Milwaukee EDs join forces on Internet

Eleven Milwaukee EDs and 19 EMS services have created a unique collaboration on the Internet, to provide inexpensive instant communication. "By having all our hospitals hooked up electronically, we can patch in all EMS providers, public and private, in case of disaster," says Bill Bazan, vice president of the Wisconsin Health and Hospital Association for the Milwaukee Area, the organization sponsoring the site.

The main benefit is instant information. "For example, whether a disaster is natural or manmade, we’re going to be in a position to instantly know the number of ED, OR, and ICU beds available, and the number of neurosurgeons available," says Bazan.

The web site, called EMSystem, went live this spring. "The display page indicates whether each ED is open, closed, or diverting specific types of EMS patients, such as those potentially requiring an ICU bed," says Christopher Felton, MD, FACEP, vice president of information systems for Infinity HealthCare, Inc., co-developers of EMSystem. EMS units and patients dispatched from the scene to each facility will also be displayed by the system.

In case of disaster, an audible warning would be heard. "Then, each facility would switch to mass casualty incident (MCI) mode and put in an update of their available resources," says Felton. "As EDs start to fill up, every hospital will continue to update their status."

Patients don’t always wait to be triaged, leading to inaccurate information during disasters, says Felton. "In theory, the triage officer divides everything evenly between facilities. But the reality is that patients come on their own," he explains. "With this system, EMS responders get the information in real time without having to call each ED on the phone."

The system can also track public health concerns. "We had a terrible cryptosporidian crisis here a couple years ago, which went undetected for several months as cases creeped up gradually," recalls Bazan. "Unfortunately, it didn’t get recognized until 150,000 people were infected with it. With the new system, we can track the prevalence of a given disease in our EDs."

The system will used to record data about specific conditions such as strokes, notes Bazan. "Milwaukee has a stroke task force, and we have been gathering information about t-PA and protocols," he explains. "We can use this system as an information monitoring instrument also, to improve care of stroke victims."

Likewise, if there is a weather emergency, the system can alert providers immediately. "When the city’s heat advisory committee declares an emergency, we can run warnings across the screen, instead of faxing it out as we traditionally have," says Bazan.

Although no patient-specific or proprietary information is transmitted, there was still a concern about local EDs gaining access to information about their competitors. "If a facility happens to go on bypass on a regular basis, administrators might not want that known," notes Felton.

Competitive issues have been minimized by forming an EMS data management committee with representatives from every hospital, says Felton. "The committee addresses security, confidentiality, and access issues. That serves a protective function because they decide what information is transmitted. It assures appropriate use of data generated by the system."

EM system replaces software previously used by EMS to track diversionary status of area EDs. The software was limited in capability and required a dedicated PC in each ED, says Felton. "It would only run that program, so it didn’t allow the computer to be used for anything else," he notes. "It was also a dial-up system. So if one hospital provided an update that they were on bypass, it would dial each ED individually one by one, and it took over a half hour to make a single update," says Felton.

The system costs $500 for the first year and $250 for subsequent years. "Read only" access for EMS services is available for half the hospital fee. "Because a single program runs on a single server, the only hardware needed is a standard PC with Internet connection and browser and the correct password," says Felton. "We avoid the need for expensive upgrades, and support the program locally."

A three tiered password scheme allows 1) view only status for EMS services; 2) individual facility specific updates; and 3) global update permissions for the EMS dispatching authority. "They can read and update anyone’s data. So if a hospital has lost its connection, they can call 911 and update their status," says Felton.

EDs are expected to update the system at least once every 12 hours. "It only takes a few seconds to make that entry," says Bazan. "Each hospital has a password, and during each 12-hour period, someone is designated in ED to make an entry as to where things stand." A visible flashing cursor appears on screen if it’s time to update.

When EDs notice a sudden increase in volume, they will update the system. "If 10 or 15 patients come in at once, that would be entered," says Bazan. "If an ED is filled or close to being filled, they will go online and indicate that. From that very second onward, any prehospital provider will know."

EMSystem is only the first of several Internet-based programs envisioned for Milwaukee’s emergency medical services, says Felton. "Plans are in place to develop a registry of area emergency department visits," he notes.

Editor’s note: To learn more about EMSystem™ access the web page at http://www.emsystem.com or contact Dr. Felton at cfelton@infinityhealthare.com.