Robert Wood Johnson Foundation Clinical Scholars Program, Yale University, New Haven, Connecticut 06520, USA.
Prehosp Emerg Care. 2011 Apr-Jun;15(2):149-57. doi: 10.3109/10903127.2010.534235. Epub 2011 Feb 4.
Some of the most intractable challenges in prehospital medicine include response time optimization, inefficiencies at the emergency medical services (EMS)-emergency department (ED) interface, and the ability to correlate field interventions with patient outcomes. Information technology (IT) can address these and other concerns by ensuring that system and patient information is received when and where it is needed, is fully integrated with prior and subsequent patient information, and is securely archived. Some EMS agencies have begun adopting information technologies, such as wireless transmission of 12-lead electrocardiograms, but few agencies have developed a comprehensive plan for management of their prehospital information and integration with other electronic medical records. This perspective article highlights the challenges and limitations of integrating IT elements without a strategic plan, and proposes an open, interoperable, and scalable prehospital information technology (PHIT) architecture. The two core components of this PHIT architecture are 1) routers with broadband network connectivity to share data between ambulance devices and EMS system information services and 2) an electronic patient care report to organize and archive all electronic prehospital data. To successfully implement this comprehensive PHIT architecture, data and technology requirements must be based on best available evidence, and the system must adhere to health data standards as well as privacy and security regulations. Recent federal legislation prioritizing health information technology may position federal agencies to help design and fund PHIT architectures.
一些在院前医疗中最棘手的挑战包括优化响应时间、急救医疗服务（EMS）与急诊部（ED）之间的效率低下以及将现场干预与患者结果相关联的能力。信息技术（IT）可以通过确保在需要时何地接收系统和患者信息、与先前和后续患者信息完全集成以及安全存档来解决这些和其他问题。一些 EMS 机构已经开始采用信息技术，例如 12 导联心电图的无线传输，但很少有机构制定了管理其院前信息并与其他电子病历集成的综合计划。本文从无战略计划的角度出发，重点介绍了整合 IT 要素所面临的挑战和局限性，并提出了一种开放、互操作和可扩展的院前信息技术（PHIT）架构。该 PHIT 架构的两个核心组件是 1）具有宽带网络连接的路由器，用于在救护车设备和 EMS 系统信息服务之间共享数据，以及 2）电子患者护理报告，用于组织和存档所有电子院前数据。要成功实施这种全面的 PHIT 架构，数据和技术要求必须基于最佳可用证据，并且系统必须遵守健康数据标准以及隐私和安全法规。最近联邦立法将卫生信息技术列为优先事项，这可能使联邦机构有能力帮助设计和资助 PHIT 架构。
