California’s red-hot test of health information exchange

With help from Darius Tahir and Mohana Ravindranath

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A PULSE BEHIND THE FIREFIGHT: California’s Patient Unified Lookup System for Emergencies, the health information exchange portal known as PULSE, is undergoing its first major deployment during the Camp Fire. The conflagration, the worst in the state’s history, has killed at least 79 people and scorched 150,000 acres, and still burns. Many patients in the fire area have records accessible to PULSE, and clinicians have downloaded at least 100 of them at six shelters for Camp Fire victims, says Leslie Witten-Rood, who directs PULSE for the Emergency Medical Services Authority of California.

PULSE, created with help from a $2.7 million ONC grant in 2015, is the spearhead of the national effort to create an emergency HIE system. One disaster after another has created a real urgency to the program. PULSE plans to link up soon to Carequality and eHealth Exchange, and with the help of the Californian Association of Health Information Exchange will add additional local California organizations. The California EMS has also been working with Texas, North Carolina and Florida, hit hard by storms over the past two years and lagging behind in their HIE disaster preparedness. The Sequoia Project has copied PULSE’s architecture and is starting to offer it to other states, Witten-Rood said.

September’s Delta Fire, around Redding, Ca., motivated PULSE to integrate SacValley Medshare, a health information exchange that includes most providers in Butte County, including Adventist Health’s Feather River hospital in Paradise, which was destroyed in the blaze. The availability of a patient’s EHR on a laptop or iPod in an emergency tent or high school auditorium improves patient triage, she said. Instead of sending everyone to clogged emergency departments, those who simply need refills or exams can be seen and get prescriptions on the spot. The PULSE record provides a consolidated care document with 21 data points completed by the last physician who saw the patient.

“Seeing this used to help people at one of the lower points of their lives, to expedite their medical treatment was one of the most rewarding things in my career,” Witten-Rood said.

She described helping a patient who was running out of insulin get a refill in Chico, where a pharmacy couldn’t find his records. “The guy was trying to explain, ‘I can’t call my doctor, his office burned down. Our CVS burned down, my house burned down, the hospital burned down.’ We were able to pull up his records and get one of the emergency clinicians to assess him and prescribe his meds.”

EMSA has pulled in a series of medical emergency reserves and volunteers to deal with the firestorms as well as clinicians from the 143rd and 144th California Air National Guard units, and the California Army National Guard’s 297th Area Support Medical Company. All trained on PULSE at the organization’s headquarters in Sacramento before their deployments.

Tweet of the Day: Lucia Savage @SavageLucia If everyone who has had a comparable experience retweeted this, we would number millions.

Aaron E. Carroll @aaronecarroll THIS IS THE STUPIDEST HEALTH CARE SYSTEM IN ALL THE WORLD AND AS A PATIENT IN IT I CANNOT FATHOM HOW THERE IS NOT OPEN REVOLT.

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APPLE TO SUPPLY EHRS TO VA?: A report Tuesday night in the Wall Street Journal says the Cupertino giant is in talks with the VA to provide the health record program it is supplying to about 700 hospitals. This would give Apple access to nine million VA patients and their interactions with app makers who use the Apple platform to provide the veterans services. Talks on the issue started with Bruce Moskowitz, the internist who is a member of the Mar-a-Lago country club, the report says.

SECURING TELEHEALTH: The National Cybersecurity Center of Excellence at NIST is seeking comments on a draft paper describing how to secure remote monitoring devices and systems. It is intended to provide a reference architecture that will address the security and privacy risks for providers using telehealth and remote patient monitoring. As telehealth spreads beyond medical offices, “it is important to ensure the infrastructure supporting [it] can maintain the confidentiality, integrity, and availability of patient data, as well as ensure the safety of patients,” the agency said.The public comment period on the position paper is open until Dec. 21.

CYBER THREATS WORRY FINANCE COMMITTEE CHIEF-TO-BE: In a letter to FDA Commissioner Scott Gottlieb, Sen. Chuck Grassley asked how the agency is dealing with cybersecurity issues highlighted in a recent HHS Office of Inspector General report. The OIG pointed to a lack of preparedness at FDA for cybersecurity attacks aimed at medical devices.

ECRI LAUNCHES GUIDELINE PORTAL: The ECRI Institute has launched a free-access portal to expert, evidence-based guidelines in response to the outcry from health care professionals when federal funding cuts forced AHRQ to shut down its National Guideline Clearinghouse. ECRI had developed and maintained the NGC website for 20 years. The ECRI Guidelines Trust features new summaries of evidence-based guidelines from participating guideline developers, medical specialty societies, and other health care organizations. Details here.

FDA TURNS TO ‘ACTIVE’ MONITORING ON WOMEN’S HEALTH DEVICES: The agency on Tuesday announced a break from its current post-market surveillance system that largely relies on device users to report problems and sometimes results in underreporting. Instead, it will focus on what it calls real-world evidence — especially with regard to vaginal mesh, long-term birth control devices, certain breast implants and other products for women. More here.

GO GO LIVONGO: The CDC gave Livongo Health’s diabetes prevention program full recognition as meeting its standards, the company announced Tuesday. The company has a year-long program that combines live or recorded classes with digital self-monitoring tools, along with an online community and coaching possibilities. Noom, Omada and Canary Health are among the other CDC-recognized virtual programs.

Deep neural networks are as good as sleep experts at scoring laboratory polysomnography data — the charts produced by wires hooked up to slumbering patients to assess their sleep stages, apnea and limb movements, according to a Journal of the American Medical Informatics Association (JAMIA) study. The computer model examined 10,000 clinical reports as well as 5,800 research reports and did about equally well on both. The authors, led by Siddharth Biswal at Massachusetts General Hospital, say scoring automation “opens the path toward broader and more timely access to sleep diagnostics” by spreading expertise beyond sleep clinics.

… Researchers running a pragmatic trial on aspirin dosing found that querying EHRs to find patients who met the study criteria was a good way to recruit them, according to another JAMIA paper by Emily Pfaff and other University of North Carolina researchers.

… Veterans undergoing mental health therapy got more involved in their care and improved their communication with clinicians when they read provider notes, according to a third JAMIA study. The Portland VA researchers, led by Lauren Denneson, used a web-based educational program designed to educate patients on the content of the notes.

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