of HL7 C-CDA CCD via national networks, rather than the use of HL7 version 2 messages (described below), which are usually only available via point-to-point connections with individual hospital medical record systems.
- Status: Active
- Latest Release: 3.0, May 2024
- HL7 versions supported: v3, FHIR (see CDA on FHIR)
- Hospital support: Widespread via national networks
Hospitals commonly generate many HL7 version 2 messages during a patient encounter. Admit, Discharge, and Transfer (ADT) messages that are relevant to EMS to understand a patient's hospital outcome include A01 Admit, A02 Transfer, A03 Discharge, A04 Registration, A05 Pre-admission, A06 Outpatient to Inpatient Status Change, and A08 Information Update. The patient's primary diagnosis is usually contained in an A03 Discharge message or an A08 Information Update message.
- Status: Active
- Latest Release: 2.9, December 2019
- HL7 versions supported: v2
- Hospital support: Widespread via point-to-point connections
Resources:
- IHE Profiles for Health Information Exchange, by IHE USA