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Current Status
PRESENTATION PURPOSE: OASIS Outreach and Education on the draft Standard – questions at the end
Practitioner Submission to EIC May 14, 2010 Practitioner Submission to OASIS June 8, 2010 TEP Voted within OASIS as a Work Product June 22, 2010 TEP Sub-committee Created Within EM-TC subcommittee
& Chairs Voted in (T. Grapes / D. McGarry) August 2010 Plan to Engage Sub-Committee Work Beginning of Oct. MOU in-progress between OASIS and HL7 for standard
collaboration Interagency MOU in-progress (privacy, adoption etc.)
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Background – TEP & TEC Messaging Standards
The NASEMSO with many other agencies and organizations recognized the need for standards-based interoperability to realize the potential of the numerous patient tracking systems in existence or planned
Introduced TEP to the DHS S&T Office for Interoperability and Compatibility (OIC), sponsor of the EDXL development process – a mature, proven process for developing cross-profession, practitioner-driven messaging standards
Effort was Initiated by the PSG as the next EDXL Priority Helps close HITSP ER-EHR IS04 Gaps Supports HHS & DOD AHRQ Objectives
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TEP & TEC Messaging Standards
Requirements definition for Tracking of Emergency Patients and Tracking of Emergency Clients is occurring in two phases. TEP is in-process with the Practitioner Steering and Working Groups (PSG / SWG).
Phase I - Tracking of Emergency Patients (TEP): An XML standard for exchange of emergency patient and EMS tracking information; to increase the effectiveness of emergency medical management, patient tracking and care, and family notification.
Phase II - Tracking of Emergency Clients (TEC): Expands Phase I scope to support clients across the general population. TEC is aimed at more effective evacuation and services management, client tracking, Regulation, Re-unification, and use of assets for all Emergency clients.
Client: Generic term for any person displaced, evacuated, sheltering in place, expired, and/or requiring medical attention – i.e. Clients or customers of Emergency ServicesPatient: A type of client requiring medical attention, being medically evaluated; or a fatality .
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TEP Scope EDXL-TEP is an XML
messaging standard for exchange of emergency patient and tracking information across the EMS emergency medical care continuum.
TEP provides real-time information to responders, management and care facilities in the chain of emergency care and transport.
Emergency / Disaster EMS, ED / Hospitals / Care Facilities, Emergency Management, Ops, Dispatch, Command
Patient tracking information is exchanged from patient encounter (possibly re-using dispatch information) through admission or release.
TEP also supports hospital evacuations and day to day patient transfers.
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TEP Use Case
Events / Triggers
Key Events That Trigger Messages
Description
Responders dispatched PSAP / dispatch center dispatches responders to an incident. Possible starting point for sharing of incident and patient data
Patient Encountered The first or initial meeting or contact between a given care provider and a given patient.
Patient Evaluated or Triaged Medical observation, measurement, and assessment of a patient or possible patient
Patient Treated Medical performance or administering of procedures, medications, or other treatments.
Patient moved/ transported (physical location tracking)
Patient is physically moved from one location, site, or facility to another
Patient being transferred to new care provider Patient care responsibility is transferred from one care provider to another
Patient condition changes Patient health / medical condition changes in some way
Patient vitals and monitoring taken Care Provider takes vital signs or other measurements, typically using various monitoring equipment, some of which may be electronic
Patient Released Patient is released from care, and is no longer considered to be part of the EMS incident continuum of care, and is no longer tracked using TEP
Patient Admitted Patient is formally admitted into a fixed medical facility or a temporary deployable facility capable of providing definitive care, which typically involves transfer of Care Provider and physical location.
