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Electronic Exchange of Poisoning Information

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Health information exchange capability between a poison control center and emergency department has the potential to reduce errors, improve decision making, and improve continuity of care for poisonings.

Project Details -
Completed

Poisonings are the leading cause of unintentional injury and death in the United States and have been increasing steadily over the last two decades. Poison control centers (PCCs) play a critical role in emergency treatment of unintentional poisonings managed in healthcare facilities. These centers are primarily staffed by registered nurses and pharmacists with specialized education in toxicology. Staff assess poison exposures via telephone and provide information and recommendations for treatment to healthcare providers.

While PCC consultation is essential to quality care, the current process of emergency department (ED)–PCC collaboration is highly dependent upon synchronous and asynchronous telephone communication. In previous AHRQ-funded work, a team of researchers at the University of Utah looked at the typical telephone-based ED-PCC communication process and found a number of inefficiencies and safety vulnerabilities. These included workflow interruption for the ED, poor data quality and capture, and unreliable processes for sharing patient care information among team members. Many of these issues would be resolved if EDs and PCCs were able to seamlessly exchange electronic data. In this followup study, the team, along with colleagues at Intermountain Healthcare (IHC), set about to develop a process so that PCCs would be able to participate in existing health information exchanges (HIEs).

The specific aims were as follows:

  • Develop a model process for HIE supported ED–PCC collaboration. 
  • Develop and implement informatics tools for HIE supported ED–PCC collaboration. 
  • Evaluate the effects of the model HIE process and informatics tools on workflow, communication, efficiency, and utilization. 

Focused on replicability and scalability, they utilized an existing standardized data exchange template, Health Level Seven’s (HL7s) Consolidated Clinical Document Architecture (C-CDA) consultation note. Using a user-centered design approach, the team brought together stakeholders, including the Utah PCC and the Utah Health Information Exchange Network (UHIN), users, and experts to identify critical data elements to be shared between PCCs and EDs. These same groups also contributed to the planning and design of the user interface, SNOWHITE, for populating the data exchange template. This user interface seamlessly maps data into the C-CDA template and then makes it available to UHIN.

With the creation of SNOWHITE and the initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah PCC, the research team built a system that represents the first participation of a PCC in standards-based HIE in the United States. This milestone is an important first step in ensuring that important and timely PCC information and management guidance for poisoning cases is available for decision making at the point of care in cases of acute poisoning.

Health Information Exchange Streamlines Communication Between Poison Control Centers and Emergency Departments

Health Information Exchange Streamlines Communication Between Poison Control Centers and Emergency Departments

The research team created the first HIE capability between a poison control center (PCC) and ED to reduce errors, improve decision making, and improve continuity of care for poisonings, including drug overdoses. Their developed process, along with the software and informatics tools, can be used by other U.S. PCCs interested in participating in standards-based HIE.

Principal Investigator: Cummins, Mollie Rebecca
Organization: University of Utah
Research Profile: Electronic Exchange of Poisoning Information
Funded Amount: $1,249,994

Communication between poison control centers and emergency departments is based on phone communication, which is inefficient and can lead to errors

Poisonings are the leading cause of unintentional injury and death in the United States and have been increasing steadily over the last two decades. PCCs play a critical role in emergency treatment of unintentional poisonings, including drug overdoses managed in healthcare facilities. These largely publicly funded call centers are primarily staffed by registered nurses and pharmacists with specialized education in toxicology. They assess poison exposures via telephone and provide information and recommendations for treatment to healthcare providers, typically in an ED.

While PCC consultation is essential to quality care, the current process of ED–PCC collaboration is highly dependent upon synchronous and asynchronous telephone communication. In previous AHRQ-funded work, Dr. Mollie Cummins and her team at the University of Utah looked at the typical telephone-based communication process and found a number of inefficiencies and safety vulnerabilities in the ED–PCC collaboration process. These included workflow interruption for the ED, poor data quality and capture, and unreliable processes for sharing information among team members who are caring for the patient. Many of these issues would be resolved if EDs and PCCs were able to seamlessly exchange electronic data.

Developing the first PCC-ED HIE capability in the United States

In this followup study, Dr. Cummins and her team and colleagues at Intermountain Healthcare (IHC) set about to develop a process so that PCCs would be able to participate in existing HIEs. Focused on replicability and scalability, they utilized an existing standardized data exchange template, Health Level Seven’s (HL7s®) Consolidated Clinical Document Architecture (C-CDA) consultation note. Using a user-centered design approach, the team brought together stakeholders, including the Utah PCC and the Utah Health Information Exchange Network (UHIN), users, and experts to identify critical data elements to be shared between PCCs and EDs. These same groups also contributed to the planning and design of the user interface, SNOWHITE, for populating the data exchange template. This user interface seamlessly maps data into the C-CDA template and then makes it available to UHIN.

To date, the researchers have successfully implemented SNOWHITE in the workflow and operations of the Utah PCC and created the ability to bi-directionally exchange the C-CDA documents with IHC EDs. Technical integration into IHC’s ED tracking systems will be completed in the future, allowing full ED workflow integration.

In our previous AHRQ-funded research, we studied the process of communication and collaboration between emergency departments and poison control centers, and found a number of inefficiencies and vulnerabilities. These are the type of vulnerabilities that occur when two humans talk on the telephone and try to pass detailed information like lab results. It's really analogous to reading a bank statement over the telephone. You would never call your bank and have them read you your statement.”
– Dr. Cummins

Expanding standards-based HIE capability to other PCCs

With the creation of SNOWHITE and the initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah PCC, the research team built a system that represents the first participation of a PCC in standards-based HIE in the United States. This milestone is an important first step in ensuring that important and timely PCC information and management guidance for poisoning cases is available for decision making at the point of care in cases of acute poisoning. This work paves the way for replicating and expanding standards-based HIE at other U.S. PCCs. PCC data and information can now be routed to multiple recipients and for different purposes, including individual patient care during poisoning emergencies such as overdose events.