Patient ID information updated Further identifying information is collected / shared about the patient
Time-driven information i.e. transfer to AHRQ National Database
Patient Tracking information is automatically or manually shared with a National Database used for consolidated tracking of patients and clients
Change in conditions requiring patient reroute (change in patient condition, receiving facility full)
Change in circumstances requiring patient transport to re-route from current destination to a new destination
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EDXL-TEP Structure and Elements
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EDXL-TEP Structure and Elements
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EDXL-TEP Structure and Elements
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Emergency Data Exchange Language Tracking of Emergency Patients (EDXL-TEP)
Documentation may be found at the following website: http://www.evotecinc.com/TEP/
• Requirements and Draft Messaging Specification:
“EDXL-TEP-Rqmts&draftMessagingSpecFinalV2.2_05-05-2010.pdf”Stakeholder issues list: “TEP-Stakeholder-IssuesRev2.2_05-7-2010.xls”
(Filtered for “open” or “in-process” for review of resolutions)
• Data Dictionary: TEPdictionaryV2.1.xls
(Excel version provides mappings to NEMSIS and NIEM)
• Project Initiation Document:EDXL-TEP Project Initiation Document (PID) v4.3.pdf
• Subject Matter Expert listEDXL-TEP-Participants-FullList5-12-10.pdf
(Steering, Stakeholders, Vendors, and PSG / (SWG)
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EDXL Process and Pilot
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TEP Research
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TEP Stakeholders – Practitioner-Driven Approach
Incumbent Practitioner Steering Group (PSG) & Standards Working Group (SWG) EMS, Law Enforcement, Fire, Emergency Management, Health, Public Safety, States, Counties, Cities
Over 80 Newly Added Stakeholders plus Vendors – Examples: Health Information IT Standards Panel (HITSP) Gap-Filler National Association of State EMS Officials (NASEMSO) Joint National Emergency Medical Services Leadership Conference (JNEMSLC) DoD Health & Medical Defense Support of Civil Authorities – OASD(HD&ASA) HHS-Agency for Healthcare Research and Quality (AHRQ) HHS-Assistant Secretary for Preparedness and Response (ASPR)
National Disaster Medical System (NDMS) American Hospital Association (AHA) American Red Cross LA R-7 Hospital Disaster Preparedness/Emergency Nurses Association-ENA Association of Public Safety Communications Officials (APCO) National Emergency Numbering Association (NENA) Federal Emergency Management Agency (FEMA) State of Tennessee
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Standards Development Process
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LN FN Organization Represented
Mann Clay, Dr.NASEMSD, National EMS Information System (NEMSIS)
Mears Greg, Dr. UNC Chapel Hill EMS Medical Director
Donohue John Maryland Institute for EMS Systems (MIEMSS)
Sexton JeffTennessee DOH Office of Information Technology Services, HITSP
Moreland Joe Kansas Board of EMS
Whitney Jolene Bureau of EMS State of Utah
McGinnis KevinJNEMSLC, NASEMSO, Vice-Chair-OIC PSG, National Association of State EMS Officials-NASEMSO
TEP Steering Committee
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TEP Practitioner Submission
• Final Stakeholder review period completed March 1 – March 31, 2010; extended to April 14, 2010
• Additional comments received from:• National Institute of Health (NIH) / US National Library of
Medicine “Lost Person Finder (LPF)” effort. • Multiple DoD reviewers including the Health & Medical
Defense Support of Civil Authorities.
• Draft TEP Piloted and Improved: National Disaster Medical System (NDMS) live exercise at the Tennessee Air National Guard 164th Airlift Wing in Memphis
• Excellent TEP participation and inputTotal Issues submitted: 289
• Project Initiation Document (PID): 156• Requirements and draft Messaging Specification: 133
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Tennessee NDMS Patient Movement Exercise
• Draft EDXL-TEP interoperability pilot inserted into the 2010 National Disaster Medical System (NDMS) Patient Movement Full-Scale Exercise, with follow-on analysis and presentation
• A live exercise using volunteer patients, driven by objectives of federal, state and local agencies and NDMS partner hospitals.
• DHS OIC pilot the draft EDXL-TEP specification in a field exercise before submitting to the standards approval process
• A hurricane makes landfall resulting in mass casualties requiring evacuation and medical treatment.
• Patients were tracked utilizing five independent Patient Tracking systems from Maryland's BWI airport, to a Memphis triage area where an actual C-130 landed and deplaned patients. Patients were then tracked through triage and ambulance boarding, through arrival at one of 5 Memphis area hospitals.
• Patient registration timeframes dramatically reduced – hours to 30 minutes
• First Electronic Patient Manifest for TN Air National Guard
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NDMS Patient Movement Exercise OrganizationsDHS Office for Interoperability and CompatibilityDHS Tech Support - Evolution TechnologiesHHS / ASPR / NDMSMaryland Institute for Emergency Medical Services Systems (MIEMSS)Memphis / Shelby County Health DepartmentMemphis / Shelby EMAMemphis FireMemphis Shelby Regional Hospital CoordinatorMethodist Hospital CorpVendor - Disaster Management Solutions (DMS)Vendor - EMSystemsVendor - Global Emergency Resources (GER)Vendor - HHS Joint Patient Assessment & Tracking System (JPATS) Vendor - UPP TechnologiesTN DOH Exercise Coordinator & State Response CoordinatorTN Air National GuardVeterans Administration
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EvacuationPatient Receiving Area (PRA) Maryland (MIEMSS)
1- Tag and Transport patient to NDMS DMAT at BWI Thurgood Marshall Airport
Begin tracking patients via DE-TEP(100 Patients for on-load to air transport.
To be moved by NDMS to another State for Hospitalization and/or Treatment)
DE-TEPDE-TEP
JPATSCOG 6978(Apprio)
JPATSCOG 6978(Apprio)
DM OPEN
DM OPEN
First TrackCOG 6975
(DM Solutions)
First TrackCOG 6975
(DM Solutions)
Patient TrackingCOG 6974
(UPP Technology)
Patient TrackingCOG 6974
(UPP Technology)
HAVECOG 6976
(EM Systems)
HAVECOG 6976
(EM Systems)
HC StandardCOG 6977(GER911)
HC StandardCOG 6977(GER911)
DE-TEPDE-TEP
2 – Load patients to aircraft and provide TEP
updates (JPATS update all)
Tennessee – Memphis Shelby:3 -Offload patients from aircraft (First Track update all)4 - Patient ambulance transport (First Track update all)
DE-TEPDE-TEPLocalHospital
NDMSHospital
NDMSHospital
LocalHospital
EMSystemsEDXL-HAVE
TNCRN/WebEOC(No Message
Exchange via DM OPEN)
5 – Patients received at
hospitals (First Track update all)
First TrackCOG 6975
(DM Solutions)
First TrackCOG 6975
(DM Solutions)DM
OPEN
DE-TEPDE-TEP
DM OPEN
DE-TEP UpdatesDE-TEP Updates
Landing
Take-off
WebEOCWebEOCDE-HAVEDE-HAVE
…Hospitals provide HAVE
updates
HC StandardCOG 6977(GER911)
HC StandardCOG 6977(GER911)
EMTrackMissouri
COG 6951
EMTrackMissouri
COG 6951
Missouri / Louisiana Hospitals & NDMSTEP Patient Tracking Proof of Concept
NOTE: EMTrack is configured as a single “instance”, self-updating between Missouri and Louisiana
1- May 19, 2011 Missouri hospital enters 35 patients into EMTrack for evacuation (paper patients) to be moved to another State for
Hospitalization and/or TreatmentEMTrack
Missouri
COG 6951
EMTrackMissouri
COG 6951
Missouri Hospital Evacuation
2,3 send
1send
UPPTechnology
TennesseeCOG 6972
UPPTechnology
TennesseeCOG 6972
2 - Missouri EMTrack Receipt of Patient arrival at airport
3 - Missouri EMTrack assign 35 patients to Shreveport, LA Region 7 NDMS hospitals
IPAWSOPEN
1,2,3
HC StandardMinnesota / Georgia
National GuardCOG 6983
HC StandardMinnesota / Georgia
National GuardCOG 6983
Missouri Airport
TRAC2ESTRAC2ES
Missouri Airport
A R RShreveportCOG 6971
A R RShreveportCOG 6971
3IPAWSOPEN
EMTrackShreveport
COG 6951
EMTrackShreveport
COG 6951
IPAWSOPEN
4,5,6
4,5,6
4 – Shreveport EMTrack patients land / received at Shreveport PRA
5 – Shreveport EMTrack assign patients to ambulances destined to specified local hospitals
LocalHospitals
EMTrackShreveport Hospital(s)
COG 6951
EMTrackShreveport Hospital(s)
COG 6951
EMResourceEMResource
Hospitals provide HAVBed updates
Paper HAVE Report to VA Area Emergency Manager
Paper HAVE Report to VA Area Emergency Manager
Shreveport PRA
Shreveport PRA
National Family Reunification CenterTennessee
3 send
NDMSHospitals
6 send
4,5 sendLanding
6- EMTrack patient arrival at each
Shreveport hospital
7 & 8– May 16–19, 2011 SEPARATE from and parallel with the end-to-end tracking of the 35 patients, HC Standard sends
TEP updates to Tennessee (UPP) and later to EMTrack for up to 1000 total patients
7send May 16-19
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Manual
Mississippi & Wisconsin
IPAWSOPEN
8 send May 19 8
“Monitor”COG
COG 6993
“Monitor”COG
COG 6993
ALL Messages 1-8
EMSTATLa
EMSTATLa
Manual
Missouri / Louisiana Hospitals &Mississippi, Wisconsin & Tennessee Tracking
TEP Patient Tracking Proof of ConceptMESSAGE FLOW-ONLY VIEW
A R RShreveportCOG 6971
A R RShreveportCOG 6971
EMTrackMissouri
COG 6951
EMTrackMissouri
COG 6951
National Family Reunification Center (notional)
UPPTechnology
TennesseeCOG 6972
UPPTechnology
TennesseeCOG 6972
EMTrackShreveport
COG 6951
EMTrackShreveport
COG 6951
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1. EMTrack Missouri Hospital evacuation to the airport
• NO TEP to ARR
2. EMTrack Missouri Receipt of Patient arrival at airport
• NO TEP to ARR
3. EMTrack Missouri updated to assign 35 patients to Shreveport, LA Region 7 NDMS hospitals (JPATS assigns to appropriate flight)
4. EMTrack Shreveport patients land / received at Shreveport PRA
5. EMTrack Shreveport assign patients to ambulances at the PRA, destined to specified local hospitals
6. EMTrack patient arrival at each Shreveport hospital
7. May 16–19 SEPARATE from and parallel with the end-to-end tracking of the 35 patients above, HC Standard sends TEP updates to the Tennessee National Family Reunification Center (UPP) for up to 1000 patients during the course of their movement and tracking.
8. May 19 2011 HC Standard now begins to send TEP updates to EMTrack today in addition to UPP
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HC StandardMississippi / Wisconsin
COG 6983
HC StandardMississippi / Wisconsin
COG 6983
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3
4
4
5
5
6
6
7 (as provided – up to 1000 patients)
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“Monitor” COG
COG 6993
“Monitor” COG
COG 6993
ALL Messages 1 - 8
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EDXL-TEC update
Emergency Data Exchange Language (EDXL) Tracking of Emergency Patients (TEP)
August 25, 2010
Presentation to the:OASIS Emergency Management Technical Committee
Dial in: 1-888-325-3989 pass code: 561413 #Attendee URL: https://www323.livemeeting.com/cc/eiip/join?id=DHSOICSWG
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Expands Phase I scope to support clients across the general population for more effective evacuation and services management.
Provides real-time information to responders, decision-makers, and facilities in the chain of care and transport.
TEC primary objectives include the following:
Non-medical evacuee movement & tracking(also self-evacuees and shelter-in-place)
Regulation “Richer” data sources
Person finding Family notification &
re-unification Sharing of “self-
registration” data
TEC Scope
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TEP-TEC Jurisdictions and Systems
DoDJPTA
TRAC2ESETAS
FederalHHS (JPATS)
FEMA (NEFRLS,NMETS,
NSS),NLM (LPF)
Local / StatesTX (SNETS, TWIRP)
LATNMD
…etc.
NGO’sARC (Family Links)
HospitalsShelters
Ushahidi, SahanaiREPORTFacebook
TEP-TEC TEP-TEC
TEP-TEC
TEP-TEC
Incident
LocalAll incidents start locally
TE
P-T
EC
TEP-TEC
TE
P-T
EC
TEP-TEC
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TEC “Generic Process”
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TEC “Generic Process”
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TEC “Generic Process”
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TEC “Generic Process”
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TEC Standard Possible Messages
MESSAGE NAME and DEFINITION
Client Movement/TrackingUsage: (1)Evacuee encounters, transport / departure, arrival, etc. (2) Sent to other tracking and/or registry systems. Info used to match needs with transportation and shelter availability. Similar to TEP equivalent for patient tracking from one location to the next.
Client “Registry” Information New or updated info sent from one registry system to another, to enrich the evacuee information across registries and increase the usefulness of people finding applications, family reunification and family notification. Consider PFIF adoption in whole or in part as component of message (see TEC Info Model). Consider promotion of PFIF to become an international standard to establish robust governance.
Shelter AvailabilityProvide evacuation management and info about shelter options in order to better match evacuee needs with possible shelter destinations. Also provide info about current population of shelter vs their available capacity.
Transport Availability & RegulationSame as Shelter Availability, except for transportation options. Availability of transport (Air-fixed wing, air-rotor, ambulance, bus, water - ship etc. What info and to what level of detail?
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2
3
4
4
2
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Draft TEC “Data View”
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